How well do Parkinson's disease patients turn in bed? Quantitative analysis of nocturnal hypokinesia using multisite wearable inertial sensors

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.…”

“…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]. Multiple device platforms were described in three of the studies [90,93,94]; of note, Gros et al [90] were interested in quantifying apnoea, hypopnoea, oxygen desaturation and pulse rate using two respiratory inductance plethysmography belts, a nasal pressure cannula and a pulse oximeter. Accelerometers were used in all of the wearable devices, accompanied by gyroscopes in four papers (all using the 'NIGHT-Recorder' device to measure nocturnal hypokinesia) [31,33,93,94].…”

Evaluation of nocturnal hypokinesia in Parkinson’s disease using a novel patient/proxy questionnaire and correlations with objective monitoring

“…The NADCS has three components, exploring the severity of akinesia, dystonia, and cramp during the night via an ordinal scale [7]. In addition, a random sample of 25 patients-caregivers pairs were also assessed with night-time sensor monitoring (the NIGHT-Recorder, ChulaPD, Thailand) to provide objective correlations [4,8]. Objective nocturnal parameters in this study consisted of the number of times, degree, velocity and acceleration of turning in bed as described in our prior study [4].…”

“…In clinical practice, the evaluation of nocturnal hypokinesia in PD patients is usually based on clinical interviews and specific items of validated questionnaires, with a reported prevalence of at least 50% amongst moderate stage patients [2,3]. Recently, continuous objective monitoring with body-worn sensors has provided another option to evaluate nocturnal mobility in patient's bedroom environment, with the ability to measure certain characteristics in PD patients, such as fewer, smaller and slower turns, and increased episodes of getting out of bed due to nocturia when compared to age-matched controls [4]. However, the use of night-time monitoring is still limited to research and clinical trials, and has yet to be employed in clinical practice.…”

Unmet needs in Parkinson's disease: New horizons in a changing landscape

“…Whereas, we once very much focused on 'end-of-dose wearing-off', we now increasingly consider the time taken to ON, which is related to drug absorption and has been reported to be more than twice the duration of wearing-off [56]. Nocturnal hypokinesia and early morning off is often the longest OFF period in the daily treatment cycle [5,57], and delays to ON time and dose failures have been reported to account for >60% of daily OFF time [58]. As such, this provides a rationale for using non-oral therapies such as apomorphine injections or infusion which do not rely on GI absorption to manage motor fluctuations in patients where oral treatments do not provide sufficient control.…”