Impact of inability to turn in bed assessed by a wearable three-axis accelerometer on patients with Parkinson's disease

Abstract

BackgroundDifficulty turning over in bed is a common night-time symptom in Parkinson’s disease (PD). We aimed to quantitatively evaluate overnight turnover movements using a three-axis accelerometer and to investigate whether inability to turn in bed is related to daytime sleepiness, sleep quality, and depressive mood in PD patients.MethodsWe examined 64 patients with PD (mean age, 73.3±8.21 years; modified Hoehn-Yahr [mH-Y] stage, 3.0±1.0; disease duration, 7.2±6.3 years; unified Parkinson's disease rating scale [UPDRS], 36.9±18.3). Overnight monitoring of turnover movements using a wearable three-axis accelerometer was performed in all patients. Nocturnal kinetic parameters including total time recumbent, total time supine, number of turnover movements, and mean interval between turnover movements were obtained. Daytime immobility was assessed using the Barthel index (B-I), UPDRS, and mH-Y stage. Patients were also assessed with the Epworth Sleepiness Scale (ESS), Parkinson’s Disease Sleep Scale-2 (PDSS-2), and Beck Depression Inventory (BDI).ResultsNumber of turnover movements in bed correlated negatively with disease duration (r = -0.305; p<0.05), L-dopa-equivalent dose (r = -0.281; p<0.05), mH-Y staging (r = -0.336; p<0.01), total score of UPDRS (r = -0.386; p<0.01) and positively with B-I score (r = 0.365; p<0.01). Number of turnover movements in bed was generally inconsistent with awareness of turnover movement impairment as evaluated by PDSS-2 Item 9 scores, but patients who were never aware of impaired turnover movements showed ≥5 turnover movements overnight. Multivariate logistic regression analyses revealed no correlations between number of nocturnal turnover movements in bed and BDI, ESS, or PDSS-2. Use of anti-psychotic drugs was associated with ESS (p = 0.045). UPDRS was associated with PDSS-2 (p = 0.016).ConclusionDecreased number of turnover movements may not be a direct determinant of daytime sleepiness, sleep disorders, or depressive mood in PD patients. Use of anti-psychotic drugs and higher UPDRS score are factors significantly associated with daytime sleepiness and uncomfortable sleep, respectively.

Systematic Review Looking at the Use of Technology to Measure Free-Living Symptom and Activity Outcomes in Parkinson’s Disease in the Home or a Home-like Environment

“…Sleep had been measured in 11 of the studies included in this systematic review [31,33,41,67,[89][90][91][92][93][94][95]. Wearable devices were used to measure sleep outcomes in all of these studies.…”

“…Wearable devices were used to measure sleep outcomes in all of these studies. Single devices were used in eight of the 11 studies, worn on the trunk, wrist [41,67,89,91], lower limb [92] and abdomen [95]. The location of the technology depended on what aspect of sleep was being evaluated, for example Prudon et al using lower limb placement to measure periodic limb movements of sleep [92].…”

Shedding Light on Nocturnal Movements in Parkinson’s Disease: Evidence from Wearable Technologies

“…A small number of authors have used innovative wearable sensors to investigate abnormal nocturnal movements in PD [ 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 97 ]. A single research group has performed most of these investigations (7 out of 12 studies) [ 26 , 27 , 28 , 29 , 30 , 31 , 34 ].…”

“…Along with the examination of sleep impairment, some previous studies using actigraphy in PD have also provided information about nocturnal limb movements in parkinsonian patients [ 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 ]. More recently, innovative wearable technologies including wireless sensor networks have also been used to examine nocturnal movements involving axial body rotations in PD patients [ 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 ]. Compared to clinical evaluation and polysomnography, actigraphy and innovative wearable sensors are now increasingly considered feasible solutions for the long-term recording of a large amount of ecological data due to the low costs and unobtrusiveness of these tools.…”

Overnight Accelerometric Monitoring of Nocturnal Motor Disability: Different Kinetic Properties between Parkinson’s Disease and Hemiplegic Stroke

“…Because of the lack of methods to evaluate motor function during sleep, night time disability has not been fully elucidated or its severity has only been estimated based on the daytime motor impairment as evaluated by disease-specific clinimetric scales 1)2) . Recently, wearable threeaxis accelerometers have become available to analyze kinetic data of overnight movements [3][4][5][6][7][8] . Previously, we reported the clinical utility of overnight monitoring of turnover movements in bed for patients with Parkinson's disease (PD) 3)4) .…”