Comparison of EMG, Video, and Actigraphy Signals for Detecting Motor Activity in REM Sleep Behavior Disorder

Background: Electromyography (EMG), video-polysomnography (vPSG), and wrist actigraphy are each used to develop diagnostic algorithms for rapid-eye-movement sleep behavior disorder (RBD). However, the extent to which they capture overlapping versus distinct motor phenomena remains unknown. We evaluated the respective contributions of actigraphy, EMG and vPSG to the measurement of REM sleep motor activity. Methods: Seventeen adults with RBD (Mount Sinai n = 9; Stanford n = 8) and eight control participants from an open Newcastle dataset underwent vPSG and concomitant wrist actigraphy. Flexor digitorum superficialis EMG activity and video-detected movements were manually scored in 3 s mini epochs. Actigraphy was quantified using an acceleration-magnitude-based activity count model. Statistical and agreement analyses were performed to assess the motor events captured by all three, any two, or by each modality independently during REM sleep. Results: In participants with RBD, actigraphy-derived movement load was significantly higher during REM sleep than during non-REM stages, a pattern not observed in control participants. REM movement load was also higher in RBD participants compared to controls, although this difference did not remain significant after correction for multiple comparisons. Across 12,941 3 s mini epochs, EMG, actigraphy, and video detected 1703, 1613, and 811 motor events, of which 413 were detected concurrently by all three modalities. Pairwise agreement was moderate and increased from EMG-actigraphy (κ = 0.27 ± 0.10) to actigraphy-video (κ = 0.41 ± 0.12) and EMG-video (κ = 0.45 ± 0.15). Of EMG-detected events, 49.0% were also detected by actigraphy; of actigraphy-detected events, 37.2% were detected by EMG and 34.9% by video. Actigraphy activity counts were highest for events detected by all three modalities and lowest for actigraphy-only events. Conclusions: Actigraphy-measured REM-related motor activity was elevated in RBD but not in controls. EMG, actigraphy, and video captured partially overlapping motor events in RBD patients, with actigraphy showing the highest sensitivity and manually scored video the lowest.