Objective: To identify the body position during sleep in PD patients in comparison to their spouses by using multisite wearable inertial sensors.

Background: Nocturnal hypokinesia represents one of the most distressing nocturnal symptoms in PD,which may lead to patients and caregivers’ burden.Our recent study utilizing wearable sensors indicated that PD patients made fewer,smaller turns in bed in comparison to their spouses, implying the presence of nocturnal axial rigidity(1).The identification of body position during sleep could be clinically important since the presence of akinesia in one static position may be associated with sleep disordered breathing with potential serious complications and fatality(2).

Methods: 18 PD patient pairs were included in the study.All subjects wore 3-axis inertial sensors comprising of accelerometers and gyroscopes over the sternum, bilateral wrists, and ankles(1).They also completed the NADCS and UPDRS.The recording was for 1 night, with the video monitoring in their home.Supine position was identified by the presence of 0 degree of x and y axis and 90 degree of z axis.

Results: 18 PD patients (64.9 +/-7.6yrs),18 spouses 63.8 +/-8.5yrs)completed the study.There were no significant demographic differences between the two groups and demographic data PD patients were shown in Table 1

The demographic data of 18 PD patients

Age	64.9 + 7.6
Age at onset	55.0 (10.01)
Duration of disease	10.0 (5.38)
Hoehn&Yahr stage	2.53 (0.44)
UPDRS I/II/III/IV	2.22 (1.73) /11.72 (4.82) /22.94 (8.31) /3.33 (2.85)
Presence of nocturnal akinesia	60%
Total LED (mg)	953.06 (451.89)
Night time LED (mg)	68.89 (48.46)
Nocturnal akinesia score	1.7 (1.2)
Nocturnal dystonia score	0.6 (0.7)
Nocturnal cramp score	0.8 (1.0)
Total NADCS	3.1 (2.3)

. Both PD patients and their spouses spent most of their nighttime in the supine position (table 2)

The mean duration of each body position during sleep of PD patients and their spouses

Body position (min)	Patients	Spouses	P-value
Prone position	0.687 (2.45)	18.582 (31.67)	0.030*
Right lateral position	72.368 (69.12)	137.564 (105.39)	0.079
Left lateral position	57.383 (109.94)	112.277 (99.53)	0.116
Supine position	316.583 (133.17)	209.386 (108.64)	0.034*
Upright position	49.702 (44.64)	37.804 (29.94)	0.244
Total sleep time	496.722 (81.82)	515.611 (111.69)	0.546
Sleep time exclude upright position	447.020 (59.94)	477.808 (116.16)	0.271

-Paired t-test, significant level is defined when P-value < 0.05“.However, PD patients significantly lied in the supine position during the night more than their spouses.On a contrary, PD patients also spent significantly less time in a prone position than their spouses.No significant correlation was observed between different body positions at night and night time LED dosage, long acting night time dosage, and total LED and also between supine position and NADCS.However, moderate association was identified between the upright position and total LED (r0.555,p0.017).PD patients turned with significant smaller degrees than their spouses (p <0.001).

Conclusions: Our study provided the objective evidence that PD patients spent most time of the night in the supine position more than their spouses.This prolonged supine position is likely to be a consequence of their nocturnal hypokinesia.The prolonged supine position in patients with PD may be a critical setting that lead certain patients for nighttime breathing or complications.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/body-position-during-sleep-in-patients-with-parkinsons-disease-pd-a-sensor-based-analysis/