Implementation of Actigraphy in Acute Traumatic Brain Injury (TBI) Neurorehabilitation Admissions: A Veterans Administration TBI Model Systems Feasibility Study

Towns, Stephanie J.; Zeitzer, Jamie M.; Holcomb, Erin; Silva, Marc A.; Schwartz, Daniel P.; Nakase‐Richardson, Risa

doi:10.1016/j.pmrj.2016.04.005

Cited by 15 publications

(9 citation statements)

References 33 publications

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“…29 Glasgow Coma Scale (GCS) 31 score in the ED and duration of posttraumatic amnesia (PTA) were the primary markers of injury severity (e-Appendix 2). [32][33][34][35][36][37][38][39][40][41][42][43][44][45][46][47][48] The administration of medications with sleep effects on the day of PSG was abstracted from the medical record, regardless of whether they were prescribed for sleep. STOPBANG questionnaire responses were collected from the participant or best source within 48 hours of PSG.…”

Section: Methodsmentioning

confidence: 99%

Comparison of Diagnostic Sleep Studies in Hospitalized Neurorehabilitation Patients With Moderate to Severe Traumatic Brain Injury

Nakase‐Richardson

Schwartz

Ketchum

et al. 2020

Chest

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BACKGROUND: OSA is prevalent during a time of critical neural repair after traumatic brain injury (TBI). The diagnostic utility of existing sleep studies is needed to inform clinical management during acute recovery from TBI. RESEARCH QUESTION: This study aimed to evaluate the non-inferiority and diagnostic accuracy of a portable level 3 sleep study relative to level 1 polysomnography in hospitalized neurorehabilitation patients with TBI. STUDY DESIGN AND METHODS: This is a prospective clinical trial conducted at six TBI Model System study sites between May 2017 and February 2019. Of 896 admissions, 449 were screened and eligible for the trial, with 345 consented. Additional screening left 263 eligible for and completing simultaneous administration of both level 1 and level 3 sleep studies, with final analyses completed on 214 (median age ¼ 42 years; ED Glasgow Coma Scale ¼ 6; time to polysomnography [PSG] ¼ 52 days). RESULTS: Agreement was moderate to strong (weighted kappa ¼ 0.78, 95% CI, 0.72-0.83) with the misclassification commonly occurring with mild sleep apnea due to underestimation of apnea hypopnea index (AHI). Most of those with moderate to severe sleep apnea were correctly classified (n ¼ 54/72). Non-inferiority was not demonstrated: the minimum tolerable specificity of 0.5 was achieved across all AHI cutoff scores (lower confidence limits [LCL] range, 0.807-0.943), but the minimum tolerable sensitivity of 0.8 was not (LCL range, 0.665-0.764). INTERPRETATION: Although the non-inferiority of level 3 portable diagnostic testing relative to level 1 was not established, strong agreement was seen across sleep apnea indexes. Most of those with moderate to severe sleep apnea were correctly identified; however, there was risk of misclassification with level 3 sleep studies underestimating disease severity for those with moderate to severe AHI and disease presence for those with mild AHI during early TBI neurorehabilitation.

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Section: Methodsmentioning

confidence: 99%

Comparison of Diagnostic Sleep Studies in Hospitalized Neurorehabilitation Patients With Moderate to Severe Traumatic Brain Injury

Nakase‐Richardson

Schwartz

Ketchum

et al. 2020

Chest

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“…Body movements can be monitored through actigraphy, which is frequently used in the clinical setting for evaluating rest-activity cycles (e.g., in insomnia, circadian rhythm disorders, or clinical monitoring in the rehabilitation process of patients with traumatic brain injury (TBI) [17,18]) with the major advantage of being a costefficient and easy to use tool suitable for long-term investigations. More precisely, an actigraph, worn on the wrist or ankle, allows the continuous recording of data across days, weeks, and even months in a natural setting without restricting mobility and daily life routine of the participants.…”

Section: Introductionmentioning

confidence: 99%

Actigraphy in brain-injured patients – A valid measurement for assessing circadian rhythms?

Angerer

Schabus

Raml

et al. 2020

BMC Med

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Background: Actigraphy has received increasing attention in classifying rest-activity cycles. However, in patients with disorders of consciousness (DOC), actigraphy data may be considerably confounded by passive movements, such as nursing activities and therapies. Consequently, this study verified whether circadian rhythmicity is (still) visible in actigraphy data from patients with DOC after correcting for passive movements. Methods: Wrist actigraphy was recorded over 7-8 consecutive days in patients with DOC (diagnosed with unresponsive wakefulness syndrome [UWS; n = 19] and [exit] minimally conscious state [MCS/EMCS; n = 11]). The presence and actions of clinical and research staff as well as visitors were indicated using a tablet in the patient's room. Following removal and interpolation of passive movements, non-parametric rank-based tests were computed to identify differences between circadian parameters of uncorrected and corrected actigraphy data. Results: Uncorrected actigraphy data overestimated the interdaily stability and intradaily variability of patients' activity and underestimated the deviation from a circadian 24-h rhythm. Only 5/30 (17%) patients deviated more than 1 h from 24 h in the uncorrected data, whereas this was the case for 17/30 (57%) patients in the corrected data. When contrasting diagnoses based on the corrected dataset, stronger circadian rhythms and higher activity levels were observed in MCS/EMCS as compared to UWS patients. Day-tonight differences in activity were evident for both patient groups. Conclusion: Our findings indicate that uncorrected actigraphy data overestimates the circadian rhythmicity of patients' activity, as nursing activities, therapies, and visits by relatives follow a circadian pattern itself. Therefore, we suggest correcting actigraphy data from patients with reduced mobility.

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“…Given the burdensome nature of PSG and the lack of its availability in many hospital settings, alternatives such as ACG have been used to objectively quantitate sleep. 5,10,[20][21][22][23][24][25] Kamper and colleagues reported good agreement between ACG and PSG in a sample of veterans (n = 50) that was more chronic than the current sample. 10 Across other populations, agreement between ACG and PSG has varied from good agreement between sleep/ wake epoch classification to underestimation and/or overestimation of parameters as reported in this study.…”

Section: Discussionmentioning

confidence: 76%

“…Given the burdensome nature of PSG and the lack of its availability in many hospital settings, alternatives such as ACG have been used to objectively quantitate sleep 0025. Kamper and colleagues reported good agreement between ACG and PSG in a sample of veterans (n = 50) that was more chronic than the current sample 0010.…”

Section: Discussionmentioning

confidence: 99%

Coherence Between Sleep Detection by Actigraphy and Polysomnography in a Multi‐Center, Inpatient Cohort of Individuals with Traumatic Brain Injury

Zeitzer

Hon

Whyte

et al. 2020

PM&R

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Background: Sleep is increasingly recognized as a crucial component to rapid and successful rehabilitation, especially from traumatic brain injuries (TBIs). Assessment of longitudinal patterns of sleep in a hospital setting, however, are difficult and often the expertise or equipment to conduct such studies is not available. Actigraphy (wrist-worn accelerometry) has been used for many years as a simple proxy measurement of sleep patterns, but its use has not been thoroughly validated in individuals with TBI. Objective: To determine the validity of different sensitivity settings of actigraphy analysis to optimize its use as a proxy for recording sleep patterns in individuals with a TBI. Design: Comparison of actigraphy to criterion standard polysomnographic (PSG)-determination of sleep on a single overnight study. Setting: Six rehabilitation hospitals in the TBI Model System. Participants: Two hundred twenty-seven consecutive, medically stable individuals with a TBI. Interventions: Not applicable. Main Outcome Measure: Concordance between PSG-and actigraphy-determined sleep using different sensitivity threshold settings (low, medium, high, automated). Results: Bland-Altman plots revealed increasing error with increasing amounts of wake during the sleep episode. Precision-recall statistics indicate that with less sensitive actigraphy thresholds, episodes identified as "wake" are usually "wake," but many true episodes of "wake" are missed. With more sensitive actigraphy thresholds, more episodes of "wake" are identified, but only some of these are true episodes of "wake." Conclusions: In hospitalized patients with TBI and poor sleep, actigraphy underestimates the level of sleep disruption and has poor concordance with PSG-determined sleep. Alternate methods of scoring sleep from actigraphy data are necessary in this population.

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Implementation of Actigraphy in Acute Traumatic Brain Injury (TBI) Neurorehabilitation Admissions: A Veterans Administration TBI Model Systems Feasibility Study

Abstract: III.

Cited by 15 publications

References 33 publications

Comparison of Diagnostic Sleep Studies in Hospitalized Neurorehabilitation Patients With Moderate to Severe Traumatic Brain Injury

Comparison of Diagnostic Sleep Studies in Hospitalized Neurorehabilitation Patients With Moderate to Severe Traumatic Brain Injury

Actigraphy in brain-injured patients – A valid measurement for assessing circadian rhythms?

Coherence Between Sleep Detection by Actigraphy and Polysomnography in a Multi‐Center, Inpatient Cohort of Individuals with Traumatic Brain Injury

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