title: The feasibility of sleep assessment by actigraph in patients with tetraplegia.
abstract: BACKGROUND
  Sleep disturbances are frequent in patients with high spinal cord lesions, and are difficult to diagnose by means of polysomnography (PSG).
  
  
  METHODS
  Retrospective cohort study.
  
  
  OBJECTIVE
  Examine the feasibility of sleep assessment by actigraph in patients with tetraplegia.
  
  
  METHODS
  A rehabilitation center in Israel.
  
  
  METHODS
  Twenty-one patients with tetraplegia and 20 healthy persons.
  
  
  METHODS
  Sleep assessment by actigraphs attached to the head and the wrist.
  
  
  METHODS
  The actigraphic movement index (MI), total sleep time (TST), sleep efficiency (SE), wake after sleep onset (WASO), sleep latency (SL), and number of awakenings (NOA).
  
  
  RESULTS
  In the control group actigraphy showed that during sleep the hand moves more than the head but that the movements were highly correlated. In patients with tetraplegia below C(5)-C(7) the hand also moved more than the head, but in patients with tetraplegia below C(4), the head moved more (P<0.05). No significant differences were found between patients with C(5)-C(7) tetraplegia and healthy controls in the sleep indices obtained by hand movements, or between patients with C(4) tetraplegia and healthy controls in the indices obtained by head movements. Control subjects and patients showed similar subjective assessment of sleep quality.
  
  
  CONCLUSIONS
  These preliminary findings support the validity of wrist actigraphy for sleep assessment in patients with C(5)-C(7) tetraplegia, and suggest that head-mounted actigraphy is a feasible alternative for sleep assessment in patients with tetraplegia below C(4). To establish these findings, further investigations are required, with a larger number of patients and comparison with PSG.
authors.affiliation: Department of Spinal Rehabilitation, Loewenstein Rehabilitation Hospital, Raanana, Israel.
authors.forename: E
authors.initials: E
authors.lastname: Spivak
authors.forename: A
authors.initials: A
authors.lastname: Oksenberg
authors.forename: A
authors.initials: A
authors.lastname: Catz
mesh_terms: D000328:Adult; D015331:Cohort Studies; D005260:Female; D019416:Head Movements / Q000502:physiology; D006801:Humans; D008297:Male; D009043:Motor Activity / Q000502:physiology*; D017286:Polysomnography; D011782:Quadriplegia / Q000503:physiopathology*; D012016:Reference Values; D012189:Retrospective Studies; D012890:Sleep / Q000502:physiology*; D012893:Sleep Wake Disorders / Q000150:complications / Q000503:physiopathology; D011795:Surveys and Questionnaires; D014953:Wrist / Q000502:physiology