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Volume 09 No. 11
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Accepted Papers

Scientific Investigations

Periodic Leg Movements Are Associated with Reduced Sleep Quality in Older Men: The MrOS Sleep Study

David M. Claman, M.D., F.A.A.S.M.1; Susan K. Ewing, M.S.1; Susan Redline, M.D., M.P.H.2; Sonia Ancoli-Israel, Ph.D., F.A.A.S.M.4; Jane A. Cauley, Dr.P.H.5; Katie L. Stone, Ph.D.3
1University of California, San Francisco, San Francisco, CA; 2Department of Medicine, Brigham and Women's Hospital and Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA; 3San Francisco Coordinating Center and California Pacific Medical Center Research Institute, San Francisco, CA; 4Departments of Psychiatry and Medicine, University of California, San Diego, CA; 5Department of Epidemiology, University of Pittsburgh, Pittsburgh, PA

Study Objectives:

Periodic limb movements in sleep (PLMS) are common in the elderly. A previous large polysomnographic (PSG) study examining the relationship of PLMS to sleep architecture and arousals from sleep in women found that leg movements were common in elderly women, and PLMS which were associated with EEG arousals had a strong and consistent association with markers of disturbed sleep. Since sleep differs in men and women, we now investigate the association between PLMS and PSG indices of sleep quality in a large community-based sample of older men.


Observational study, cross-sectional analyses.


Six clinical sites participating in the Osteoporotic Fractures in Men (MrOS) Study.


2,872 older community-dwelling men (mean age 76.4 years) who completed in-home PSG from 2003-2005.



Measurements and Results:

In-home PSG was performed which included bilateral measurement of leg movements. The total number of leg movements per hour of sleep (PLMI) and the number of leg movements causing EEG-documented arousals per hour of sleep (PLMA) were computed. A PLMI ≥ 5 (70.8%) and PLMA ≥ 5 (27.4%) were both prevalent. Linear regression models were used to examine the relationship between PLMS as predictors and sleep architecture, arousal index, and sleep efficiency as outcomes. The highest quintiles of PLMI (≥ 65.1) and PLMA (≥ 6.8) showed the largest association with indices of sleep architecture; PLMA showed a larger magnitude of effect. After multivariate adjustment, participants with a higher PLMA had a small but significantly higher arousal index, lower sleep efficiency, higher percentages of stages 1 and 2 sleep, and lower percentages of stage 3-4 and REM sleep (p < 0.01). An increased PLMI was similarly associated with a higher arousal index, higher percentage of stage 2 sleep, and lower percentage of stage 3-4 (p < 0.0001), but not with an increase in stage 1, REM sleep, or sleep efficiency. Neither PLMI nor PMLA was associated with subjective sleepiness measured by the Epworth Sleepiness Scale.


This study demonstrated that periodic leg movements are very common in older community-dwelling men and regardless of associated arousals, are associated with evidence of lighter and more fragmented sleep.


Claman DM; Ewing SK; Redline S; Ancoli-Israel S; Cauley JA; Stone KL; for the Study of Osteoporotic Fractures Research Group. Periodic leg movements are associated with reduced sleep quality in older men: The MrOS Sleep Study. J Clin Sleep Med 2013;9(11):1109-1117.

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