Problems of Using Actigraphy in People With Parkinson’s Disease
The advent of actigraphy in the 1990s made it possible to indirectly record a person’s sleep-wake cycles based on the person’s activity level, with increased activity indicating wakefulness and decreased activity indicating sleep. In actigraphy, a device — an actigraph — which is typically worn on the wrist, continually records movement data over a prolonged time — one week or more.
The collected data is relayed to a computer and analyzed. It is then presented in a histogram that shows sleep and wake characteristics such as total sleep time, percent of time spent asleep, total wake time, percent of time spent awake and number of awakenings. Algorithms (i.e., specialized mathematical formulas) used in actigraphs are well-suited to measure the activity level of healthy or young people. However, the algorithms may not accurately detect sleep and wake disturbances in people with Parkinson’s disease.
Dysfunctional motor activity in Parkinson’s disease such as dyskinesia (i.e., impaired voluntary movement), bradykinesia (i.e., slow movement) and abnormal motor activity during sleep such as rapid eye movement (REM) sleep behavior disorder, can be misinterpreted by an actigraph. Some recent research indicates that using immobility (i.e., low activity) rather than activity level may more accurately assess certain aspects of sleep and wake in people with Parkinson’s disease.
Parkinson’s disease is a neurodegenerative brain disorder in which certain dopamine containing cells at the base of the brain, which are involved in movement, are progressively destroyed. Why this destruction occurs is unclear. The initial symptoms of Parkinson’s disease are muscle rigidity, akinesia (i.e., loss of voluntary movement or reduced ability to make voluntary movement) and a tremor that initially affects the fingers of one hand.
Other symptoms that occur as the disease progresses are bradykinesia, walking in a stooped position, walking with a shuffle, festinating gait (i.e., brief episode of involuntary short rapid shuffling steps), freezing (i.e., momentary inability to initiate voluntary movement), an expressionless (i.e., “mask-like”) face with a stare, difficulty in enunciation, difficulty swallowing, excess saliva production and voice problems such as speaking in a low voice because of weakness of the muscles involved in speech.
In the rest of this article from the Q2 2018 issue of A2Zzz, Regina Patrick, RPSGT, RST, delves into the sleep issues people with Parkinson's disease experience.
This article is one of four designated CEC articles in this issue of A2Zzz. AAST members who read A2Zzz and claim their credits online by the deadline can earn 2.00 AAST Continuing Education Credits (CECs) per issue – for up to 8.00 AAST CECs per year. AAST CECs are accepted by the Board of Registered Polysomnographic Technologists (BRPT) and the American Board of Sleep Medicine (ABSM).
To earn AAST CECs, carefully read the four designated CEC articles and claim your credits online. You must go online to claim your credits by the deadline of Sept. 1, 2018.
After the successful completion of this educational activity, your certificates will be available in the My CEC Portal acknowledging the credits earned.