Tossing and turning in bed a sign of poor health in older adults

Monitoring nightly body movements in bed may help develop digital biomarkers that can be used for the early detection of health deterioration in older adults, allowing for timelier, more personalized interventions, according to a recent study.

“We found body movements in bed, quantified by the number of toss-and-turn events, to be the most predictive sleep parameter for EuroQol visual analogue scale (EQ-VAS)-based perceived health ratings among 20 potential sleep parameters,” the researchers said. “Supporting this finding, increases in toss-and-turn events turned out to often be a precursor of reported real-world health incidents.”

The present study used a pressure sensor device placed underneath the mattress to collect sleep parameters from 37 community-dwelling older adults. Every week, participants were given questionnaires and interviewed by healthcare personnel for their health status. The researchers looked at the interaction between sleep parameters—such as efficiency, onset delay, and vital signs, among others—with self-reported health via the EQ-VAS.

Linear mixed-effects modelling showed that of all sleep parameters assessed, the total number of toss-and-turn events most strongly predicted perceived health (t, –4.35; p<0.001), which was one of two factors that remained significant after correcting for multiple comparisons. The other was average nightly respiration rate (t, –3.148; p=0.032). [JMIR Mhealth Uhealth 2021;9:e24666]

Qualitative case-by-case analysis further revealed the potential predictive value of nightly body movements. More than half (54 percent) of abnormally looking toss-and-turn patterns could be linked to reports of health-related events.

There were three instances where there had been a particularly sharp increase of >200 toss-and-turns per night, all of which were associated with medical events. Of these, two were deemed severe, needing hospitalization. One led to death.

Among the health events that could be linked to toss-and-turn events were heart failure, urinary tract infections, gastrointestinal problems, seasonal flu, abdominal tumours, and hypertension.

The researchers then presented cases of four participants, three of whom encountered severe medical events: heart failure leading to two hospitalizations, a large abdominal tumour eventually ending in death, and worsening hypertension that needed institutionalization. In all three cases, toss-and-turn events rose sharply right before all health episodes.

The final participant encountered no health issue but showed an abrupt change in sensor signal, which the researchers deemed to be due to device repositioning.

“Population ageing is posing multiple social and economic challenges to society,” the researchers said, pointing to the economic burden of healthcare for older individuals suffering from many conditions.

“The use of modern pervasive computing technology makes it possible to continuously monitor the health status of community-dwelling older adults at home. Early detection of health issues through these technologies may allow for reduced treatment costs and initiation of targeted preventive measures leading to better health outcomes,” they added.

“While further evidence from larger, more targeted studies will be necessary, the potential of such a digital biomarker to be used as digital care support measure might be significant and should be further investigated,” the researchers said.