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Breuss A, Strasser M, Nuoffer JM, Klein A, Perret-Hoigné E, Felder C, Stauffer R, Wolf P, Riener R, Gautschi M. Nocturnal vestibular stimulation using a rocking bed improves a severe sleep disorder in a patient with mitochondrial disease. J Sleep Res 2024:e14153. [PMID: 38499951 DOI: 10.1111/jsr.14153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Accepted: 01/11/2024] [Indexed: 03/20/2024]
Abstract
Mitochondrial diseases are rare genetic disorders often accompanied by severe sleep disorders. We present the case of a 12-year-old boy diagnosed with a severe primary mitochondrial disease, exhibiting ataxia, spasticity, progressive external ophthalmoplegia, cardiomyopathy and severely disrupted sleep, but no cognitive impairment. Interestingly, his parents reported improved sleep during night train rides. Based on this observation, we installed a rocking bed in the patient's bedroom and performed different interventions, including immersive multimodal vestibular, kinesthetic and auditory stimuli, reminiscent of the sensory experiences encountered during train rides. Over a 5-month period, we conducted four 2-week nocturnal interventions, separated by 1-week washout phases, to determine the subjectively best-perceived stimulation parameters, followed by a final 4-week intervention using the optimal parameters. We assessed sleep duration and quality using the Mini Sleep Questionnaire, monitored pulse rate changes and used videography to document nocturnal interactions between the patient and caregivers. Patient-reported outcome measures, clinical examinations and personal outcomes of specific interests were used to document daytime sleepiness, restlessness, anxiety, fatigue, cognitive performance and physical posture. In the final 4-week intervention, sleep duration increased by 25%, required caregiver interactions reduced by 75%, and caregiving time decreased by 40%. Subjective fatigue, assessed by the Checklist Individual Strength, decreased by 40%, falling below the threshold of severe fatigue. Our study suggests that rocking beds could provide a promising treatment regime for selected patients with persistent severe sleep disorders. Further research is required to validate these findings in larger patient populations with sleep disorders and other conditions.
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Affiliation(s)
- Alexander Breuss
- ETH Zurich, Sensory-Motor Systems Lab, Institute of Robotics and Intelligent Systems, Zurich, Switzerland
| | - Marco Strasser
- Department of Paediatrics, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Jean-Marc Nuoffer
- Division of Paediatric Endocrinology, Diabetology and Metabolism, Department of Paediatrics, and Institute of Clinical Chemistry, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Andrea Klein
- Division of Neuropediatrics, Inselspital, Bern University Hospital, Bern, Switzerland
| | - Eveline Perret-Hoigné
- Division of Neuropediatrics, Inselspital, Bern University Hospital, Bern, Switzerland
| | - Christine Felder
- Division of Neuropediatrics, Inselspital, Bern University Hospital, Bern, Switzerland
| | - Ruth Stauffer
- Institute for Physiotherapy, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Peter Wolf
- ETH Zurich, Sensory-Motor Systems Lab, Institute of Robotics and Intelligent Systems, Zurich, Switzerland
| | - Robert Riener
- ETH Zurich, Sensory-Motor Systems Lab, Institute of Robotics and Intelligent Systems, Zurich, Switzerland
- Spinal Cord Injury Center, University Hospital Balgrist, Zurich, Switzerland
| | - Matthias Gautschi
- Division of Paediatric Endocrinology, Diabetology and Metabolism, Department of Paediatrics, and Institute of Clinical Chemistry, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
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Effect of the Sway Bed on Autonomic Response, Emotional Responses, and Muscle Stiffness in Children with Severe Motor and Intellectual Disabilities: A Pilot Study. Healthcare (Basel) 2022; 10:healthcare10112337. [DOI: 10.3390/healthcare10112337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2022] [Revised: 11/18/2022] [Accepted: 11/19/2022] [Indexed: 11/23/2022] Open
Abstract
This cross-sectional study aimed to examine the effects of being swayed in a sway bed on children with severe motor and intellectual difficulties by examining potential differences in their autonomic and emotional responses, as well as their muscle hardness, and by comparing them with “a control condition without any stimulation”. Children’s heart rate variability, rectus femoris hardness, and passive hip abduction range of motion (ROM) were measured in two experimental conditions, differentiated by the presence of a 5-min sway stimulus. In each condition, the children’s faces were video-recorded and retrospectively rated subjectively by their homeroom teacher concerning the visible expression of eight emotions. Significant intervention-related effects were observed on the heart rate variability and the “Relax” item of the emotional response indicators but not on muscle hardness or hip ROM. Our findings provide evidence that using a motorized sway bed can promote relaxation in children with severe motor and intellectual disabilities by influencing their autonomic response.
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Baek S, Yu H, Roh J, Lee J, Sohn I, Kim S, Park C. Effect of a Recliner Chair with Rocking Motions on Sleep Efficiency. SENSORS (BASEL, SWITZERLAND) 2021; 21:8214. [PMID: 34960304 PMCID: PMC8706869 DOI: 10.3390/s21248214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Revised: 11/29/2021] [Accepted: 11/30/2021] [Indexed: 11/16/2022]
Abstract
In this study, we analyze the effect of a recliner chair with rocking motions on sleep quality of naps using automated sleep scoring and spindle detection models. The quality of sleep corresponding to the two rocking motions was measured quantitatively and qualitatively. For the quantitative evaluation, we conducted a sleep parameter analysis based on the results of the estimated sleep stages obtained on the brainwave and spindle estimation, and a sleep survey assessment from the participants was analyzed for the qualitative evaluation. The analysis showed that sleep in the recliner chair with rocking motions positively increased the duration of the spindles and deep sleep stage, resulting in improved sleep quality.
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Affiliation(s)
- Suwhan Baek
- Department of Computer engineering, Kwangwoon University, Seoul 01897, Korea
| | - Hyunsoo Yu
- Department of Computer engineering, Kwangwoon University, Seoul 01897, Korea
| | - Jongryun Roh
- Digital Transformation RnD Department, Korea Institute of Industrial Technology, Ansan 15588, Korea
| | - Jungnyun Lee
- Digital Transformation RnD Department, Korea Institute of Industrial Technology, Ansan 15588, Korea
| | - Illsoo Sohn
- Department of Computer Science and Engineering, Seoul National University of Science and Technology, Seoul 01811, Korea
| | - Sayup Kim
- Digital Transformation RnD Department, Korea Institute of Industrial Technology, Ansan 15588, Korea
| | - Cheolsoo Park
- Department of Computer engineering, Kwangwoon University, Seoul 01897, Korea
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Pasquier F, Bessot N, Martin T, Gauthier A, Bulla J, Denise P, Quarck G. Effect of vestibular stimulation using a rotatory chair in human rest/activity rhythm. Chronobiol Int 2020; 37:1244-1251. [PMID: 32845722 DOI: 10.1080/07420528.2020.1797762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
The vestibular system is responsible for sensing every angular and linear head acceleration, mainly during periods of motor activity. Previous animal and human experiments have shown biological rhythm disruptions in small rodents exposed to a hypergravity environment, but also in patients with bilateral vestibular loss compared to a control population. This raised the hypothesis of the vestibular afferent influence on circadian rhythm synchronization. The present study aimed to test the impact of vestibular stimulation induced by a rotatory chair on the rest/activity rhythm in human subjects. Thirty-four healthy adults underwent both sham (SHAM) and vestibular stimulation (STIM) sessions scheduled at 18:00 h. An off-vertical axis rotation on a rotatory chair was used to ecologically stimulate the vestibular system by head accelerations. The rest/activity rhythm was continuously registered by actigraphy. The recording started one week before the first session (BASELINE), continued in the week between the two sessions and one week after the second session. Vestibular stimulation caused a significant decrease in the average activity level in the evening following the vestibular stimulation. A significant phase advance in the rest/activity rhythm occurred two days after the 18:00 h vestibular stimulation session. Moreover, the level of motion sickness symptoms increased significantly after vestibular stimulation. The present study confirms previous results on the effect of vestibular stimulation and the role of vestibular afferents on circadian biological rhythmicity. Our results support the hypothesis of the implication of vestibular afferents as non-photic stimuli acting on circadian rhythms.
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Affiliation(s)
- Florane Pasquier
- Normandie University, Unicaen, Inserm, Comete, Gip Cyceron , Caen, France
| | - Nicolas Bessot
- Normandie University, Unicaen, Inserm, Comete, Gip Cyceron , Caen, France
| | - Tristan Martin
- Normandie University, Unicaen, Inserm, Comete, Gip Cyceron , Caen, France
| | - Antoine Gauthier
- Normandie University, Unicaen, Inserm, Comete, Gip Cyceron , Caen, France
| | - Jan Bulla
- Department of Mathematics, University of Bergen , Bergen, Norway.,Department of Psychiatry and Psychotherapy, University Regensburg , Regensburg, Germany
| | - Pierre Denise
- Normandie University, Unicaen, Inserm, Comete, Gip Cyceron , Caen, France
| | - Gaëlle Quarck
- Normandie University, Unicaen, Inserm, Comete, Gip Cyceron , Caen, France
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van Sluijs RM, Wilhelm E, Rondei QJ, Jäger L, Gall M, Garn H, Achermann P, Jenni OG, Riener R, Hill CM. Sensory stimulation in the treatment of children with sleep-related rhythmic movement disorder: a feasibility and acceptability study. SLEEP SCIENCE AND PRACTICE 2020. [DOI: 10.1186/s41606-020-00049-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Sleep-related rhythmic movement disorder is characterized by repetitive gross-motor movements at sleep onset or during sleep, which result in clinical consequences such as impact on daytime functioning and injury. No well-established therapies exist today. Substituting the patient’s movements with external sensory stimulation may offer a treatment modality. The aim of the current study was to test the feasibility and acceptability of vestibular stimulation using a rocking bed (Somnomat) in children with rhythmic movement disorder and to assess children’s movement preference.
Methods
Children with rhythmic movement disorder (n = 6, Age: 5–14 years) were studied over three nights in a sleep laboratory: adaptation night (normal bed) and randomised-order baseline (Somnomat) and intervention nights (Somnomat). Child’s preferred movement direction (head-to-toe or side-to-side) and frequency (between 0.25 and 2 Hz), determined during an afternoon protocol, were applied using the Somnomat for 1 h after lights out, and in response to subsequent episodes of rhythmic movement during intervention nights. Comfort assessed using a questionnaire, and objective sleep parameters assessed using videosomnography, were compared.
Results
The participants’ sometimes violent rhythmic movements did not disturb device performance. All children rated intervention nights equally or more comfortable than baseline nights. Self-reported sleep quality, as well as the number and duration of movement episodes did not significantly differ between baseline and intervention nights.
Conclusions
Providing rocking movements using the Somnomat is both technically feasible and acceptable to the target population. The therapeutic value of this novel stimulus substitution for rhythmic movement disorder should now be evaluated in a larger sample over a longer period in the home setting.
Trial registration
The trial was retrospectively registered at clinicaltrials.gov (NCT03528096) on May 17th 2018.
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Kompotis K, Hubbard J, Emmenegger Y, Perrault A, Mühlethaler M, Schwartz S, Bayer L, Franken P. Rocking Promotes Sleep in Mice through Rhythmic Stimulation of the Vestibular System. Curr Biol 2019; 29:392-401.e4. [DOI: 10.1016/j.cub.2018.12.007] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Revised: 10/29/2018] [Accepted: 12/06/2018] [Indexed: 10/27/2022]
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Gall M, Kohn B, Wiesmeyr C, van Sluijs RM, Wilhelm E, Rondei Q, Jäger L, Achermann P, Landolt HP, Jenni OG, Riener R, Garn H, Hill CM. A Novel Approach to Assess Sleep-Related Rhythmic Movement Disorder in Children Using Automatic 3D Analysis. Front Psychiatry 2019; 10:709. [PMID: 31681030 PMCID: PMC6806394 DOI: 10.3389/fpsyt.2019.00709] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Accepted: 09/04/2019] [Indexed: 11/25/2022] Open
Abstract
Background: Unlike other episodic sleep disorders in childhood, there are no agreed severity indices for rhythmic movement disorder. While movements can be characterized in detail by polysomnography, in our experience most children inhibit rhythmic movement during polysomnography. Actigraphy and home video allow assessment in the child's own environment, but both have limitations. Standard actigraphy analysis algorithms fail to differentiate rhythmic movements from other movements. Manual annotation of 2D video is time consuming. We aimed to develop a sensitive, reliable method to detect and quantify rhythmic movements using marker free and automatic 3D video analysis. Method: Patients with rhythmic movement disorder (n = 6, 4 male) between age 5 and 14 years (M: 9.0 years, SD: 4.2 years) spent three nights in the sleep laboratory as part of a feasibility study (https://clinicaltrials.gov/ct2/show/NCT03528096). 2D and 3D video data recorded during the adaptation and baseline nights were analyzed. One ceiling-mounted camera captured 3D depth images, while another recorded 2D video. We developed algorithms to analyze the characteristics of rhythmic movements and built a classifier to distinguish between rhythmic and non-rhythmic movements based on 3D video data alone. Data from 3D automated analysis were compared to manual 2D video annotations to assess algorithm performance. Novel indices were developed, specifically the rhythmic movement index, frequency index, and duration index, to better characterize severity of rhythmic movement disorder in children. Result: Automatic 3D video analysis demonstrated high levels of agreement with the manual approach indicated by a Cohen's kappa >0.9 and F1-score >0.9. We also demonstrated how rhythmic movement assessment can be improved using newly introduced indices illustrated with plots for ease of visualization. Conclusion: 3D video technology is widely available and can be readily integrated into sleep laboratory settings. Our automatic 3D video analysis algorithm yields reliable quantitative information about rhythmic movements, reducing the burden of manual scoring. Furthermore, we propose novel rhythmic movement disorder severity indices that offer a means to standardize measurement of this disorder in both clinical and research practice. The significance of the results is limited due to the nature of a feasibility study and its small number of samples. A larger follow up study is needed to confirm presented results.
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Affiliation(s)
- Markus Gall
- Sensing and Vision Solutions, AIT Austrian Institute of Technology GmbH, Vienna, Austria
| | - Bernhard Kohn
- Sensing and Vision Solutions, AIT Austrian Institute of Technology GmbH, Vienna, Austria
| | - Christoph Wiesmeyr
- Sensing and Vision Solutions, AIT Austrian Institute of Technology GmbH, Vienna, Austria
| | - Rachel M van Sluijs
- Sensory-Motor Systems Lab, ETH Zurich, Zurich, Switzerland.,Sleep & Health Zurich, University Center of Competence, University of Zurich, Zurich, Switzerland
| | | | - Quincy Rondei
- Sensory-Motor Systems Lab, ETH Zurich, Zurich, Switzerland
| | - Lukas Jäger
- Sensory-Motor Systems Lab, ETH Zurich, Zurich, Switzerland
| | - Peter Achermann
- Sleep & Health Zurich, University Center of Competence, University of Zurich, Zurich, Switzerland.,Institute for Pharmacology and Toxicology, University of Zurich, Zurich, Switzerland.,The KEY Institute for Brain Mind Research, Department of Psychiatry, Psychotherapy and Psychosomatics, University Hospital of Psychiatry, Zurich, Switzerland
| | - Hans-Peter Landolt
- Sleep & Health Zurich, University Center of Competence, University of Zurich, Zurich, Switzerland.,Institute for Pharmacology and Toxicology, University of Zurich, Zurich, Switzerland
| | - Oskar G Jenni
- Sleep & Health Zurich, University Center of Competence, University of Zurich, Zurich, Switzerland.,Child Development Center, University Children's Hospital Zurich, Zurich, Switzerland
| | - Robert Riener
- Sensory-Motor Systems Lab, ETH Zurich, Zurich, Switzerland.,Sleep & Health Zurich, University Center of Competence, University of Zurich, Zurich, Switzerland.,Faculty of Medicine, University of Zurich, Zurich, Switzerland
| | - Heinrich Garn
- Sensing and Vision Solutions, AIT Austrian Institute of Technology GmbH, Vienna, Austria
| | - Catherine M Hill
- Division of Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, United Kingdom
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8
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Abstract
Rocking movements appear to affect human sleep. Recent research suggested a facilitated transition from wake to sleep and a boosting of slow oscillations and sleep spindles due to lateral rocking movements during an afternoon nap. This study aimed at investigating the effect of vestibular stimulation on sleep onset, nocturnal sleep and its potential to increase sleep spindles and slow waves, which could influence memory performance. Polysomnography was recorded in 18 males (age: 20–28 years) during three nights: movement until sleep onset (C1), movement for 2 hours (C2), and one baseline (B) without motion. Sleep dependent changes in memory performance were assessed with a word-pair learning task. Although subjects preferred nights with vestibular stimulation, a facilitated sleep onset or a boost in slow oscillations was not observed. N2 sleep and the total number of sleep spindles increased during the 2 h with vestibular stimulation (C2) but not over the entire night. Memory performance increased over night but did not differ between conditions. The lack of an effect might be due to the already high sleep efficiency (96%) and sleep quality of our subjects during baseline. Nocturnal sleep in good sleepers might not benefit from the potential facilitating effects of vestibular stimulation.
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Omlin X, Crivelli F, Heinicke L, Zaunseder S, Achermann P, Riener R. Effect of Rocking Movements on Respiration. PLoS One 2016; 11:e0150581. [PMID: 26954500 PMCID: PMC4783003 DOI: 10.1371/journal.pone.0150581] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2015] [Accepted: 02/16/2016] [Indexed: 11/29/2022] Open
Abstract
For centuries, rocking has been used to promote sleep in babies or toddlers. Recent research suggested that relaxation could play a role in facilitating the transition from waking to sleep during rocking. Breathing techniques are often used to promote relaxation. However, studies investigating head motions and body rotations showed that vestibular stimulation might elicit a vestibulo-respiratory response, leading to an increase in respiration frequency. An increase in respiration frequency would not be considered to promote relaxation in the first place. On the other hand, a coordination of respiration to rhythmic vestibular stimulation has been observed. Therefore, this study aimed to investigate the effect of different movement frequencies and amplitudes on respiration frequency. Furthermore, we tested whether subjects adapt their respiration to movement frequencies below their spontaneous respiration frequency at rest, which could be beneficial for relaxation. Twenty-one healthy subjects (24–42 years, 12 males) were investigated using an actuated bed, moving along a lateral translation. Following movement frequencies were applied: +30%, +15%, -15%, and -30% of subjects’ rest respiration frequency during baseline (no movement). Furthermore, two different movement amplitudes were tested (Amplitudes: 15 cm, 7.5 cm; movement frequency: 0.3 Hz). In addition, five subjects (25–28 years, 2 males) were stimulated with their individual rest respiration frequency. Rocking movements along a lateral translation caused a vestibulo-respiratory adaptation leading to an increase in respiration frequency. The increase was independent of the applied movement frequencies or amplitudes but did not occur when stimulating with subjects’ rest respiration frequency. Furthermore, no synchronization of the respiration frequency to the movement frequency was observed. In particular, subjects did not lower their respiration frequency below their resting frequency. Hence, it was not feasible to influence respiration in a manner that might be considered beneficial for relaxation.
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Affiliation(s)
- Ximena Omlin
- Sensory-Motor Systems Lab, ETH Zurich, Zurich, Switzerland
- * E-mail:
| | | | | | | | - Peter Achermann
- Institute of Pharmacology and Toxicology, University of Zurich, Zurich, Switzerland
- Zurich Center for Integrative Human Physiology, University of Zurich, Zurich, Switzerland
- Neuroscience Center, University and ETH Zurich, Zurich, Switzerland
- Zurich Center for Interdisciplinary Sleep Research, University of Zurich, Zurich, Switzerland
| | - Robert Riener
- Sensory-Motor Systems Lab, ETH Zurich, Zurich, Switzerland
- Medical Faculty, University of Zurich, Zurich, Switzerland
- Neuroscience Center, University and ETH Zurich, Zurich, Switzerland
- Zurich Center for Interdisciplinary Sleep Research, University of Zurich, Zurich, Switzerland
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