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Actigraphy in brain-injured patients – A valid measurement for assessing circadian rhythms?

Monika Angerer, View ORCID ProfileManuel Schabus, Marion Raml, Gerald Pichler, View ORCID ProfileAlexander B. Kunz, Monika Scarpatetti, Eugen Trinka, View ORCID ProfileChristine Blume
doi: https://doi.org/10.1101/839472
Monika Angerer
1University of Salzburg; Department of Psychology; Laboratory for Sleep, Cognition and Consciousness Research; Salzburg, Austria
2University of Salzburg; Centre for Cognitive Neuroscience Salzburg (CCNS); Salzburg, Austria
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Manuel Schabus
1University of Salzburg; Department of Psychology; Laboratory for Sleep, Cognition and Consciousness Research; Salzburg, Austria
2University of Salzburg; Centre for Cognitive Neuroscience Salzburg (CCNS); Salzburg, Austria
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Marion Raml
1University of Salzburg; Department of Psychology; Laboratory for Sleep, Cognition and Consciousness Research; Salzburg, Austria
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Gerald Pichler
3Geriatric Health Centres of the City of Graz; Albert Schweitzer Clinic; Apallic Care Unit; Graz, Austria
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Alexander B. Kunz
4Department of Neurology; Paracelsus Medical University; Christian Doppler Medical Center; Salzburg, Austria
5Gunther Ladurner Nursing Home; Salzburg, Austria
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Monika Scarpatetti
3Geriatric Health Centres of the City of Graz; Albert Schweitzer Clinic; Apallic Care Unit; Graz, Austria
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Eugen Trinka
2University of Salzburg; Centre for Cognitive Neuroscience Salzburg (CCNS); Salzburg, Austria
4Department of Neurology; Paracelsus Medical University; Christian Doppler Medical Center; Salzburg, Austria
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Christine Blume
2University of Salzburg; Centre for Cognitive Neuroscience Salzburg (CCNS); Salzburg, Austria
6Centre for Chronobiology; Psychiatric Hospital of the University of Basel; Basel, Switzerland
7Transfaculty Research Platform Molecular and Cognitive Neurosciences; University of Basel; Basel, Switzerland
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  • For correspondence: christine.blume@sbg.ac.at
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Abstract

Background Actigraphy has received increasing attention in classifying rest-activity cycles. However, in patients with disorders of consciousness (DOC), actigraphy data may be considerably confounded by passive movements, such as nursing activities and therapies. Consequently, this study verified whether circadian rhythmicity is (still) visible in actigraphy data from patients with DOC after correcting for passive movements.

Methods Wrist actigraphy was recorded over 7-8 consecutive days in patients with DOC (diagnosed with unresponsive wakefulness syndrome [UWS; n=19] and [exit] minimally conscious state [MCS/EMCS; n=11]). Presence and actions of clinical and research staff as well as visitors were indicated using a tablet in the patient’s room. Following removal and interpolation of passive movements, non-parametric rank-based tests were computed to identify differences between circadian parameters of uncorrected and corrected actigraphy data.

Results Uncorrected actigraphy data overestimated the interdaily stability and intradaily variability of patients’ activity and underestimated the deviation from a circadian 24h rhythm. Only 5/30 (17%) patients deviated more than 1h from 24h in the uncorrected data, whereas this was the case for 17/30 (57%) patients in the corrected data. When contrasting diagnoses based on the corrected dataset, stronger circadian rhythms and higher activity levels were observed in MCS/EMCS as compared to UWS patients. Day-to-night differences in activity were evident for both patient groups.

Conclusion Our findings indicate that uncorrected actigraphy data overestimates the circadian rhythmicity of patients’ activity, as nursing activities, therapies, and visits by relatives follow a circadian pattern itself. Therefore, we suggest correcting actigraphy data from patients with reduced mobility.

Footnotes

  • Email-Addresses: MA: monika.angerer{at}sbg.ac.at; MaS: manuel.schabus{at}sbg.ac.at, MR: marion_raml{at}yahoo.de; GP: Gerald.Pichler{at}stadt.graz.at; ABK: a.kunz{at}salk.at; MoS: monika.scarpatetti{at}stadt.graz.at; ET: e.trinka{at}salk.at

  • Change of author order; Supplemental files updated

  • Abbreviations

    AI
    anoxic-ischemic brain injury
    CRS-R
    Coma Recovery Scale – Revised
    DOC
    disorders of consciousness
    EMCS
    exit minimally conscious state
    GCS
    Glasgow Coma Scale
    IQR
    interquartile range
    IS
    interdaily stability
    IV
    intradaily variability
    MCS
    minimally conscious state
    NTBI
    non-traumatic brain injury
    TBI
    traumatic brain injury
    UWS
    unresponsive wakefulness syndrome
  • Copyright 
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    Posted March 20, 2020.
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    Actigraphy in brain-injured patients – A valid measurement for assessing circadian rhythms?
    Monika Angerer, Manuel Schabus, Marion Raml, Gerald Pichler, Alexander B. Kunz, Monika Scarpatetti, Eugen Trinka, Christine Blume
    bioRxiv 839472; doi: https://doi.org/10.1101/839472
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    Actigraphy in brain-injured patients – A valid measurement for assessing circadian rhythms?
    Monika Angerer, Manuel Schabus, Marion Raml, Gerald Pichler, Alexander B. Kunz, Monika Scarpatetti, Eugen Trinka, Christine Blume
    bioRxiv 839472; doi: https://doi.org/10.1101/839472

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