World Association of Sleep Medicine (WASM) 2016 standards for recording and scoring leg movements in polysomnograms developed by a joint task force from the International and the European Restless Legs Syndrome Study Groups (IRLSSG and EURLSSG)
R. Ferri, S. Fulda, R.P. Allen, M. Zucconi, O. Bruni, S. Chokroverty, L. Ferini-Strambi, B. Frauscher, D. Garcia-Borreguero, M. Hirshkowitz, B. Högl, Y. Inoue, A. Jahangir, M. Manconi, C.L. Marcus, D.L. Picchietti, G. Plazzi, J.W.Winkelman, R.S. Zak on behalf of the International and European Restless Legs Syndrome Study Groups (IRLSSG and EURLSSG)
• Candidate leg movements (CLM) are all leg movements meeting criteria for periodicity evaluation.
• CLM with intermovement intervals <10 s interrupt a periodic series.
• Several non-CLM events, in particular leg movements >10 s end a periodic series.
• A new criterion was included for morphology of CLM.
• New criteria define respiratory event associated leg movements.
This report presents the results of the work by a joint task force of the International and European Restless Legs Syndrome Study Groups and World Association of Sleep Medicine that revised and updated the current standards for recording and scoring leg movements (LM) in polysomnographic recordings (PSG). First, the background of the decisions made and the explanations of the new rules are reported and then specific standard rules are presented for recording, detecting, scoring and reporting LM activity in PSG. Each standard rule has been classified with a level of evidence. At the end of the paper, Appendix 1 provides algorithms to aid implementation of these new standards in software tools. There are two main changes introduced by these new rules: 1) Candidate LM (CLM), are any monolateral LM 0.5–10 s long or bilateral LM 0.5–15 s long; 2) periodic LM (PLM) are now defined by runs of at least four consecutive CLM with an intermovement interval ≥10 and ≤ 90 s without any CLM preceded by an interval <10 s interrupting the PLM series. There are also new options defining CLM associated with respiratory events. The PLM rate may now first be determined for all CLM not excluding any related to respiration (providing a consistent number across studies regardless of the rules used to define association with respiration) and, subsequently, the PLM rate should also be calculated without considering the respiratory related events. Finally, special considerations for pediatric studies are provided. The expert visual scoring of LM has only been altered by the new standards to require accepting all LM > 0.5 s regardless of duration, otherwise the technician scores the LM as for the old standards. There is a new criterion for the morphology of LM that applies only to computerized LM detection to better match expert visual detection. Available automatic scoring programs will incorporate all the new rules so that the new standards should reduce technician burden for scoring PLMS.
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