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Sola Valls, NuriaAuthorIranzo, AAuthorGaig, CAuthorGuaita, MAuthorSola, NAuthorSalamero, MAuthorTolosa, EAuthorSantamaria, JAuthor
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Article

Normative EMG Values during REM Sleep for the Diagnosis of REM Sleep Behavior Disorder

Publicated to:Sleep. 35 (6): 835-847 - 2012-06-01 35(6), DOI: 10.5665/sleep.1886

Authors: Frauscher, Birgit; Iranzo, Alex; Gaig, Carles; Gschliesser, Viola; Guaita, Marc; Raffelseder, Verena; Ehrmann, Laura; Sola, Nuria; Salamero, Manel; Tolosa, Eduardo; Poewe, Werner; Santamaria, Joan; Hoegl, Birgit

Affiliations

CIBERNED, Neurol Serv, Hosp Clin Barcelona, IDIBAPS, Barcelona, Spain - Author
Hosp Clin Barcelona, Psychol Serv, Barcelona, Spain - Author
Innsbruck Med Univ, Dept Neurol, A-6020 Innsbruck, Austria - Author
Medizinische Universitat Innsbruck - Author

Abstract

Correct diagnosis of rapid eye movement sleep behavior disorder (RBD) is important because it can be the first manifestation of a neurodegenerative disease, it may lead to serious injury, and it is a well-treatable disorder. We evaluated the electromyographic (EMG) activity in the Sleep Innsbruck Barcelona (SINBAR) montage (mentalis, flexor digitorum superficialis, extensor digitorum brevis) and other muscles to obtain normative values for the correct diagnosis of RBD for clinical practice.Two university hospital sleep disorder centers.Thirty RBD patients (15 idiopathic [iRBD], 15 with Parkinson disease [PD]) and 30 matched controls recruited from patients with effectively treated sleep related breathing disorders.Not applicable.Participants underwent video-polysomnography, including registration of 11 body muscles. Tonic, phasic, and "any" (any type of EMG activity, irrespective of whether it consisted of tonic, phasic or a combination of both) EMG activity was blindly quantified for each muscle. When choosing a specificity of 100%, the 3-sec miniepoch cutoff for a diagnosis of RBD was 18% for "any" EMG activity in the mentalis muscle (area under the curve [AUC] 0.990). Discriminative power was higher in upper limb (100% specificity, AUC 0.987-9.997) than in lower limb muscles (100% specificity, AUC 0.813-0.852). The combination of "any" EMG activity in the mentalis muscle with both phasic flexor digitorum superficialis muscles yielded a cutoff of 32% (AUC 0.998) for patients with iRBD and with PD-RBD.For the diagnosis of iRBD and RBD associated with PD, we recommend a polysomnographic montage quantifying "any" (any type of EMG activity, irrespective of whether it consisted of tonic, phasic or a combination of both) EMG activity in the mentalis muscle and phasic EMG activity in the right and left flexor digitorum superficialis muscles in the upper limbs with a cutoff of 32%, when using 3-sec miniepochs.

Keywords
cutoffemg activitymovement disordersnormal valuessinbar emg montageAgeAgedCase-control studiesChildrenCutoffElectromyographyEmg activityFemaleHumansMaleMovement disordersMuscle, skeletalNormal valuesParkinsons-diseasePolysomnographyQuantificationReference valuesRem sleep behavior disorderSinbar emg montageSleep, rem

Quality index

Bibliometric impact. Analysis of the contribution and dissemination channel

The work has been published in the journal Sleep due to its progression and the good impact it has achieved in recent years, according to the agency WoS (JCR), it has become a reference in its field. In the year of publication of the work, 2012, it was in position 17/192, thus managing to position itself as a Q1 (Primer Cuartil), in the category Clinical Neurology.

From a relative perspective, and based on the normalized impact indicator calculated from World Citations provided by WoS (ESI, Clarivate), it yields a value for the citation normalization relative to the expected citation rate of: 7.36. This indicates that, compared to works in the same discipline and in the same year of publication, it ranks as a work cited above average. (source consulted: ESI Nov 14, 2024)

This information is reinforced by other indicators of the same type, which, although dynamic over time and dependent on the set of average global citations at the time of their calculation, consistently position the work at some point among the top 50% most cited in its field:

  • Weighted Average of Normalized Impact by the Scopus agency: 8.72 (source consulted: FECYT Feb 2024)

Specifically, and according to different indexing agencies, this work has accumulated citations as of 2025-05-12, the following number of citations:

  • WoS: 278
  • Scopus: 326
  • Europe PMC: 169
Impact and social visibility

From the perspective of influence or social adoption, and based on metrics associated with mentions and interactions provided by agencies specializing in calculating the so-called "Alternative or Social Metrics," we can highlight as of 2025-05-12:

  • The use, from an academic perspective evidenced by the Altmetric agency indicator referring to aggregations made by the personal bibliographic manager Mendeley, gives us a total of: 296.
  • The use of this contribution in bookmarks, code forks, additions to favorite lists for recurrent reading, as well as general views, indicates that someone is using the publication as a basis for their current work. This may be a notable indicator of future more formal and academic citations. This claim is supported by the result of the "Capture" indicator, which yields a total of: 296 (PlumX).

With a more dissemination-oriented intent and targeting more general audiences, we can observe other more global scores such as:

  • The Total Score from Altmetric: 3.
Leadership analysis of institutional authors

This work has been carried out with international collaboration, specifically with researchers from: Austria; WESTCHESTER.