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. 2024 Jun 24;47(9):zsae138. doi: 10.1093/sleep/zsae138

Figure 1.

Figure 1.

The three-step classification system for sleep-related movements in healthy participants, based on type, topography, and the identification of potential motor patterns (MPs). The movements analysis was conducted using a three-step method. In the first step, movements were categorized by type. Movements that did meet the criteria of International Classification of Sleep Disorders (ICSD-3-TR) [7] or the American Academy of Sleep Medicine (AASM) manual for the Scoring of Sleep and Associated Events [8] were commonly described in the literature [9, 11] were classified as codified. Codified Movements include limb movements associated with the EMG activity consistent with alternating leg muscle activation (ALMA), hypnagogic foot tremor (HFT), or leg movement (LM). Chewing-like movements associated with rhythmic masticatory muscle activity (RMMA) on the chin channel and/or only isolated oro-alimentary automatisms-OAs (including stereotyped movements involving the lower part of the face such as yawning, coughing, chewing, swallowing, tongue clicking, licking the lips and mouth opening/closing without the required EMG criteria for RMMA) were also included into the codified movements. The remaining non-codified movements were classified into elementary movements (EMs) and complex movements (CMs), depending on whether it was a single movement or a sequence of movements. In addition, the non-codified movements were divided into myocloniform and non-myocloniform, whether they resulted from a sudden muscle contraction or not. In the second step, EMs and CMs were classified by the number of body parts involved and categorized as focal, segmental, multifocal, or generalized. CMs topography (as they consisted of a sequence of movements) was analyzed both at the onset (T0) and at the end of the entire motor event (T1). The third step involved a comprehensive review of all movements to assign them to specific motor patterns (MPs). ALMA, alternating leg muscle activation; HFT, hypnagogic foot tremor; LM, limb movement; PLMS, periodic limb movements in sleep; RMMA, rhythmic masticatory muscle activity.