Abstract
<b>Introduction</b> Disturbances of sleep/wake behaviour are amongst the most disabling symptoms of dementia, leading to increased carers’ burden and institutionalisation. The lack of unobtrusive, low- burden technologies validated to monitor sleep in patients living with dementia (PLWD) has prevented longitudinal studies of nocturnal disturbances and their correlates.
<b>Aims</b> To examine the effect of medication changes and clinical status on the intraindividual variation in sleep/wake behaviour in PLWD.
<b>Methods</b> Using under-mattress pressure-sensing mat in 46 PLWD, we monitored sleep/wake behavioural metrics for 13,711 nights between 2019-2021. Machine learning and >3.6million nightly summaries from 13,671 individuals from the general population were used to detect abnormalities in PLWD’s nightly sleep/wake metrics and convert them to risk scores. Additionally, GP records were reviewed for each patient to determine whether medication changes and clinical events affected sleep parameters.
<b>Results</b> PLWD’s went to bed earlier and rose later than sex- and age-matched controls. They had more nocturnal awakenings with longer out-of-bed durations. Notably, at the individual patient level, increased metric-specific risk scores were temporally related to changes in antipsychotics and antidepressants, and acute illness, including UTI, cardiac events, and depressive episodes.
<b>Conclusions</b> Passive monitoring of sleep/wake behaviours is a promising way to identify novel markers of disease progression and evaluate the effectiveness of pharmaceutical interventions in patients with dementia.