Tossing and Turning in Bed: Nocturnal Movements in Parkinson's Disease

Abstract

BackgroundSleep disturbances and nocturnal hypokinesia are common in Parkinson's disease (PD). Recent work using wearable technologies showed fewer nocturnal movements in PD when compared with controls. However, it is unclear how these manifest across the disease spectrum.ObjectivesWe assessed the prevalence of sleep disturbances and nocturnal hypokinesia in early and advanced PD and their relation to nonmotor symptoms and dopaminergic medication.MethodsA total of 305 patients with PD with diverse disease severity (Hoehn and Yahr [H&Y] stage 1 = 47, H&Y stage 2 = 181, H&Y stage 3 = 77) and 205 healthy controls continuously wore a tri‐axial accelerometer on the lower back for at least 2 days. Lying, turning, and upright ‐time at night were extracted from the acceleration signals. Percent upright time and nighttime walking were classified as sleep interruptions. The number, velocity, time, side, and degree of rotations in bed were used to evaluate nocturnal movements.ResultsNocturnal lying time was similar among all groups (healthy controls, 7.5 ± 1.2 hours; H&Y stage 1, 7.3 ± 0.9 hours; H&Y stage 2, 7.2 ± 1.3 hours; H&Y stage 3, 7.4 ± 1.6 hours; P = 0.501). However, patients with advanced PD had more upright periods, whereas the number and velocity of their turns were reduced (P ≤ 0.021). Recently diagnosed patients (<1 year from diagnosis) were similar to controls in the number of nocturnal turns (P = 0.148), but showed longer turning time (P = 0.001) and reduced turn magnitude (P = 0.002). Reduced nocturnal movements were associated with increased PD motor severity and worse dysautonomia and cognition and with dopaminergic medication.ConclusionsUsing wearable sensors for continuous monitoring of movement at night may offer an unbiased measure of disease severity that could enhance optimal nighttime dopaminergic treatment and utilization of turning strategies. © 2020 International Parkinson and Movement Disorder Society

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 ].…”

“…Overall, these studies have examined a heterogeneous cohort of PD patients, including subjects with early and advanced disease stages. Only 8 out of 12 studies also enrolled HS [ 25 , 26 , 27 , 29 , 31 , 34 , 35 , 98 ]. Of the studies that did not enrol HS [ 28 , 30 , 32 , 33 ], one investigated changes in nocturnal movements based on disease stage and severity [ 32 ], while another investigated subjective perception of impaired bed mobility [ 33 ].…”

“…Concerning the type and placement of wearable sensors, all authors adopted inertial devices, including accelerometers and gyroscopes. Most studies used a single inertial sensor placed on the trunk [ 27 , 28 , 29 , 30 ], waist [ 25 , 35 , 98 ], or abdomen [ 32 ]. Conversely, a few authors monitored nocturnal movements through a wireless sensor network composed of five inertial devices located on the wrists, ankles, trunk, or abdomen [ 26 , 31 , 33 , 34 ].…”

“…Regarding output measures, all authors examined body rotations by analysing the number, velocity, acceleration, and degree of axial turns in bed [ 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 98 ]. Moreover, some studies also assessed overnight body positions [ 27 , 31 , 35 ], number of limb movements [ 26 , 31 , 33 ], and frequency of getting out of bed [ 26 , 27 , 28 , 29 , 31 , 33 ]. Concerning body rotations, while several studies found a reduced number of nocturnal turns in PD patients compared to HS [ 26 , 27 , 29 , 31 ], a few authors demonstrated a similar frequency in the two groups [ 25 , 35 ].…”

“…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.…”