Study Investigates Using Wearable Technology to Assess Trauma-Related Symptoms

Reduced 24-hour activity variance and changes in both rest activity measures and in total sleep transitions have been linked to changes in markers of pain and its endurance over time, in sleep patterns, and in symptoms of anxiety following an investigation that gathered biomarker data on recovery and traumatic stress exposure via wrist-wearable technology.

These new study findings were published in JAMA Psychiatry, with the authors noting, “We derived and validated cross-sectional and longitudinal associations between 24-hour activity patterns and adverse posttraumatic neuropsychiatric sequelae (APNS) symptoms during the 8 weeks following a traumatic event, a high-risk period during which individuals transition to symptom recovery or persistence. To our knowledge, this study is the first to examine such associations.”

Their investigation was a subanalysis of data from the AURORA study of patients seen at 27 emergency departments (EDs) after exposure to traumatic stress. Of the 3040 who met initial study inclusion criteria—aged 18 to 65 years, could speak and read English, and had arrived at an ED within 72 hours of experiencing trauma, such as a car collision, physical assault, sexual assault, a fall from more than 10 feet, and mass casualty incidents—2021 patients provided device data and were included in this 8-week assessment and analysis; their mean (SD) age was 35.8 (13.0) years and the most common annual income was less than $35,000. In addition, most patients were female (62.2%), Black (50.2%), did not have a college degree (79.3%), and ended up in the ED because of a vehicle collision (75.2%).

The 8 biomarkers evaluated for symptoms of posttraumatic neuropsychiatric sequelae were pain (24-hour activity variance and percent of awake time in 24 hours), somatic symptoms (percent of awake time in 24 hours and total sleep transitions), depressive symptoms, hyperarousal, and nightmares (percent of awake time in 24 hours and total sleep transitions). Of these, reduced 24-hour activity variance was associated with greater pain severity (r = –0.14; 95% CI, –0.20 to –0.07).

In addition, changes in 6 rest activity measures were associated with changes in pain over time, and changes in the number of transitions between sleep and wake over time were associated with changes in pain, sleep, and anxiety. Furthermore, these device biomarkers identified individuals with good recovery for pain (positive predictive model [PPV], 0.85; 95% CI, 0.82-0.88), sleep (PPV, 0.83; 95% CI, 0.59-0.67), and anxiety (PPV, 0.76; 95% CI, 0.72-0.80).

Overall, the researchers identified that reduced activity variance was a biomarker for increased pain, as well as 9 other rest-activity biomarkers that changed with APNS symptoms over time.

Six activity-related biomarkers changed with pain, and 1 sleep-related biomarker was associated with changes in pain, sleep, and anxiety symptoms over time. Participants who experienced worsening pain showed increasing number of transitions between wake and sleep.

The researchers acknowledged that this study had certain limitations, including that the generalizability of their findings to patients who do not go to the ED is unknown and that missing or inaccurate self-reported data may not have been accounted for in their findings. The researchers believe that future studies should also examine patients wearing wrist devices over a longer period of time, and not just for the 8 weeks following a traumatic event.

Despite some limitations and uncertainties, the researchers believe that wrist-wearing devices can facilitate the collection of data on potential biomarkers for identifying adverse changes in pain, sleep, and anxiety symptoms in patients after a traumatic event.

“In the future, such biomarkers might be useful to identify trauma survivors who merit further evaluation for adverse trauma outcomes, particularly in vulnerable populations,” wrote the researchers. “Such biomarkers might also be useful to help clinicians and patients evaluate their responses to treatment interventions for pain, sleep, or anxiety and to help patients understand how their activity, rest, and sleep affect their health.”

Reference

Straus LD, An X, Ji Y, et al. Utility of wrist-wearable data for assessing pain, sleep, and anxiety outcomes after traumatic stress exposure. JAMA Psychiatry. Published online January 11, 2023. doi:10.1001/jamapsychiatry.2022.4533