title: Time for a strategy in night-time dopaminergic therapy? An objective sensor-based analysis of nocturnal hypokinesia and sleeping positions in Parkinson's disease.
abstract: BACKGROUND
  Nocturnal hypokinesia is a common night-time symptom in patients with Parkinson's disease (PD). However, there is still little understanding of the nature, and variations of severity of this symptom.
  
  
  OBJECTIVE
  To evaluate the severity of nocturnal hypokinesia and sleep positions in PD patients using multisite wearable sensors.
  
  
  METHODS
  Nocturnal parameters and sleep positions in 18 PD couples were assessed and compared using wearable sensors (limbs and trunk) for one night in their homes. Nocturnal parameters included number, velocity, acceleration, degree, limb movements and the number of times they got out of bed.
  
  
  RESULTS
  PD patients had significantly fewer episodes of turns in bed than their spouses (p=0.043), which was associated with significantly slower speed (p=0.005), acceleration (p=0.005) and fewer degrees (p=0.017). When we split the night into the first and second half, significant findings were mainly demonstrated in the second half of the night, including significantly fewer turns (p=0.02) with smaller degrees (p=0.017), slower speed (p=0.005) and acceleration (p=0.007). No significant differences in these parameters were shown in the first half of the night except for smaller degrees of turn in bed in PD patients (p=0.028) and slower acceleration (p=0.037). In addition, PD patients spent significantly more time in a supine position compared to their spouses (p=0.031) with significantly less time in a prone position (p=0.041).
  
  
  CONCLUSIONS
  Nocturnal hypokinesia gets worse as the night progresses. Treatment of nocturnal hypokinesia should aim at providing a continuous dopaminergic delivery that can achieve a sustained therapeutic level of dopamine throughout the night.
authors.affiliation: Chulalongkorn Center of Excellence for Parkinson's Disease & Related Disorders, Department of Medicine, Faculty of Medicine, Chulalongkorn University, King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok 10330, Thailand.
authors.forename: Jirada
authors.initials: J
authors.lastname: Sringean
authors.affiliation: Chulalongkorn Center of Excellence for Parkinson's Disease & Related Disorders, Department of Medicine, Faculty of Medicine, Chulalongkorn University, King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok 10330, Thailand.
authors.forename: Chanawat
authors.initials: C
authors.lastname: Anan
authors.affiliation: Biomedical Signal Processing Laboratory, National Electronics and Computer Technology Center (NECTEC), Pathumthani, Thailand.
authors.forename: Chusak
authors.initials: C
authors.lastname: Thanawattano
authors.affiliation: Chulalongkorn Center of Excellence for Parkinson's Disease & Related Disorders, Department of Medicine, Faculty of Medicine, Chulalongkorn University, King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok 10330, Thailand; Department of Rehabilitation Medicine, Juntendo University, Tokyo, Japan. Electronic address: rbh@chulapd.org.
authors.forename: Roongroj
authors.initials: R
authors.lastname: Bhidayasiri
mesh_terms: D056044:Actigraphy / Q000295:instrumentation; D000368:Aged; D000978:Antiparkinson Agents / Q000009:adverse effects / Q000627:therapeutic use*; D015259:Dopamine Agents / Q000009:adverse effects / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D018476:Hypokinesia / Q000209:etiology / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D009068:Movement / Q000187:drug effects / Q000502:physiology; D010300:Parkinson Disease / Q000150:complications / Q000188:drug therapy* / Q000503:physiopathology*; D011187:Posture; D012720:Severity of Illness Index; D012890:Sleep / Q000187:drug effects / Q000502:physiology; D012893:Sleep Wake Disorders / Q000209:etiology / Q000503:physiopathology*; D018454:Spouses; D013997:Time Factors; D059015:Wireless Technology / Q000295:instrumentation
chemical_list: D000978:Antiparkinson Agents; D015259:Dopamine Agents
keywords: Nocturnal akinesia; Nocturnal hypokinesia; Parkinson's disease; Sensors; Sleep position; Supine