Objective: To quantify the number of turning in bed throughout the night as a determinant of the severity of nocturnal hypokinesia.

Background: Nocturnal hypokinesia or impaired bed mobility is the most common nocturnal motor problem in patients with Parkinson’s disease(PD),and is associated with potential serious complications, including aspiration pneumonia, sleep-disordered breathing, and even sudden death.Although this problem is likely to exist throughout the night,there is little information available on the worst period of nocturnal hypokinesia.

Methods: 18 PD patients were included in study.All subjects wore 3-axis inertial sensors comprising of accelerometers and gyroscopes over the sternum, bilateral wrists, and ankles. The detailed description of the device set-up was described elsewhere(1).All patients completed the NADCS and UPDRS.The recording was for 1 night with the video monitoring in their home environment.The 5-minute periods after going to bed and before waking up in the morning were excluded from the analysis.The definition of turning in bed is a change of at least 15 degrees from the previous position and sustained for at least 5 minutes in any axis.The limb movement is defined as a change of at least 15 degree from previous position.We devised the sleep period to the first half and second half period.

Results: 18 PD patients (13 males and 5 female, 64.9 + 7.6 years) completed the study (Table 1).PD patients significantly had fewer turning in bed during the second half than the first half of the night(p 0.042) while no significant differences were observed in both upper and lower limb movements(Table2).However, there was no significant correlation between the number of turning in bed in the first or second half period of the night with NADCS, UPDRS axial score or UPDRS part III.

Conclusions: Our study suggested that PD patients had fewer turning in bed during the second half than the first half of the night, which is indicative of worsened nocturnal hypokinesia in the latter half of the night.This finding is clinically important for physicians to determine the therapeutic option for nocturnal hypokinesia in these patients, to provide sustained dopaminergic stimulation during both the first and second half of the night. Further study to include more patients as well as therapeutic trial of long-acting dopaminergic agents with objective outcomes are needed to confirm our findings.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/when-is-the-worst-period-of-nocturnal-hypokinesia-in-parkinsons-disease-a-sensor-based-analysis/