Consensus roadmap on periodic leg movements during sleep: outcomes of the international PLMS taskforce

Clinical Snapshot

Key Findings

• Effect Size: Not applicable — no primary quantitative analysis performed

• Primary Outcome: Consensus that PLMS should be reconceptualised as a spectrum of sleep-related motor activity with heterogeneous neurophysiological substrates and variable clinical impact, rather than a single countable polysomnographic index

• Nnt Or Sensitivity: Not applicable — no therapeutic or diagnostic test evaluation performed; roadmap identifies need for future studies to establish these parameters

• Confidence Interval: Not reported — qualitative consensus document

Clinical Application

The roadmap's immediate clinical utility is limited, as it is explicitly not a practice guideline. However, clinicians can apply the conceptual reframing — treating PLMS as a spectrum requiring contextualised interpretation rather than threshold-based diagnosis — in current practice. Adoption of harmonised scoring standards and wearable technologies will require infrastructure investment and future guideline updates. In Australia, PLMS assessment occurs primarily in accredited sleep laboratories under AASM polysomnography standards. The Australasian Sleep Association (ASA) has not yet issued specific PLMS management guidelines beyond those embedded in RLS and periodic limb movement disorder (PLMD) frameworks. PBS-listed treatments relevant to PLMS-associated RLS include dopamine agonists (pramipexole, ropinirole) and alpha-2-delta ligands (pregabalin, gabapentin), though the roadmap highlights that treatment evidence specifically targeting PLMS outcomes — as distinct from RLS symptoms — remains insufficient. TGA-approved wearable devices for sleep monitoring are an emerging area aligned with the roadmap's technology recommendations. RACGP guidelines on sleep disorders do not currently provide specific PLMS management pathways, reinforcing the roadmap's call for outcome-oriented research to inform future guideline development. Adults and children undergoing polysomnography with incidental or symptomatic PLMS, particularly those with restless legs syndrome, cardiovascular comorbidities, neurodegenerative conditions, or unexplained sleep fragmentation

Abstract

Periodic leg movements during sleep (PLMS) are a frequently observed motor phenomenon in polysomnography, yet their biological meaning and clinical relevance are debated. Further, how these should be assessed and tabulated for optimal evaluation is uncertain. To address these gaps, an international, multidisciplinary taskforce convened a series of online meetings followed by an in person taskforce workshop held in Troina, Italy, on November 14-15, 2025, where agreement was reached through iterative discussion (qualitative; no Delphi or predefined voting thresholds). This taskforce roadmap summarizes the taskforce conclusions across five priority domains: (1) clinical significance and impact, (2) measurement and characterization, (3) treatment, (4) basic and translational research, and (5) PLMS across the life span and epidemiology. For each domain, we delineate where the field currently stands, identify critical gaps in knowledge, and propose concrete strategies, including key milestones, study designs, and infrastructure needs, to advance the field in a coordinated and standardized manner. A central unifying theme is that PLMS should no longer be viewed solely as a countable polysomnographic index, but rather as a spectrum of sleep-related motor activity with heterogeneous neurophysiological substrates and variable clinical impact. Achieving progress will require harmonized scoring standards, validated automated and wearable technologies, large longitudinal and outcome-oriented studies, and sustained international collaboration. This roadmap provides a framework to guide research, clinical innovation, and future guideline development, but it is not a clinical practice guideline or standards statement.

References

1. 1.Fulda, S., Baumert, M., Cesari, M., Clemens, S., Dauvilliers, Y., Ferini Strambi, L., Khachatryan, S. G., Koo, B. B., Manconi, M., Mignot, E., Pennestri, M.-H., Penzel, T., Plazzi, G., Salanitro, M., Silvestri, R., Stefani, A., Thomas, R. J., Winkelman, J. W., Zak, R., & Ferri, R. (2026). Consensus roadmap on periodic leg movements during sleep: outcomes of the international PLMS taskforce. Sleep. https://doi.org/10.1093/sleep/zsag093