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Nocturnal Physiological Associations with Agitation Occurrence and Severity in Dementia: An Explanatory Study Using Contactless Sleep Sensing
Liu Z, Bono M, Flisar A, Decloedt R, Van Den Bossche M, De Vos M.. medRxiv, 2026-03-02
Topic: Brain imaging, connectivity and assessment
Background Agitation is a common and burdensome neuropsychiatric symptom in dementia that fluctuates from day to day, but objective tools for short-term risk stratification are limited. Objective We aimed to investigate whether nocturnal physiological signals from unobtrusive under-mattress sensors predict next-day daytime agitation and whether associations differ for agitation occurrence versus severity. Methods We extracted cardiorespiratory, movement, and sleep-proxy features from two long-term care cohorts ( N =55; 333 nights) and one external home-monitoring cohort ( N =17; 801 nights). A two-part mixed-effects framework was used to model next-day agitation episodes. Results Lower nocturnal respiratory rate and greater activity variability were independently associated with higher odds of next-day agitation occurrence, whereas no sleep-derived feature was FDR-significant for agitation severity. Exploratory subtype-specific analyses yielded more FDR-significant associations for motor agitation than for verbal agitation. Respiration-related associations were also observed in the external cohort. Conclusions Passive sleep monitoring identified physiologically interpretable sleep markers associated with next-day agitation occurrence, supporting prospective evaluation of under-mattress sensing as a source of short-term risk information for dementia care.
Key findings
- Objective We aimed to investigate whether nocturnal physiological signals from unobtrusive under-mattress sensors predict next-day daytime agitation and whether associations differ for agitation occurrence versus severity.
- Results Lower nocturnal respiratory rate and greater activity variability were independently associated with higher odds of next-day agitation occurrence, whereas no sleep-derived feature was FDR-significant for agitation severity.
- Exploratory subtype-specific analyses yielded more FDR-significant associations for motor agitation than for verbal agitation.
- Conclusions Passive sleep monitoring identified physiologically interpretable sleep markers associated with next-day agitation occurrence, supporting prospective evaluation of under-mattress sensing as a source of short-term risk information for dementia care.
Study details
- Participants55
- Evidence strengthModerate
How this study scored 16/100
Preprint — not yet peer-reviewed. It scored 31 on the same rubric, but non-peer-reviewed sources are capped at 16, so it shows as 16. Scored zero for study design, effect reported and randomised / blinded because the record does not state it. We have no data on times cited, citations per year, impact for its field and year, cited by studies here, still being cited, senior author's track record, institution's track record and multi-centre collaboration, so those were left out: it earned 19 of the 62 points we could judge it on, which is 31 out of 100.
| Component | Points | Why |
|---|---|---|
| Journal tier | 2 / 10 | Tier 4 — not a peer-reviewed journal (medRxiv) |
| Journal's citation record | 0 / 4 | Not a journal article, so the journal's record does not count |
| Study design | 0 / 12 | No study design recorded — scores zero, not guessed (not stated in the record — scored 0) |
| Strength of evidence | 3 / 5 | Rated “moderate” in our summary |
| Peer-review validation | 4 / 10 | Preprint — not yet peer-reviewed. Hosted on a preprint server. |
| How recent | 5 / 5 | 2026 — within 1 year(s) of the newest study here |
| Sample size | 1 / 4 | 55 participants |
| Effect reported | 0 / 3 | No effect size reported — scores zero (not stated in the record — scored 0) |
| Studied in people | 3 / 3 | Studied in people (participant count stated) |
| Randomised / blinded | 0 / 2 | No randomisation or blinding stated — scores zero (not stated in the record — scored 0) |
| Times cited | — / 7 | No citation count (not found in OpenAlex) — left out of this score |
| Citations per year | — / 5 | No citation count or no year — left out of this score |
| Impact for its field and year | — / 6 | No field-weighted citation impact (OpenAlex has none yet) — left out of this score |
| Cited by studies here | — / 6 | Not yet checked against this library's citation graph — left out of this score |
| Still being cited | — / 4 | No yearly citation counts — left out of this score |
| Senior author's track record | — / 4 | Senior author's record not available — left out of this score |
| Institution's track record | — / 3 | No institution listed in OpenAlex — left out of this score |
| Multi-centre collaboration | — / 3 | Institutions not listed — left out of this score |
| Indexed in PubMed | 1 / 2 | Not in PubMed, but has a DOI |
| Free to read | 0 / 2 | Behind a paywall — scores zero |
| Points | 19 / 62 | Scored on 12 of 20 parts. We have no data for the rest, so they are left out: 19 of the 62 points we could judge it on is 31 out of 100. |
| Total | 31 / 100 | Capped to 16 because this is not a peer-reviewed article. |
What each of these 20 components measures, and what this score is not →
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Cite this study APA, Vancouver, BibTeX · download .bib or .ris
Built from the record alzhub holds for this paper, not looked up. Volume, issue and page numbers are not held in the record. Check the citation against the original before you use it.
APA 7th
Liu, Z., Bono, M., Flisar, A., Decloedt, R., Van Den Bossche, M., & De Vos, M. (2026). Nocturnal Physiological Associations with Agitation Occurrence and Severity in Dementia: An Explanatory Study Using Contactless Sleep Sensing. medRxiv. https://doi.org/10.64898/2026.02.27.26346707
Vancouver
Liu Z, Bono M, Flisar A, Decloedt R, Van Den Bossche M, De Vos M. Nocturnal Physiological Associations with Agitation Occurrence and Severity in Dementia: An Explanatory Study Using Contactless Sleep Sensing. medRxiv. 2026. doi:10.64898/2026.02.27.26346707.
BibTeX
@article{liu2026-624c7fe3,
author = {Liu, Z. and Bono, M. and Flisar, A. and Decloedt, R. and Van Den Bossche, M. and De Vos, M.},
title = {{Nocturnal Physiological Associations with Agitation Occurrence and Severity in Dementia: An Explanatory Study Using Contactless Sleep Sensing}},
journal = {medRxiv},
year = {2026},
doi = {10.64898/2026.02.27.26346707},
url = {https://doi.org/10.64898/2026.02.27.26346707}
}
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