Abstract
In Parkinson’s disease (PD), abnormal movements consisting of hypokinetic and hyperkinetic manifestations commonly lead to nocturnal distress and sleep impairment, which significantly impact quality of life. In PD patients, these nocturnal disturbances can reflect disease-related complications (e.g., nocturnal akinesia), primary sleep disorders (e.g., rapid eye movement behaviour disorder), or both, thus requiring different therapeutic approaches. Wearable technologies based on actigraphy and innovative sensors have been proposed as feasible solutions to identify and monitor the various types of abnormal nocturnal movements in PD. This narrative review addresses the topic of abnormal nocturnal movements in PD and discusses how wearable technologies could help identify and assess these disturbances. We first examine the pathophysiology of abnormal nocturnal movements and the main clinical and instrumental tools for the evaluation of these disturbances in PD. We then report and discuss findings from previous studies assessing nocturnal movements in PD using actigraphy and innovative wearable sensors. Finally, we discuss clinical and technical prospects supporting the use of wearable technologies for the evaluation of nocturnal movements.
Highlights
Parkinson’s disease (PD) is the fastest-growing neurological disorder in prevalence, disability, and deaths worldwide [1]
Linear correlation between actigraphy and PSG measurements partially dependant on disease stage; higher sleep efficiency and total sleep time when recording lower limbs compared to upper limbs
Actigraphic sleep measures correlated with disease stage and severity, PDSS sleep quality, non-motor symptoms, morning mobility, LEDD, cognitive function, and melatonin blood concentration
Summary
Parkinson’s disease (PD) is the fastest-growing neurological disorder in prevalence, disability, and deaths worldwide [1]. Abnormal movements consisting of hypokinetic and hyperkinetic manifestations are major contributing factors to nocturnal distress and sleep impairment in PD patients and their bed partners. Abnormal nocturnal movements in PD can reflect disease-related complications, primary sleep disorders, or both [7]. Among disease-related nocturnal complications, akinesia is one of the most disabling consequences, leading to abnormal nocturnal movements in PD [9]. Nocturnal akinesia is a hypokinetic disorder consisting of partial or complete loss of movement in the axial body and limbs, limiting body position changes and leading to prolonged immobilization, pain, and sleep impairment [9]. PD patients can manifest primary sleep disorders, such as restless legs syndrome (RLS), periodic limb movement disorder (PLMD), and rapid eye movement (REM) behaviour disorder (RBD), which, unlike nocturnal akinesia, may occur in early or even prodromal phases of PD [10]. It is crucial to recognise and classify abnormal nocturnal movements in order to optimise therapeutic strategies in PD patients
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