title: Periodic limb movements in sleep exhibit a circadian rhythm that is maximal in the late evening/early night.
abstract: OBJECTIVE
  Periodic limb movements in sleep (PLMS) show a time-of-night pattern, with most movements at the beginning of the night. Our study aimed to determine whether this pattern is due to an endogenous circadian rhythm, like that in the related movement disorder Restless Legs Syndrome (RLS).
  
  
  METHODS
  Four healthy older adults with a screening PLMI>20 were studied in an inpatient forced desynchrony protocol with an imposed sleep-wake cycle of 20 h for 12 "nights," allowing separation of circadian and sleep homeostatic influences on leg movements. We recorded sleep polysomnographically throughout each scheduled episode, including left and right anterior tibialis EMG.
  
  
  RESULTS
  PLMS in Stage 2 showed both a significant time-within-sleep pattern and a significant circadian rhythm. The circadian rhythm in PLMS peaked at the circadian phases when usual sleep onset occurs, preceding the evening rise in melatonin secretion.
  
  
  CONCLUSIONS
  In our subjects, the circadian pattern of PLMs expression was very similar to that previously reported in patients with RLS. This evidence for a circadian rhythm in PLMS has implications for treatment and provides direction for future studies of the pathophysiology of this movement disorder.
authors.affiliation: Division of Sleep Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA. jduffy@hms.harvard.edu
authors.forename: Jeanne F
authors.initials: JF
authors.lastname: Duffy
authors.forename: Alex S W
authors.initials: AS
authors.lastname: Lowe
authors.forename: Edward J
authors.initials: EJ
authors.lastname: Silva
authors.forename: John W
authors.initials: JW
authors.lastname: Winkelman
mesh_terms: D000368:Aged; D002940:Circadian Rhythm / Q000502:physiology*; D004576:Electromyography; D005121:Extremities / Q000502:physiology; D006801:Humans; D008875:Middle Aged; D009068:Movement / Q000502:physiology*; D017286:Polysomnography; D012890:Sleep / Q000502:physiology*; D012894:Sleep Stages / Q000502:physiology