title: Estimation of sleep disturbances using wrist actigraphy in patients with postural tachycardia syndrome.
abstract: OBJECTIVE
  Patients with postural tachycardia syndrome (POTS) commonly complain of fatigue, unrefreshing sleep, daytime sleepiness and diminished quality of life. The study objective was to assess sleep quality in POTS patients using wrist actigraphy.
  
  
  METHODS
  Prospective study with control group.
  
  
  METHODS
  Patients with POTS (n = 36) and healthy subjects (n = 36) completed a detailed sleep log and actigraphy for 7 days.
  
  
  RESULTS
  Compared with healthy subjects, POTS patients have more self-reported problems including days with restless sleep (53 ± 30% vs. 21 ± 20%; P<0.001) and tiredness (75 ± 23% vs. 39 ± 27%; P<0.001). Using actigraphy, POTS patients have lower sleep efficiency (73 ± 13% vs. 79 ± 6%; P = 0.01). Actigraphy determined sleep onset latency (SOL) did not vary significantly in the two groups, but subjective SOL was higher in POTS patient (56 ± 66 min vs. 1 3 ± 9 min; P = 0.001). In POTS patients, there was a significant correlation between subjective complaints of tiredness and actigraphic sleep efficiency (Rs = -0.36; R(2) = 0.15; P = 0.01), significant correlations between actigraphic SOL and upright norepinephrine levels (P = 0.040), and between wake after sleep onset and standing heart rate (P = 0.02).
  
  
  CONCLUSIONS
  POTS patients have more sleep-related symptoms and poor sleep efficiency. The pattern of subjective vs. objective SOL mismatch is suggestive of sleep-state misperception. High norepinephrine correlated with actigraphic SOL, and this activation of the stress system may contribute significantly to a hyperarousal state with consequent insomnia, poor mental and physical health in POTS patients.
authors.affiliation: Autonomic Dysfunction Center, Vanderbilt University School of Medicine, Nashville, TN, USA; Department of Neurology, Vanderbilt University School of Medicine, Nashville, TN, USA.
authors.forename: Kanika
authors.initials: K
authors.lastname: Bagai
authors.forename: Candy I
authors.initials: CI
authors.lastname: Wakwe
authors.forename: Beth
authors.initials: B
authors.lastname: Malow
authors.forename: Bonnie K
authors.initials: BK
authors.lastname: Black
authors.forename: Italo
authors.initials: I
authors.lastname: Biaggioni
authors.forename: Sachin Y
authors.initials: SY
authors.lastname: Paranjape
authors.forename: Carlos
authors.initials: C
authors.lastname: Orozco
authors.forename: Satish R
authors.initials: SR
authors.lastname: Raj
mesh_terms: D056044:Actigraphy / Q000379:methods*; D000328:Adult; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017286:Polysomnography / Q000379:methods; D054972:Postural Orthostatic Tachycardia Syndrome / Q000453:epidemiology / Q000503:physiopathology*; D011446:Prospective Studies; D012894:Sleep Stages / Q000502:physiology*; D012893:Sleep Wake Disorders / Q000175:diagnosis* / Q000453:epidemiology / Q000503:physiopathology*; D014953:Wrist / Q000502:physiology*; D055815:Young Adult
keywords: Actigraphy; Autonomic; Human; Orthostatic tachycardia; Sleep
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