Objective: We aimed to explore the relationship between impaired bed mobility, disease severity, and other factors putatively related to NH.

Background: Nocturnal hypokinesia (NH) is a common motor problem in Parkinson’s disease (PD). Recent studies using wearable technologies reported that patients with PD have fewer nocturnal movements than controls. NH has been associated with relative under treatment during the night (nocturnal off periods).

Method: Subjects wore a tri-axial accelerometer continuously (24/7) on the lower back for >3 days. Nocturnal activity was extracted from 100Hz raw acceleration data, with lying defined based on the vertical axis. Turning was defined as a change in position that was sustained for at least 5 min while wake-time as upright position during the night. Disease severity was classified using the Hoehn and Yahr (H&Y) staging scale. The MoCA was used to assess cognitive function and autonomic function was evaluated using the Non-Motor Symptom Questionnaire (NMS). All analyses were adjusted for age.

Results: Data from 272 patients with PD were included in the analysis (H&Y1: n=36, H&Y2: n=150, H&Y3: n=86). Age and disease duration differed between the groups (p<0.005). Sleep duration was similar (H&Y1: 7.8±1.3hrs; H&Y2: 8.1±1.3hrs; H&Y3: 8.1±1.4hrs; p=0.348). However, H&Y3 patients were more awake during the night than the two other groups (p=0.004) and the number and velocity of their turns in bed was significantly reduced (p<=0.004). Percent wake-time at night was associated with poorer cognitive performance (r=-0.141, p=0.014) and more non-motor symptoms (r=0.369, p<0.0001). Similarly, the number of turns during the night was positively correlated with cognitive performance (r=0.122, p=0.035) and less non-motor symptoms (r=-0.450, p<0.0001) while turning velocity was significantly associated with less non-motor symptoms (r=-0.254, p=0.004), but not with cognitive performance (p=0.844).

Conclusion: Although sleep duration is similar in different disease stages, worse nocturnal movement at night is associated with increasing PD severity and worse dysautonomia. From a clinical perspective, the use of a wearable sensor for continuous monitoring at night could provide valuable information to enhance clinical care including optimal nighttime dopaminergic treatment and turning strategies.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/objective-quantifiable-assessment-of-nocturnal-movements-in-patients-with-parkinsons-disease-using-a-wearable-sensor/