![]() By leveraging wrist-worn accelerometers, high-resolution measurements can be collected for weeks to months at a time with minimal disturbance to a patient’s daily life. identifying sleep stages, gross body movements, and respiration patterns), the technically demanding, in-clinic, overnight requirements and cost make it a poor choice for long-term monitoring in situations when these additional parameters are not needed. While PSG provides rich information beyond distinguishing between sleep and wake states (e.g. With improved algorithms, the hope is that actigraphy would provide a more practical and valid option to longitudinally monitor sleep compared to polysomnography (PSG) (the gold standard for sleep assessment) 14. ![]() Measurement of sleep/wake cycles using wrist-worn accelerometers has continued to evolve since their introduction 11, 12, 13. These types of measurements not only have the potential to provide more reliable indicators of intervention efficacy, but may also help improve management of the disease.Īdvances in wearable sensor technology have already led to more objective measures of health, both within and outside of healthcare settings. Therefore, there is a need for more objective measures that accurately reflect the impact of AD on a patient’s daily life. In contrast, while PROs provide insight into the perceived condition from the patient’s perspective, they are subjective and can be affected by mood or suggestion, lack compliance, and are qualitative in nature 10. COAs are aimed at assessing total body surface area (BSA) of the lesion 8 as well as lesion severity (redness, induration, excoriations, etc.) 9 but these are physician-derived measurements and provide limited insight into the fluctuations of symptoms experienced outside the clinic. Traditional assessments of pruritus and sleep are primarily based on clinical outcome assessments (COAs) and patient reported outcome assessments (PROs). The itch–scratch cycle compounded with sleep disturbances reduces the quality of life of patients as well as caregivers 6, 7. Furthermore, pruritus often occurs during the evening and at night and disrupts patients’ sleep 5. A common reaction to the pruritus sensation is to scratch the affected area 2, 3, which results in additional inflammation/lesion formation thus exacerbating the pruritus and perpetuating the itch–scratch cycle 4. Pruritus (itch) is a primary symptom seen in numerous chronic eczematous conditions, especially prevalent in patients with atopic dermatitis (AD) 1. These results support the use of wearable sensors for objective, continuous measurement of nighttime scratching and sleep during daily life. Log transformed sensor derived measures of total scratching duration achieve strong agreement with reference annotated video recordings ( r = 0.82, p < 0.001 N = 25). Leveraging reference data collected in a sleep laboratory (NCT ID: NCT03490877), results show that sensor-derived measures of total sleep opportunity (TSO time when patient intends to sleep) and total sleep time (TST) correlate well with reference polysomnography data (TSO: r = 0.72, p < 0.001 TST: r = 0.76, p < 0.001 N = 32). This approach uses heuristic and machine learning algorithms in a hierarchical paradigm by first determining when the patient intends to sleep, then detecting sleep–wake states along with scratching episodes, and lastly deriving objective measures of both sleep and scratch. In this work, we present the development and analytical validation of a method that sequentially processes epochs of sample-level accelerometer data from a wrist-worn device to provide continuous digital measures of nighttime scratching and sleep quantity. Wearable sensors can provide novel, objective measures of nighttime scratching and sleep however, many current approaches were not designed for passive, unsupervised monitoring during daily life. ![]() ![]() ![]() Objective measurements of nighttime scratching and sleep quantity can help assess the efficacy of an intervention. Patients with atopic dermatitis experience increased nocturnal pruritus which leads to scratching and sleep disturbances that significantly contribute to poor quality of life. ![]()
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