{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,2]],"date-time":"2026-10-02T18:55:16Z","timestamp":1790967316132,"version":"4.1.0"},"reference-count":24,"publisher":"MDPI AG","issue":"6","license":[{"start":{"date-parts":[[2025,3,13]],"date-time":"2025-03-13T00:00:00Z","timestamp":1741824000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Polish National Science Centre (NCN)","award":["2019\/33\/N\/NZ5\/02815"],"award-info":[{"award-number":["2019\/33\/N\/NZ5\/02815"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background: Periodic limb movements in sleep (PLMS) are characterised by repetitive, involuntary limb movements that occur during sleep and are often associated with autonomic nervous system dysregulation. While it is known that PLMS influence cardiovascular parameters, the exact role of heart rate variability (HRV) and the balance between sympathetic and parasympathetic activity remains unclear. Previous studies have suggested that longer PLMS events may trigger more pronounced autonomic responses, but the relationship between the duration of PLMS and autonomic dynamics has yet to be fully explored. This study aims to investigate the influence of PLMS duration on autonomic co-activation and its potential cardiovascular implications. Methods: A retrospective analysis was conducted on polysomnographic, demographic, and medical data from five patients, encompassing a total of 1348 PLMS events. We measured heart rate (HR), high-frequency HRV (HF-HRV), systolic blood pressure (SBP), and diastolic blood pressure (DBP) for 10 heartbeats before and 10 heartbeats after each PLMS series. A time\u2013frequency approach was used, employing 10 RR interval segments to analyse HF-HRV dynamics. Statistical analysis was performed using IBM SPSS Statistics (v. 28.0.0.0), and the Kruskal\u2013Wallis test was used to assess statistically significant deviations from baseline. Results: HF-HRV increased during PLMS, indicating enhanced parasympathetic activation. No significant changes in mean DBP or SBP were observed with leg movements of &lt;2.1 s. However, with movements of &gt;2.1 s, significant increases in DBP and SBP were noted, suggesting sympathetic activation. Longer PLMS events were associated with greater parasympathetic activity, while the absence of HR changes indicates concurrent sympathetic activation, supporting autonomic co-activation. Conclusions: Our study indicates that PLMS events lasting &gt;2.1 s are linked to increased parasympathetic activity, likely accompanied by sympathetic activation. This simultaneous activation of both branches of the autonomic nervous system, referred to as autonomic co-activation, could lead to autonomic dysregulation and an increased risk of cardiovascular instability, including potentially life-threatening events.<\/jats:p>","DOI":"10.3390\/jcm14061940","type":"journal-article","created":{"date-parts":[[2025,3,13]],"date-time":"2025-03-13T06:53:00Z","timestamp":1741848780000},"page":"1940","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["Time-Dependent Autonomic Dysregulation and Co-Activation Induced by Periodic Limb Movements in Sleep"],"prefix":"10.3390","volume":"14","author":[{"given":"Marta A.","family":"Malkiewicz","sequence":"first","affiliation":[{"name":"Applied Cognitive Neuroscience Lab, Department of Neurophysiology, Neuropsychology and Neuroinformatics, Medical University of Gdansk, 80-210 Gdansk, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6533-5774","authenticated-orcid":false,"given":"Malgorzata","family":"Grzywinska","sequence":"additional","affiliation":[{"name":"Neuroinformatics and Artificial Intelligence Lab, Department of Neurophysiology, Neuropsychology and Neuroinformatics, Medical University of Gdansk, 80-210 Gdansk, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Krzysztof S.","family":"Malinowski","sequence":"additional","affiliation":[{"name":"Department of Neurophysiology, Neuropsychology and Neuroinformatics, Medical University of Gdansk, 80-210 Gdansk, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eemil","family":"Partinen","sequence":"additional","affiliation":[{"name":"Helsinki Sleep Clinic, Terveystalo Healthcare, 00100 Helsinki, Finland"},{"name":"Department of Neurology, Helsinki University Central Hospital, 00280 Helsinki, Finland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Markku","family":"Partinen","sequence":"additional","affiliation":[{"name":"Helsinki Sleep Clinic, Terveystalo Healthcare, 00100 Helsinki, Finland"},{"name":"Sleep Disorder Outpatient Clinic, Department of Psychiatry, Helsinki University Central Hospital, 00280 Helsinki, Finland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jan","family":"Pyrzowski","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, Medical University of Gdansk, 80-210 Gdansk, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5180-7224","authenticated-orcid":false,"given":"Magdalena","family":"Wszedybyl-Winklewska","sequence":"additional","affiliation":[{"name":"Department of Neurophysiology, Neuropsychology and Neuroinformatics, Medical University of Gdansk, 80-210 Gdansk, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,3,13]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"61","DOI":"10.1002\/mds.870120111","article-title":"Clinical, polysomnographic, and genetic characteristics of restless legs syndrome: A study of 133 patients diagnosed with new standard criteria","volume":"12","author":"Montplaisir","year":"1997","journal-title":"Mov. 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