Abstract

Several sleep disorders are characterized by periodic leg movements during sleep including Restless Leg Syndrome, and can indicate disrupted sleep in otherwise healthy individuals. Current technologies to measure periodic leg movements during sleep are limited. Polysomnography and some home sleep tests use surface electromyography to measure electrical activity from the anterior tibilias muscle. Actigraphy uses three-axis accelerometers to measure movement of the ankle. Electromyography misses periodic leg movements that involve other leg muscles and is obtrusive because of the wires needed to carry the signal. Actigraphy based devices require large amplitude movements of the ankle to detect leg movements (missing the significant number of more subtle leg movements) and can be worn in multiple configurations precluding precision measurement. These limitations have contributed to their lack of adoption as a standard of care for several sleep disorders. In this study, we develop the RestEaze sleep assessment tool as an ankle-worn wearable device that combines capacitive sensors and a six-axis inertial measurement unit to precisely measure periodic leg movements during sleep. This unique combination of sensors and the form-factor of the device addresses current limitations of periodic leg movements during sleep measurement techniques. Pilot data collected shows high correlation with polysomnography across a heterogeneous participant sample and high usability ratings. RestEaze shows promise in providing ecologically valid, longitudinal measures of leg movements that will be useful for clinicians, researchers, and patients to better understand sleep.

References

1.
Siddiqui
,
F.
,
Strus
,
J.
,
Ming
,
X.
,
Lee
,
I. A.
,
Chokroverty
,
S.
, and
Walters
,
A. S.
,
2007
, “
Rise of Blood Pressure With Periodic Limb Movements in Sleep and Wakefulness
,”
Clin. Neurophysiol.
,
118
(
9
), pp.
1923
1930
.10.1016/j.clinph.2007.05.006
2.
Chenini
,
S.
,
Rassu
,
A. L.
,
Guiraud
,
L.
,
Evangelista
,
E.
,
Barateau
,
L.
,
Lopez
,
R.
,
Jaussent
,
I.
, and
Dauvilliers
,
Y.
,
2019
, “
Blood Pressure Profile and Endothelial Function in Restless Legs Syndrome
,”
Sci. Rep.
,
9
(
1
), p.
15933
.10.1038/s41598-019-52401-4
3.
Cassel
,
W.
,
Kesper
,
K.
,
Bauer
,
A.
,
Grieger
,
F.
,
Schollmayer
,
E.
,
Joeres
,
L.
, and
Trenkwalder
,
C.
,
2016
, “
Significant Association Between Systolic and Diastolic Blood Pressure Elevations and Periodic Limb Movements in Patients With Idiopathic Restless Legs Syndrome
,”
Sleep Med.
,
17
, pp.
109
120
.10.1016/j.sleep.2014.12.019
4.
Murali
,
N. S.
,
Svatikova
,
A.
, and
Somers
,
V. K.
,
2003
, “
Cardiovascular Physiology and Sleep
,”
Front. Biosci. J. Virtual Libr.
,
8
(
6
), pp.
s636
s652
.https://pubmed.ncbi.nlm.nih.gov/12700080/
5.
Michaud
,
M.
,
Paquet
,
J.
,
Lavigne
,
G.
,
Desautels
,
A.
, and
Montplaisir
,
J.
,
2002
, “
Sleep Laboratory Diagnosis of Restless Legs Syndrome
,”
Eur. Neurol.
,
48
(
2
), pp.
108
113
.10.1159/000062996
6.
Ohayon
,
M. M.
, and
Roth
,
T.
,
2002
, “
Prevalence of Restless Legs Syndrome and Periodic Limb Movement Disorder in the General Population
,”
J. Psychosom. Res.
,
53
(
1
), pp.
547
554
.10.1016/S0022-3999(02)00443-9
7.
Mirza
,
M.
,
Shen
,
W.-K.
,
Sofi
,
A.
,
Jahangir
,
A.
,
Mori
,
N.
,
Tajik
,
A. J.
, and
Jahangir
,
A.
,
2013
, “
Frequent Periodic Leg Movement During Sleep is Associated With Left Ventricular Hypertrophy and Adverse Cardiovascular Outcomes
,”
J. Am. Soc. Echocardiogr.
,
26
(
7
), pp.
783
790
.10.1016/j.echo.2013.03.018
8.
Manconi
,
M.
,
Ferri
,
R.
,
Zucconi
,
M.
,
Fantini
,
M. L.
,
Plazzi
,
G.
, and
Ferini-Strambi
,
L.
,
2007
, “
Time Structure Analysis of Leg Movements During Sleep in REM Sleep Behavior Disorder
,”
Sleep
,
30
(
12
), pp.
1779
1785
.10.1093/sleep/30.12.1779
9.
Winkelman
,
J.
,
2003
, “
High Rates of Periodic Leg Movements of Sleep in REM-Sleep Behavior Disorder Raise More Questions About the Relationship Between Sleep-Related Movement Disorders
,”
Sleep Med.
,
4
(
3
), pp.
261
262
.10.1016/S1389-9457(03)00066-2
10.
Sadeh
,
A.
,
Pergamin
,
L.
, and
Bar-Haim
,
Y.
,
2006
, “
Sleep in Children With Attention-Deficit Hyperactivity Disorder: A Meta-Analysis of Polysomnographic Studies
,”
Sleep Med. Rev.
,
10
(
6
), pp.
381
398
.10.1016/j.smrv.2006.03.004
11.
Picchietti
,
D. L.
, and
Stevens
,
H. E.
,
2008
, “
Early Manifestations of Restless Legs Syndrome in Childhood and Adolescence
,”
Sleep Med.
,
9
(
7
), pp.
770
781
.10.1016/j.sleep.2007.08.012
12.
Simakajornboon
,
N.
,
Gozal
,
D.
,
Vlasic
,
V.
,
Mack
,
C.
,
Sharon
,
D.
, and
McGinley
,
B. M.
,
2003
, “
Periodic Limb Movements in Sleep and Iron Status in Children
,”
Sleep
,
26
(
6
), pp.
735
738
.10.1093/sleep/26.6.735
13.
Tilma
,
J.
,
Tilma
,
K.
,
Norregaard
,
O.
, and
Ostergaard
,
J. R.
,
2013
, “
Early Childhood-Onset Restless Legs Syndrome: Symptoms and Effect of Oral Iron Treatment
,”
Acta Paediatr.
,
102
(
5
), pp.
e221
e226
.10.1111/apa.12173
14.
Trotti
,
L. M.
,
Bliwise
,
D. L.
,
Greer
,
S. A.
,
Sigurdsson
,
A. P.
,
Gudmundsdóttir
,
G. B.
,
Wessel
,
T.
,
Organisak
,
L. M.
,
Sigthorsson
,
T.
,
Kristjansson
,
K.
,
Sigmundsson
,
T.
, and
Rye
,
D. B.
,
2009
, “
Correlates of PLMs Variability Over Multiple Nights and Impact Upon RLS Diagnosis
,”
Sleep Med.
,
10
(
6
), pp.
668
671
.10.1016/j.sleep.2008.06.009
15.
Newell
,
J.
,
Mairesse
,
O.
,
Verbanck
,
P.
, and
Neu
,
D.
,
2012
, “
Is a One-Night Stay in the Lab Really Enough to Conclude? First-Night Effect and Night-to-Night Variability in Polysomnographic Recordings Among Different Clinical Population Samples
,”
Psychiatry Res.
,
200
(
2–3
), pp.
795
801
.10.1016/j.psychres.2012.07.045
16.
Sforza
,
E.
,
Johannes
,
M.
, and
Claudio
,
B.
,
2005
, “
The PAM-RL Ambulatory Device for Detection of Periodic Leg Movements: A Validation Study
,”
Sleep Med.
,
6
(
5
), pp.
407
413
.10.1016/j.sleep.2005.01.004
17.
King
,
M. A.
,
Jaffre
,
M.-O.
,
Morrish
,
E.
,
Shneerson
,
J. M.
, and
Smith
,
I. E.
,
2005
, “
The Validation of a New Actigraphy System for the Measurement of Periodic Leg Movements in Sleep
,”
Sleep Med.
,
6
(
6
), pp.
507
513
.10.1016/j.sleep.2004.12.010
18.
Yang
,
M. S.
,
Montplaisir
,
J.
,
Desautels
,
A.
,
Winkelman
,
J. W.
,
Cramer Bornemann
,
M. A.
,
Earley
,
C. J.
, and
Allen
,
R. P.
,
2014
, “
Valid Measures of Periodic Leg Movements (PLMs) During a Suggested Immobilization Test Using the PAM-RL Leg Activity Monitors Require Adjusting Detection Parameters for Noise and Signal in Each Recording
,”
Sleep Med.
,
15
(
1
), pp.
132
137
.10.1016/j.sleep.2013.08.788
19.
Jha
,
A.
,
Banerjee
,
N.
,
Feltch
,
C.
,
Robucc
,
R.
,
Earley
,
C.
,
Lam
,
J.
, and
Allen
,
R.
,
2021
, “
Pilot Study: Can Machine-Learning Analyses of Movement Discriminate Between Leg Movements in Sleep (LMS) With vs. Without Cortical Arousals?
,”
Sleep Breath
,
25
(
1
), pp.
373
379
.10.1007/s11325-020-02100-6
20.
Bobovych
,
S.
,
Sayeed
,
F.
,
Banerjee
,
N.
,
Robucci
,
R.
, and
Allen
,
R. P.
,
2020
, “
RestEaZe: Low-Power Accurate Sleep Monitoring Using a Wearable Multi-Sensor Ankle Band
,”
Smart Health
,
16
, p.
100113
.10.1016/j.smhl.2020.100113
21.
Berry
,
R. B.
,
Brooks
,
R.
,
Gamaldo
,
C.
,
Harding
,
S. M.
,
Lloyd
,
R. M.
,
Quan
,
S. F.
,
Troester
,
M. T.
, and
Vaughn
,
B. V.
,
2017
, “
AASM Scoring Manual Updates for 2017 (Version 2.4)
,”
J. Clin. Sleep Med.
,
13
(
05
), pp.
665
666
.10.5664/jcsm.6576
22.
Ferri
,
R.
,
Fulda
,
S.
,
Allen
,
R. P.
,
Zucconi
,
M.
,
Bruni
,
O.
,
Chokroverty
,
S.
,
Ferini-Strambi
,
L.
,
Frauscher
,
B.
,
Garcia-Borreguero
,
D.
,
Hirshkowitz
,
M.
,
Högl
,
B.
,
Inoue
,
Y.
,
Jahangir
,
A.
,
Manconi
,
M.
,
Marcus
,
C. L.
,
Picchietti
,
D. L.
,
Plazzi
,
G.
,
Winkelman
,
J. W.
, and
Zak
,
R. S.
,
2016
, “
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)
,”
Sleep Med.
,
26
, pp.
86
95
.10.1016/j.sleep.2016.10.010
23.
Allen
,
R. P.
,
Picchietti
,
D. L.
,
Garcia-Borreguero
,
D.
,
Ondo
,
W. G.
,
Walters
,
A. S.
,
Winkelman
,
J. W.
,
Zucconi
,
M.
,
Ferri
,
R.
,
Trenkwalder
,
C.
, and
Lee
,
H. B.
,
2014
, “
Restless Legs Syndrome/Willis–Ekbom Disease Diagnostic Criteria: Updated International Restless Legs Syndrome Study Group (IRLSSG) Consensus Criteria – History, Rationale, Description, and Significance
,”
Sleep Med.
,
15
(
8
), pp.
860
873
.10.1016/j.sleep.2014.03.025
24.
Fida
,
A.
,
Egbe
,
S.
,
Scheid
,
D. C.
,
Welborn
,
T. L.
, and
McCarthy
,
L. H.
,
2014
, “
In Adults What is the Best Diagnostic Test for Restless Leg Syndrome?
,”
J. Okla. State Med. Assoc.
,
107
(
8
), pp.
432
434
.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4734084/
25.
Einollahi
,
B.
, and
Izadianmehr
,
N.
,
2014
, “
Restless Leg Syndrome: A Neglected Diagnosis
,”
Nephro-Urol. Mon.
,
6
(
5
), p.
e22009
.10.5812/numonthly.22009
26.
Hening
,
W.
,
2004
, “
Impact, Diagnosis and Treatment of Restless Legs Syndrome (RLS) in a Primary Care Population: The REST (RLS Epidemiology, Symptoms, and Treatment) Primary Care Study
,”
Sleep Med.
,
5
(
3
), pp.
237
246
.10.1016/j.sleep.2004.03.006
27.
Kushida
,
C. A.
,
Nichols
,
D. A.
,
Simon
,
R. D.
,
Young
,
T.
,
Grauke
,
J. H.
,
Britzmann
,
J. B.
,
Hyde
,
P. R.
, and
Dement
,
W. C.
,
2000
, “
Symptom-Based Prevalence of Sleep Disorders in an Adult Primary Care Population
,”
Sleep Breath. Schlaf Atm.
,
04
(
01
), pp.
0009
14
.10.1055/s-2000-11530
28.
Montplaisir
,
J.
,
Boucher
,
S.
,
Nicolas
,
A.
,
Lesperance
,
P.
,
Gosselin
,
A.
,
Rompré
,
P.
, and
Lavigne
,
G.
,
1998
, “
Immobilization Tests and Periodic Leg Movements in Sleep for the Diagnosis of Restless Leg Syndrome
,”
Mov. Disord. Off. J. Mov. Disord. Soc.
,
13
(
2
), pp.
324
329
.10.1002/mds.870130220
29.
Allen
,
R.
,
Becker
,
P. M.
,
Bogan
,
R.
,
Schmidt
,
M.
,
Kushida
,
C. A.
,
Fry
,
J. M.
,
Poceta
,
J. S.
, and
Winslow
,
D.
,
2004
, “
Ropinirole Decreases Periodic Leg Movements and Improves Sleep Parameters in Patients With Restless Legs Syndrome
,”
Sleep
,
27
(
5
), pp.
907
914
.10.1093/sleep/27.5.907
30.
Partinen
,
M.
,
Hirvonen
,
K.
,
Jama
,
L.
,
Alakuijala
,
A.
,
Hublin
,
C.
,
Tamminen
,
I.
,
Koester
,
J.
, and
Reess
,
J.
,
2006
, “
Efficacy and Safety of Pramipexole in Idiopathic Restless Legs Syndrome: A Polysomnographic Dose-Finding Study—The PRELUDE Study
,”
Sleep Med.
,
7
(
5
), pp.
407
417
.10.1016/j.sleep.2006.03.011
31.
Beneš
,
H.
,
Kurella
,
B.
,
Kummer
,
J.
,
Kazenwadel
,
J.
,
Selzer
,
R.
, and
Kohnen
,
R.
,
1999
, “
Rapid Onset of Action of Levodopa in Restless Legs Syndrome: A Double-Blind, Randomized, Multicenter, Crossover Trial
,”
Sleep
,
22
(
8
), pp.
1073
1081
.10.1093/sleep/22.8.1073
32.
Provini
,
F.
,
Vetrugno
,
R.
,
Meletti
,
S.
,
Plazzi
,
G.
,
Solieri
,
L.
,
Lugaresi
,
E.
,
Coccagna
,
G.
, and
Montagna
,
A. P.
,
2001
, “
Motor Pattern of Periodic Limb Movements During Sleep
,”
Neurology
,
57
(
2
), pp.
300
304
.10.1212/WNL.57.2.300
33.
Plazzi
,
G.
,
Vetrugno
,
R.
,
Meletti
,
S.
, and
Provini
,
F.
,
2002
, “
Motor Pattern of Periodic Limb Movements in Sleep in Idiopathic RLS Patients
,”
Sleep Med.
,
3
, pp.
S31
S34
.10.1016/S1389-9457(02)00146-6
You do not currently have access to this content.