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Anjum MF, Smyth C, Zuzuárregui R, Dijk DJ, Starr PA, Denison T, Little S. Multi-night cortico-basal recordings reveal mechanisms of NREM slow-wave suppression and spontaneous awakenings in Parkinson's disease. Nat Commun 2024; 15:1793. [PMID: 38413587 PMCID: PMC10899224 DOI: 10.1038/s41467-024-46002-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Accepted: 02/12/2024] [Indexed: 02/29/2024] Open
Abstract
Sleep disturbance is a prevalent and disabling comorbidity in Parkinson's disease (PD). We performed multi-night (n = 57) at-home intracranial recordings from electrocorticography and subcortical electrodes using sensing-enabled Deep Brain Stimulation (DBS), paired with portable polysomnography in four PD participants and one with cervical dystonia (clinical trial: NCT03582891). Cortico-basal activity in delta increased and in beta decreased during NREM (N2 + N3) versus wakefulness in PD. DBS caused further elevation in cortical delta and decrease in alpha and low-beta compared to DBS OFF state. Our primary outcome demonstrated an inverse interaction between subcortical beta and cortical slow-wave during NREM. Our secondary outcome revealed subcortical beta increases prior to spontaneous awakenings in PD. We classified NREM vs. wakefulness with high accuracy in both traditional (30 s: 92.6 ± 1.7%) and rapid (5 s: 88.3 ± 2.1%) data epochs of intracranial signals. Our findings elucidate sleep neurophysiology and impacts of DBS on sleep in PD informing adaptive DBS for sleep dysfunction.
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Affiliation(s)
- Md Fahim Anjum
- Movement Disorders and Neuromodulation Centre, University California San Francisco, San Francisco, CA, USA.
| | - Clay Smyth
- Movement Disorders and Neuromodulation Centre, University California San Francisco, San Francisco, CA, USA
| | - Rafael Zuzuárregui
- Movement Disorders and Neuromodulation Centre, University California San Francisco, San Francisco, CA, USA
- Parkinson's Disease Research Education and Clinical Center, San Francisco Veteran's Affairs Medical Center, San Francisco, CA, USA
| | - Derk Jan Dijk
- Surrey Sleep Research Centre, University of Surrey, Guildford, UK
- UK Dementia Research Institute, Care Research and Technology Centre at Imperial College, London and The University of Surrey, Guildford, UK
| | - Philip A Starr
- Movement Disorders and Neuromodulation Centre, University California San Francisco, San Francisco, CA, USA
| | - Timothy Denison
- MRC Brain Network Dynamics Unit, University of Oxford, Oxford, UK
| | - Simon Little
- Movement Disorders and Neuromodulation Centre, University California San Francisco, San Francisco, CA, USA
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Verma AK, Nandakumar B, Acedillo K, Yu Y, Marshall E, Schneck D, Fiecas M, Wang J, MacKinnon CD, Howell MJ, Vitek JL, Johnson LA. Slow-wave sleep dysfunction in mild parkinsonism is associated with excessive beta and reduced delta oscillations in motor cortex. Front Neurosci 2024; 18:1338624. [PMID: 38449736 PMCID: PMC10915200 DOI: 10.3389/fnins.2024.1338624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Accepted: 01/17/2024] [Indexed: 03/08/2024] Open
Abstract
Increasing evidence suggests slow-wave sleep (SWS) dysfunction in Parkinson's disease (PD) is associated with faster disease progression, cognitive impairment, and excessive daytime sleepiness. Beta oscillations (8-35 Hz) in the basal ganglia thalamocortical (BGTC) network are thought to play a role in the development of cardinal motor signs of PD. The role cortical beta oscillations play in SWS dysfunction in the early stage of parkinsonism is not understood, however. To address this question, we used a within-subject design in a nonhuman primate (NHP) model of PD to record local field potentials from the primary motor cortex (MC) during sleep across normal and mild parkinsonian states. The MC is a critical node in the BGTC network, exhibits pathological oscillations with depletion in dopamine tone, and displays high amplitude slow oscillations during SWS. The MC is therefore an appropriate recording site to understand the neurophysiology of SWS dysfunction in parkinsonism. We observed a reduction in SWS quantity (p = 0.027) in the parkinsonian state compared to normal. The cortical delta (0.5-3 Hz) power was reduced (p = 0.038) whereas beta (8-35 Hz) power was elevated (p = 0.001) during SWS in the parkinsonian state compared to normal. Furthermore, SWS quantity positively correlated with delta power (r = 0.43, p = 0.037) and negatively correlated with beta power (r = -0.65, p < 0.001). Our findings support excessive beta oscillations as a mechanism for SWS dysfunction in mild parkinsonism and could inform the development of neuromodulation therapies for enhancing SWS in people with PD.
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Affiliation(s)
- Ajay K. Verma
- Department of Neurology, University of Minnesota, Minneapolis, MN, United States
| | - Bharadwaj Nandakumar
- Department of Neurology, University of Minnesota, Minneapolis, MN, United States
| | - Kit Acedillo
- Department of Neurology, University of Minnesota, Minneapolis, MN, United States
| | - Ying Yu
- Department of Neurology, University of Minnesota, Minneapolis, MN, United States
| | - Ethan Marshall
- Department of Neurology, University of Minnesota, Minneapolis, MN, United States
| | - David Schneck
- Masonic Institute for the Developing Brain, University of Minnesota, Minneapolis, MN, United States
| | - Mark Fiecas
- Division of Biostatistics, University of Minnesota, Minneapolis, MN, United States
| | - Jing Wang
- Department of Neurology, University of Minnesota, Minneapolis, MN, United States
| | - Colum D. MacKinnon
- Department of Neurology, University of Minnesota, Minneapolis, MN, United States
| | - Michael J. Howell
- Department of Neurology, University of Minnesota, Minneapolis, MN, United States
| | - Jerrold L. Vitek
- Department of Neurology, University of Minnesota, Minneapolis, MN, United States
| | - Luke A. Johnson
- Department of Neurology, University of Minnesota, Minneapolis, MN, United States
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3
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Liang J, Wang Y, Zhu X, Hou X, Luo G, Li W, Liu J, Wang W, Wang J, Sun J, Yu F, Wu W, Pan W, Liu Z, Zhang Y. Short sleep duration is associated with worse quality of life in Parkinson's disease: A multicenter cross-sectional study. Sleep Med 2024; 114:182-188. [PMID: 38215669 DOI: 10.1016/j.sleep.2024.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2023] [Revised: 12/16/2023] [Accepted: 01/02/2024] [Indexed: 01/14/2024]
Abstract
OBJECTIVE To characterize sleep duration and investigate its association with quality of life among Parkinson's Disease (PD) patients. METHODS In this multicenter cross-sectional study, 970 PD patients were divided into five groups based on self-reported sleep duration: <5, ≥5 to <6, ≥6 to <7, ≥7 to ≤8, and >8 h. The quality of life was evaluated using the 39-Item Parkinson's Disease Questionnaire (PDQ-39). Multivariable linear regression analysis, subgroup analysis, and mediation analysis were conducted to examine the association between sleep duration and quality of life. RESULTS In multivariable linear regression model, patients with sleep duration (<5 h) had significantly higher PDQ-39 scores (β = 8.132, 95 % CI: 3.99 to 12.266), especially in mobility, activities of daily living, emotional well-being, stigma, social support, cognition, communication, and bodily discomfort (p < 0.05). The association between sleep duration (<5 h) and worse quality of life was more pronounced in patients with higher HY stage, longer disease duration, and sleep disorders. Moreover, a significant indirect effect of sleep duration (<5 h) on quality of life was observed, with UPDRS I, UPDRS II, and UPDRS IV scores acting as mediators. CONCLUSIONS Short sleep duration (<5 h) is associated with worse quality of life among PD patients. This association was stronger among patients with advanced PD and sleep disorders, while non-motor symptoms and motor complications were identified as significant mediators in this association. These findings highlight the significance of adequate sleep duration and suitable interventions for sleep may help improve quality of life.
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Affiliation(s)
- Jingxue Liang
- Department of Neurology, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200092, China
| | - Yuhui Wang
- Department of Neurology, Shanghai Punan Hospital, Shanghai, 200125, China
| | - Xiaobo Zhu
- Department of Neurology, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200092, China
| | - Xiaojun Hou
- Department of Neurology, The Navy Medical University Affiliated Changhai Hospital, Shanghai, 200433, China
| | - Guojun Luo
- Department of Neurology, Jinshan Branch of Shanghai Sixth People's Hospital, Shanghai, 201599, China
| | - Wen Li
- Department of Neurology, Kong Jiang Hospital of Yangpu District, Shanghai, 200093, China
| | - Jun Liu
- Department of Neurology, Ruijin Hospital, Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, 200025, China
| | - Wenzhao Wang
- Health Management Center, Changzheng Hospital, Naval Medical University, Shanghai, 200003, China
| | - Jianmin Wang
- Department of Neurology, Renhe Hospital, Baoshan District, Shanghai, 200431, China
| | - Jialan Sun
- Department of Neurology, Gongli Hospital, Pu Dong New Area, Shanghai, 200135, China
| | - Feng Yu
- Department of Neurology, Jiangwan Hospital, Hongkou District, Shanghai, 200081, China
| | - Weiwen Wu
- Department of Neurology, Zhongshan Hospital Qingpu Branch, Fudan University, Shanghai, 201799, China
| | - Weidong Pan
- Department of Neurology, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, 201203, China
| | - Zhenguo Liu
- Department of Neurology, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200092, China.
| | - Yu Zhang
- Department of Neurology, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200092, China.
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Verma AK, Nandakumar B, Acedillo K, Yu Y, Marshall E, Schneck D, Fiecas M, Wang J, MacKinnon CD, Howell MJ, Vitek JL, Johnson LA. Excessive cortical beta oscillations are associated with slow-wave sleep dysfunction in mild parkinsonism. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2023:2023.10.28.564524. [PMID: 37961389 PMCID: PMC10634920 DOI: 10.1101/2023.10.28.564524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2023]
Abstract
Increasing evidence associates slow-wave sleep (SWS) dysfunction with neurodegeneration. Using a within-subject design in the nonhuman primate model of Parkinson's disease (PD), we found that reduced SWS quantity in mild parkinsonism was accompanied by elevated beta and reduced delta power during SWS in the motor cortex. Our findings support excessive beta oscillations as a mechanism for SWS dysfunction and will inform development of neuromodulation therapies for enhancing SWS in PD.
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Affiliation(s)
- Ajay K. Verma
- Department of Neurology, University of Minnesota, Minneapolis, MN, USA
| | | | - Kit Acedillo
- Department of Neurology, University of Minnesota, Minneapolis, MN, USA
| | - Ying Yu
- Department of Neurology, University of Minnesota, Minneapolis, MN, USA
| | - Ethan Marshall
- Department of Neurology, University of Minnesota, Minneapolis, MN, USA
| | - David Schneck
- Masonic Institute for the Developing Brain, University of Minnesota, Minneapolis, MN, USA
| | - Mark Fiecas
- Division of Biostatistics, University of Minnesota, Minneapolis, MN, USA
| | - Jing Wang
- Department of Neurology, University of Minnesota, Minneapolis, MN, USA
| | | | - Michael J. Howell
- Department of Neurology, University of Minnesota, Minneapolis, MN, USA
| | - Jerrold L. Vitek
- Department of Neurology, University of Minnesota, Minneapolis, MN, USA
| | - Luke A. Johnson
- Department of Neurology, University of Minnesota, Minneapolis, MN, USA
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5
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Amato N, Caverzasio S, Manconi M, Staedler C, Kaelin-Lang A, Galati S. Slow wave activity across sleep-night could predict levodopa-induced dyskinesia. Sci Rep 2023; 13:15468. [PMID: 37726375 PMCID: PMC10509191 DOI: 10.1038/s41598-023-42604-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Accepted: 09/12/2023] [Indexed: 09/21/2023] Open
Abstract
A disruption in the slow wave activity (SWA) mediated synaptic downscaling process features Parkinson's disease (PD) patients presenting levodopa-induced dyskinesia (LID). To corroborate the role of SWA in LID development, 15 PD patients with LID, who underwent a polysomnography before LID's appearance, were included. Slow wave sleep epochs were extracted, combined and segmented into early and late sleep. SWA power was calculated. A linear regression model established that the SWA overnight decrease could predict the time to the emergence of LID. Our finding supports the link between SWA-mediated synaptic downscaling and the development of LID. If confirmed, it could pave the way to the study of possible sleep targeted therapies able to protect PD patients from LID development.
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Affiliation(s)
- Ninfa Amato
- Parkinson Disease and Movement Disorder Center, Neurocenter of Southern Switzerland, EOC, Via Tesserete 46, 6903, Lugano, Switzerland
| | - Serena Caverzasio
- Parkinson Disease and Movement Disorder Center, Neurocenter of Southern Switzerland, EOC, Via Tesserete 46, 6903, Lugano, Switzerland
- Faculty of Biomedical Sciences, Università Della Svizzera Italiana (USI), Via Giuseppe Buffi 13, Lugano, Switzerland
| | - Mauro Manconi
- Parkinson Disease and Movement Disorder Center, Neurocenter of Southern Switzerland, EOC, Via Tesserete 46, 6903, Lugano, Switzerland
- Faculty of Biomedical Sciences, Università Della Svizzera Italiana (USI), Via Giuseppe Buffi 13, Lugano, Switzerland
- Department of Neurology, Inselspital, Bern University Hospital, Freiburgstrasse 18, Bern, Switzerland
| | - Claudio Staedler
- Parkinson Disease and Movement Disorder Center, Neurocenter of Southern Switzerland, EOC, Via Tesserete 46, 6903, Lugano, Switzerland
| | - Alain Kaelin-Lang
- Parkinson Disease and Movement Disorder Center, Neurocenter of Southern Switzerland, EOC, Via Tesserete 46, 6903, Lugano, Switzerland
- Faculty of Biomedical Sciences, Università Della Svizzera Italiana (USI), Via Giuseppe Buffi 13, Lugano, Switzerland
- Department of Neurology, Inselspital, Bern University Hospital, Freiburgstrasse 18, Bern, Switzerland
| | - Salvatore Galati
- Parkinson Disease and Movement Disorder Center, Neurocenter of Southern Switzerland, EOC, Via Tesserete 46, 6903, Lugano, Switzerland.
- Faculty of Biomedical Sciences, Università Della Svizzera Italiana (USI), Via Giuseppe Buffi 13, Lugano, Switzerland.
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6
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Fifel K, Yanagisawa M, Deboer T. Mechanisms of Sleep/Wake Regulation under Hypodopaminergic State: Insights from MitoPark Mouse Model of Parkinson's Disease. ADVANCED SCIENCE (WEINHEIM, BADEN-WURTTEMBERG, GERMANY) 2023; 10:e2203170. [PMID: 36515271 PMCID: PMC9929135 DOI: 10.1002/advs.202203170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/29/2022] [Revised: 11/16/2022] [Indexed: 06/17/2023]
Abstract
Sleep/wake alterations are predominant in neurological and neuropsychiatric disorders involving dopamine dysfunction. Unfortunately, specific, mechanisms-based therapies for these debilitating sleep problems are currently lacking. The pathophysiological mechanisms of sleep/wake alterations within a hypodopaminergic MitoPark mouse model of Parkinson's disease (PD) are investigated. MitoPark mice replicate most PD-related sleep alterations, including sleep fragmentation, hypersomnia, and daytime sleepiness. Surprisingly, these alterations are not accounted for by a dysfunction in the circadian or homeostatic regulatory processes of sleep, nor by acute masking effects of light or darkness. Rather, the sleep phenotype is linked with the impairment of instrumental arousal and sleep modulation by behavioral valence. These alterations correlate with changes in high-theta (8-11.5 Hz) electroencephalogram power density during motivationally-charged wakefulness. These results demonstrate that sleep/wake alterations induced by dopamine dysfunction are mediated by impaired modulation of sleep by motivational valence and provide translational insights into sleep problems associated with disorders linked to dopamine dysfunction.
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Affiliation(s)
- Karim Fifel
- International Institute for Integrative Sleep Medicine (WPI‐IIIS)University of Tsukuba1‐1‐1 TennodaiTsukubaIbaraki305–8575Japan
- Department of Cell and Chemical BiologyLaboratory of NeurophysiologyLeiden University Medical CenterP.O. Box 9600Leiden2300 RCThe Netherlands
| | - Masashi Yanagisawa
- International Institute for Integrative Sleep Medicine (WPI‐IIIS)University of Tsukuba1‐1‐1 TennodaiTsukubaIbaraki305–8575Japan
| | - Tom Deboer
- Department of Cell and Chemical BiologyLaboratory of NeurophysiologyLeiden University Medical CenterP.O. Box 9600Leiden2300 RCThe Netherlands
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7
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Soares NM, Pereira GM, Dutra ACL, Artigas NR, Krimberg JS, Monticelli BE, Schumacher-Schuh AF, Almeida RMMD, Rieder CRDM. Low serum uric acid levels and levodopa-induced dyskinesia in Parkinson's disease. ARQUIVOS DE NEURO-PSIQUIATRIA 2023; 81:40-46. [PMID: 36918006 PMCID: PMC10014208 DOI: 10.1055/s-0043-1761294] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Accepted: 05/21/2022] [Indexed: 03/16/2023]
Abstract
BACKGROUND Levodopa is the most used and effective medication for motor symptoms of Parkinson disease (PD), its long-term use is associated with the appearance of levodopa-induced dyskinesia (LID). Uric acid (UA) is believed to play an important neuroprotective role in PD. OBJECTIVE To investigate if serum UA levels are related with the presence of LIDs in PD patients. Also, we investigated the associations among UA levels and clinical features of PD. METHODS We enrolled 81 PD patients (dyskinesia = 48; no dyskinesia = 33) in the present study. A blood sample was collected to evaluate serum UA levels, clinical evaluation included the following instruments: Montreal Cognitive Assessment (MoCA), Beck Depression Inventory II (BDI-II), MDS-Unified Parkinson's Disease Rating Scale (MDS-UPDRS), Hoehn and Yahr (HY), and the sub-item 4.1 of MDS-UPDRS IV (score ≥ 1). Additional relevant clinical information was obtained by a clinical questionnaire. RESULTS Serum UA levels were lower in the dyskinesia group when compared with the no dyskinesia group. The same result was found in the UA levels of both men and women. The multivariate analysis showed lower uric acid levels were significantly associated with having dyskinesia (odds ratio [OR] = 0.424; 95% confidence interval [CI]: 0.221-0.746; p = 0.005). Additional analysis verified that serum UA levels are inversely correlated with depressive symptoms, disease duration, MDS-UPDRS IV and time spent with dyskinesia. A positive correlation was found with age at onset of PD symptoms. CONCLUSIONS The present study provides a possible role of serum UA levels in LID present in PD patients.
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Affiliation(s)
- Nayron Medeiros Soares
- Universidade Federal do Rio Grande do Sul, Faculdade de Medicina, Porto Alegre RS, Brazil.
- Hospital de Clínicas de Porto Alegre, Serviço de Neurologia, Porto Alegre RS, Brazil.
- Universidade Federal de Ciências da Saúde de Porto Alegre, Curso de Física Médica, Porto Alegre RS, Brazil.
| | - Gabriela Magalhães Pereira
- Universidade Federal do Rio Grande do Sul, Faculdade de Medicina, Porto Alegre RS, Brazil.
- Hospital de Clínicas de Porto Alegre, Serviço de Neurologia, Porto Alegre RS, Brazil.
- Universidade Federal de Ciências da Saúde de Porto Alegre, Curso de Física Médica, Porto Alegre RS, Brazil.
| | - Ana Carolina Leonardi Dutra
- Universidade Federal do Rio Grande do Sul, Faculdade de Medicina, Porto Alegre RS, Brazil.
- Hospital de Clínicas de Porto Alegre, Serviço de Neurologia, Porto Alegre RS, Brazil.
| | - Nathalie Ribeiro Artigas
- Universidade Federal do Rio Grande do Sul, Faculdade de Medicina, Porto Alegre RS, Brazil.
- Hospital de Clínicas de Porto Alegre, Serviço de Neurologia, Porto Alegre RS, Brazil.
| | - Júlia Schneider Krimberg
- Hospital de Clínicas de Porto Alegre, Serviço de Neurologia, Porto Alegre RS, Brazil.
- Universidade Federal do Rio Grande do Sul, Instituto de Ciências Básicas da Saúde, Porto Alegre RS, Brazil.
| | - Bruno Elkfury Monticelli
- Hospital de Clínicas de Porto Alegre, Serviço de Neurologia, Porto Alegre RS, Brazil.
- Universidade Federal do Rio Grande do Sul, Instituto de Psicologia, Porto Alegre RS, Brazil.
| | - Artur Francisco Schumacher-Schuh
- Universidade Federal do Rio Grande do Sul, Faculdade de Medicina, Porto Alegre RS, Brazil.
- Hospital de Clínicas de Porto Alegre, Serviço de Neurologia, Porto Alegre RS, Brazil.
| | | | - Carlos Roberto de Mello Rieder
- Irmandade Santa Casa de Misericórdia de Porto Alegre, Serviço de Neurologia, Porto Alegre RS, Brazil.
- Universidade Federal de Ciências da Saúde de Porto Alegre, Departamento de Clínica Médica, Porto Alegre RS, Brazil.
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8
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Tang X, Yang J, Zhu Y, Gong H, Sun H, Chen F, Guan Q, Yu L, Wang W, Zhang Z, Li L, Ma G, Wang X. High PSQI score is associated with the development of dyskinesia in Parkinson's disease. NPJ Parkinsons Dis 2022; 8:124. [PMID: 36175559 PMCID: PMC9522669 DOI: 10.1038/s41531-022-00391-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Accepted: 09/06/2022] [Indexed: 11/09/2022] Open
Abstract
Dyskinesia is one of the most disabling motor complications in Parkinson's Disease (PD). Sleep is crucial to keep neural circuit homeostasis, and PD patients often suffer from sleep disturbance. However, few prospective studies have been conducted to investigate the association of sleep quality with dyskinesia in PD. The objective of the current study is to investigate the association between sleep quality and dyskinesia and build a prediction model for dyskinesia in PD. We prospectively followed a group of PD patients without dyskinesia at baseline for a maximum of 36 months. Univariable and multivariable Cox regression with stepwise variable selection was used to investigate risk factors for dyskinesia. The performance of the model was assessed by the time-dependent area under the receiver-operating characteristic curve (AUC). At the end of follow-up, 32.8% of patients developed dyskinesia. Patients with bad sleep quality had a significantly higher proportion of dyskinesia compared with those with good sleep quality (48.1% vs. 20.6%, p = 0.023). Multivariable Cox regression selected duration of PD, sleep quality, cognition, mood, and levodopa dose. Notably, high Pittsburgh sleep quality index (PSQI) score was independently associated with an increased risk of dyskinesia (HR = 2.96, 95% CI 1.05-8.35, p = 0.041). The model achieved a good discriminative ability, with the highest AUC being 0.83 at 35 months. Our results indicated that high PSQI score may increase the risk of developing dyskinesia in PD, implying that therapeutic intervention targeting improving sleep quality may be a promising approach to prevent or delay the development of dyskinesia in PD.
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Affiliation(s)
- Xiaohui Tang
- Department of Neurology, Shanghai Tongji Hospital, School of Medicine, Tongji University, Shanghai, China
- Department of Neurology,, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Department of Neurology, Zhabei Central Hospital, Jing'an District, Shanghai, China
| | - Jingyun Yang
- Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, IL, USA
- Department of Neurological Sciences, Rush University Medical Center, Chicago, IL, USA
| | - Yining Zhu
- School of Mathematical Sciences, Fudan University, Yangpu District, Shanghai, China
| | - Haiyan Gong
- Department of Neurology, Shanghai Tongji Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Hui Sun
- Department of Neurology, Shanghai Tongji Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Fan Chen
- Department of Neurology, Shanghai Tongji Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Qiang Guan
- Department of Neurology, Shanghai Tongji Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Lijia Yu
- Department of Neurology,, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Weijia Wang
- Department of Neurology, Suzhou BenQ Medical Center, The Affiliated BenQ Hospital of Nanjing Medical University, Suzhou, Jiangsu Province, China
| | - Zengping Zhang
- Department of Neurology, Suzhou BenQ Medical Center, The Affiliated BenQ Hospital of Nanjing Medical University, Suzhou, Jiangsu Province, China
| | - Li Li
- Department of Neurology, Suzhou BenQ Medical Center, The Affiliated BenQ Hospital of Nanjing Medical University, Suzhou, Jiangsu Province, China
| | - Guozhao Ma
- Department of Neurology, Shanghai East Hospital, School of Medicine, Tongji University, Shanghai, China.
- Department of Neurology, Shandong Provincial Hospital affiliated to Shandong First Medical University, Jinan, Shandong Province, China.
| | - Xijin Wang
- Department of Neurology, Shanghai Tongji Hospital, School of Medicine, Tongji University, Shanghai, China.
- Department of Neurology,, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China.
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9
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Schreiner SJ, Werth E, Ballmer L, Valko PO, Schubert KM, Imbach LL, Baumann CR, Maric A, Baumann-Vogel H. Sleep spindle and slow wave activity in Parkinson disease with excessive daytime sleepiness. Sleep 2022; 46:6649751. [PMID: 35877159 DOI: 10.1093/sleep/zsac165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Revised: 06/17/2022] [Indexed: 11/13/2022] Open
Abstract
Abstract
Study Objectives
Excessive daytime sleepiness (EDS) is a common and devastating symptom in Parkinson disease (PD), but surprisingly most studies showed that EDS is independent from nocturnal sleep disturbance measured with polysomnography. Quantitative electroencephalography (EEG) may reveal additional insights by measuring the EEG hallmarks of non-rapid eye movement (NREM) sleep, namely slow waves and spindles. Here, we tested the hypothesis that EDS in PD is associated with nocturnal sleep disturbance revealed by quantitative NREM sleep EEG markers.
Methods
Patients with PD (n = 130) underwent polysomnography followed by spectral analysis to calculate spindle frequency activity, slow-wave activity (SWA), and overnight SWA decline, which reflects the dissipation of homeostatic sleep pressure. We used the Epworth Sleepiness Scale (ESS) to assess subjective daytime sleepiness and define EDS (ESS > 10). All examinations were part of an evaluation for deep brain stimulation.
Results
Patients with EDS (n = 46) showed reduced overnight decline of SWA (p = 0.036) and reduced spindle frequency activity (p = 0.032) compared with patients without EDS. Likewise, more severe daytime sleepiness was associated with reduced SWA decline (ß= −0.24 p = 0.008) and reduced spindle frequency activity (ß= −0.42, p < 0.001) across all patients. Reduced SWA decline, but not daytime sleepiness, was associated with poor sleep quality and continuity at polysomnography.
Conclusions
Our data suggest that daytime sleepiness in PD patients is associated with sleep disturbance revealed by quantitative EEG, namely reduced overnight SWA decline and reduced spindle frequency activity. These findings could indicate that poor sleep quality, with incomplete dissipation of homeostatic sleep pressure, may contribute to EDS in PD.
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Affiliation(s)
- Simon J Schreiner
- Department of Neurology, University Hospital Zurich, University of Zurich , Zurich , Switzerland
- Clinical Neuroscience Center, University Hospital Zurich, University of Zurich , Zurich , Switzerland
- Sleep and Health Zurich (SHZ), University of Zurich , Zurich , Switzerland
| | - Esther Werth
- Department of Neurology, University Hospital Zurich, University of Zurich , Zurich , Switzerland
- Clinical Neuroscience Center, University Hospital Zurich, University of Zurich , Zurich , Switzerland
- Sleep and Health Zurich (SHZ), University of Zurich , Zurich , Switzerland
| | - Leonie Ballmer
- Department of Neurology, University Hospital Zurich, University of Zurich , Zurich , Switzerland
- Clinical Neuroscience Center, University Hospital Zurich, University of Zurich , Zurich , Switzerland
| | - Philipp O Valko
- Department of Neurology, University Hospital Zurich, University of Zurich , Zurich , Switzerland
- Clinical Neuroscience Center, University Hospital Zurich, University of Zurich , Zurich , Switzerland
- Sleep and Health Zurich (SHZ), University of Zurich , Zurich , Switzerland
| | - Kai M Schubert
- Department of Neurology, University Hospital Zurich, University of Zurich , Zurich , Switzerland
- Clinical Neuroscience Center, University Hospital Zurich, University of Zurich , Zurich , Switzerland
| | - Lukas L Imbach
- Department of Neurology, University Hospital Zurich, University of Zurich , Zurich , Switzerland
- Clinical Neuroscience Center, University Hospital Zurich, University of Zurich , Zurich , Switzerland
- Swiss Epilepsy Center, Klinik Lengg , Zurich , Switzerland
| | - Christian R Baumann
- Department of Neurology, University Hospital Zurich, University of Zurich , Zurich , Switzerland
- Clinical Neuroscience Center, University Hospital Zurich, University of Zurich , Zurich , Switzerland
- Sleep and Health Zurich (SHZ), University of Zurich , Zurich , Switzerland
| | - Angelina Maric
- Department of Neurology, University Hospital Zurich, University of Zurich , Zurich , Switzerland
- Clinical Neuroscience Center, University Hospital Zurich, University of Zurich , Zurich , Switzerland
- Sleep and Health Zurich (SHZ), University of Zurich , Zurich , Switzerland
| | - Heide Baumann-Vogel
- Department of Neurology, University Hospital Zurich, University of Zurich , Zurich , Switzerland
- Clinical Neuroscience Center, University Hospital Zurich, University of Zurich , Zurich , Switzerland
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10
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Impairment of sleep homeostasis in cervical dystonia patients. Sci Rep 2022; 12:6866. [PMID: 35477733 PMCID: PMC9046419 DOI: 10.1038/s41598-022-10802-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 04/06/2022] [Indexed: 12/03/2022] Open
Abstract
Alterations in brain plasticity seem to play a role in the pathophysiology of cervical dystonia (CD). Since evidences indicate that sleep regulates brain plasticity, we hypothesized that an alteration in sleep homeostatic mechanisms may be involved in the pathogenesis of CD. We explored sleep in control subjects (CTL) and CD patients before (Tpre-BoNT) and after (Tpost-BoNT) botulinum toxin (BoNT) treatment. A physiological slow wave activity (SWA) power decrease throughout the night was observed in CTL but not in CD at Tpre-BoNT. BoNT restored the physiological SWA decrease in CD at Tpost-BoNT. Furthermore, in the first part of the night, CD at Tpost-BNT showed a frontal increase and parietal decrease in SWA power compared to CD at Tpre-BoNT, with a SWA distribution comparable to that observed in CTL. Our data highlighted a pathophysiological relationship between SWA during sleep and CD and provided novel insight into the transient central plastic effect of BoNT.
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11
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Schütz L, Sixel-Döring F, Hermann W. Management of Sleep Disturbances in Parkinson's Disease. JOURNAL OF PARKINSON'S DISEASE 2022; 12:2029-2058. [PMID: 35938257 PMCID: PMC9661340 DOI: 10.3233/jpd-212749] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/23/2022] [Indexed: 06/07/2023]
Abstract
Parkinson's disease (PD) is defined by its motor symptoms rigidity, tremor, and akinesia. However, non-motor symptoms, particularly autonomic disorders and sleep disturbances, occur frequently in PD causing equivalent or even greater discomfort than motor symptoms effectively decreasing quality of life in patients and caregivers. Most common sleep disturbances in PD are insomnia, sleep disordered breathing, excessive daytime sleepiness, REM sleep behavior disorder, and sleep-related movement disorders such as restless legs syndrome. Despite their high prevalence, therapeutic options in the in- and outpatient setting are limited, partly due to lack of scientific evidence. The importance of sleep disturbances in neurodegenerative diseases has been further emphasized by recent evidence indicating a bidirectional relationship between neurodegeneration and sleep. A more profound insight into the underlying pathophysiological mechanisms intertwining sleep and neurodegeneration might lead to unique and individually tailored disease modifying or even neuroprotective therapeutic options in the long run. Therefore, current evidence concerning the management of sleep disturbances in PD will be discussed with the aim of providing a substantiated scaffolding for clinical decisions in long-term PD therapy.
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Affiliation(s)
- Lukas Schütz
- Department of Neurology, University of Rostock, Rostock, Germany
| | | | - Wiebke Hermann
- Department of Neurology, University of Rostock, Rostock, Germany
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12
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Baumgartner AJ, Kushida CA, Summers MO, Kern DS, Abosch A, Thompson JA. Basal Ganglia Local Field Potentials as a Potential Biomarker for Sleep Disturbance in Parkinson's Disease. Front Neurol 2021; 12:765203. [PMID: 34777232 PMCID: PMC8581299 DOI: 10.3389/fneur.2021.765203] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Accepted: 10/04/2021] [Indexed: 11/18/2022] Open
Abstract
Sleep disturbances, specifically decreases in total sleep time and sleep efficiency as well as increased sleep onset latency and wakefulness after sleep onset, are highly prevalent in patients with Parkinson's disease (PD). Impairment of sleep significantly and adversely impacts several comorbidities in this patient population, including cognition, mood, and quality of life. Sleep disturbances and other non-motor symptoms of PD have come to the fore as the effectiveness of advanced therapies such as deep brain stimulation (DBS) optimally manage the motor symptoms. Although some studies have suggested that DBS provides benefit for sleep disturbances in PD, the mechanisms by which this might occur, as well as the optimal stimulation parameters for treating sleep dysfunction, remain unknown. In patients treated with DBS, electrophysiologic recording from the stimulating electrode, in the form of local field potentials (LFPs), has led to the identification of several findings associated with both motor and non-motor symptoms including sleep. For example, beta frequency (13–30 Hz) oscillations are associated with worsened bradykinesia while awake and decrease during non-rapid eye movement sleep. LFP investigation of sleep has largely focused on the subthalamic nucleus (STN), though corresponding oscillatory activity has been found in the globus pallidus internus (GPi) and thalamus as well. LFPs are increasingly being recognized as a potential biomarker for sleep states in PD, which may allow for closed-loop optimization of DBS parameters to treat sleep disturbances in this population. In this review, we discuss the relationship between LFP oscillations in STN and the sleep architecture of PD patients, current trends in utilizing DBS to treat sleep disturbance, and future directions for research. In particular, we highlight the capability of novel technologies to capture and record LFP data in vivo, while patients continue therapeutic stimulation for motor symptoms. These technological advances may soon allow for real-time adaptive stimulation to treat sleep disturbances.
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Affiliation(s)
- Alexander J Baumgartner
- Department of Neurology, University of Colorado School of Medicine, Aurora, CO, United States
| | - Clete A Kushida
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, United States
| | - Michael O Summers
- Department of Medicine, Division of Pulmonary, Critical Care, Sleep, and Allergy, University of Nebraska Medical Center, Omaha, NE, United States
| | - Drew S Kern
- Department of Neurology, University of Colorado School of Medicine, Aurora, CO, United States.,Department of Neurosurgery, University of Colorado School of Medicine, Aurora, CO, United States
| | - Aviva Abosch
- Department of Neurosurgery, University of Nebraska Medical Center, Omaha, NE, United States
| | - John A Thompson
- Department of Neurology, University of Colorado School of Medicine, Aurora, CO, United States.,Department of Neurosurgery, University of Colorado School of Medicine, Aurora, CO, United States
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13
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Zahed H, Zuzuarregui JRP, Gilron R, Denison T, Starr PA, Little S. The Neurophysiology of Sleep in Parkinson's Disease. Mov Disord 2021; 36:1526-1542. [PMID: 33826171 DOI: 10.1002/mds.28562] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Revised: 02/02/2021] [Accepted: 02/16/2021] [Indexed: 12/14/2022] Open
Abstract
Sleep disturbances are among the most common nonmotor complications of Parkinson's disease (PD), can present in prodromal stages, and progress with advancing disease. In addition to being a symptom of neurodegeneration, sleep disturbances may also contribute to disease progression. Currently, limited options exist to modulate sleep disturbances in PD. Studying the neurophysiological changes that affect sleep in PD at the cortical and subcortical level may yield new insights into mechanisms for reversal of sleep disruption. In this article, we review cortical and subcortical recording studies of sleep in PD with a particular focus on dissecting reported electrophysiological changes. These studies show that slow-wave sleep and rapid eye movement sleep are both notably disrupted in PD. We further explore the impact of these electrophysiological changes and discuss the potential for targeting sleep via stimulation therapy to modify PD-related motor and nonmotor symptoms. © 2021 International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Hengameh Zahed
- Department of Neurology, University of California, San Francisco, San Francisco, California, USA
| | | | - Ro'ee Gilron
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, California, USA
| | - Timothy Denison
- Institute of Biomedical Engineering and MRC Brain Network Dynamics Unit, University of Oxford, Oxford, UK
| | - Philip A Starr
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, California, USA
| | - Simon Little
- Department of Neurology, University of California, San Francisco, San Francisco, California, USA
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14
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Ye S, Zhong J, Huang J, Chen L, Yi L, Li X, Lv J, Miao J, Li H, Chen D, Li C. Protective effect of plastrum testudinis extract on dopaminergic neurons in a Parkinson's disease model through DNMT1 nuclear translocation and SNCA's methylation. Biomed Pharmacother 2021; 141:111832. [PMID: 34153844 DOI: 10.1016/j.biopha.2021.111832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 06/08/2021] [Accepted: 06/11/2021] [Indexed: 10/21/2022] Open
Abstract
The pathological characteristics of Parkinson's disease (PD) include dopaminergic neuron damage, specifically disorders caused by dopamine synthesis, in vivo. Plastrum testudinis extract (PTE) and its bioactive ingredient ethyl stearate (PubChem CID: 8122) were reported to be correlated with tyrosine hydroxylase (TH), which is a biomarker of dopaminergic neurons. This suggests that PTE and its small-molecule active ingredient ethyl stearate have potential for development as a therapeutic drug for PD. In this study, we treated 6-hydroxydopamine (6-OHDA)-induced model rats and PC12 cells with PTE. The mechanism of action of PTE and ethyl stearate was investigated by western blotting, bisulfite sequencing PCR (BSP), real-time PCR, immunofluorescence and siRNA transfection. PTE effectively upregulated the TH expression and downregulated the alpha-synuclein expression in both the substantia nigra and the striatum of the midbrain in a PD model rat. The PC12 cell model showed that both PTE and its active monomer ethyl stearate significantly promoted TH expression and blocked alpha-synuclein, agreeing with the in vivo results. BSP showed that PTE and ethyl stearate increased the methylation level of the Snca intron 1 region. These findings suggest that some of the protective effects of PTE on dopaminergic neurons are mediated by ethyl stearate. The mechanism of ethyl stearate may involve disrupting the abnormal aggregation of DNA (cytosine-5)-methyltransferase 1 (DNMT1) with alpha-synuclein by releasing DNMT1, upregulating Snca intron 1 CpG island methylation, and ultimately, reducing the expression of alpha-synuclein.
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Affiliation(s)
- Sen Ye
- School of Basic Medical Sciences, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong 510006, PR China; Department of Human Anatomy, School of Basic Medical Sciences, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong 510006, PR China; Research Center of Integrative Medicine (Key Laboratory of Chinese Medicine Pathogenesis and Therapy Research), School of Basic Medical Sciences, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong Province, 510006, PR China
| | - Jun Zhong
- School of Basic Medical Sciences, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong 510006, PR China; Department of Human Anatomy, School of Basic Medical Sciences, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong 510006, PR China; Research Center of Integrative Medicine (Key Laboratory of Chinese Medicine Pathogenesis and Therapy Research), School of Basic Medical Sciences, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong Province, 510006, PR China
| | - Jiapei Huang
- School of Basic Medical Sciences, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong 510006, PR China; Department of Human Anatomy, School of Basic Medical Sciences, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong 510006, PR China; Research Center of Integrative Medicine (Key Laboratory of Chinese Medicine Pathogenesis and Therapy Research), School of Basic Medical Sciences, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong Province, 510006, PR China
| | - Lichun Chen
- The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong Province, 510006, PR China
| | - Lan Yi
- School of Basic Medical Sciences, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong 510006, PR China; Department of Human Anatomy, School of Basic Medical Sciences, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong 510006, PR China; Research Center of Integrative Medicine (Key Laboratory of Chinese Medicine Pathogenesis and Therapy Research), School of Basic Medical Sciences, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong Province, 510006, PR China
| | - Xican Li
- School of Pharmaceutical Sciences, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong Province 510006, PR China
| | - Jianping Lv
- Department of Neurosurgery, Guangzhou First People's Hospital, School of Medicine, South China University of Technology, Guangzhou, Guangdong Province 510006, PR China
| | - Jifei Miao
- School of Chemical Biology and Biotechnology, Peking University Shenzhen Graduate School, Shenzhen, PR China
| | - Hui Li
- School of Basic Medical Sciences, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong 510006, PR China; Department of Human Anatomy, School of Basic Medical Sciences, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong 510006, PR China
| | - Dongfeng Chen
- School of Basic Medical Sciences, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong 510006, PR China; Department of Human Anatomy, School of Basic Medical Sciences, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong 510006, PR China
| | - Caixia Li
- School of Basic Medical Sciences, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong 510006, PR China; Department of Human Anatomy, School of Basic Medical Sciences, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong 510006, PR China; Research Center of Integrative Medicine (Key Laboratory of Chinese Medicine Pathogenesis and Therapy Research), School of Basic Medical Sciences, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong Province, 510006, PR China.
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15
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Abstract
Sleep disorders in Parkinson disease have attracted the attention of clinicians and researchers for decades. Recently, major advances in their clinical characterization, polysomnographic description, pathophysiologic understanding, and treatment took place. Parkinson disease encompasses the whole spectrum of sleep medicine: every category of sleep disorder can be observed in these patients. Video polysomnography frequently is indicated, sometimes followed by multiple sleep latency/maintenance of wakefulness tests. Additional studies may include actigraphy, cardiorespiratory polygraphy, and dim light melatonin assessment. Treatment needs to be specific to the underlying sleep disorder and can include medications and nondrug treatments, for example, behavioral therapy and light therapy.
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Affiliation(s)
- Ambra Stefani
- Department of Neurology, Medical University of Innsbruck, Anichstr. 35, Innsbruck 6020, Austria
| | - Birgit Högl
- Department of Neurology, Medical University of Innsbruck, Anichstr. 35, Innsbruck 6020, Austria.
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16
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Sousouri G, Baumann CR, Imbach LL, Huber R, Werth E. Sleep electroencephalographic asymmetry in Parkinson's disease patients before and after deep brain stimulation. Clin Neurophysiol 2021; 132:857-863. [PMID: 33636602 DOI: 10.1016/j.clinph.2020.12.027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Revised: 12/04/2020] [Accepted: 12/17/2020] [Indexed: 11/18/2022]
Abstract
OBJECTIVE Unilateral manifestation of motor dysfunction is a prominent hallmark of Parkinson's disease (PD). We investigated how the motor laterality of the disorder affects sleep neural asymmetry before and after Deep Brain Stimulation (DBS). METHODS Twenty-seven PD patients of the akinetic-rigid subtype were studied; 11 with right dominant (RD) and 16 with left dominant (LD) motor symptoms. Neuronal sleep asymmetry was computed as the difference of sleep slow-wave energy (SWE) between left and right hemispheres. We used linear mixed models to assess the relationship between symptomatic profile and SWE asymmetry. RESULTS LD PD patients exhibited frontal electroencephalographic (EEG) asymmetry and motor laterality pre-DBS with increased SWE contralateral to their affected body side, which diminished post-DBS. The RD group did not exhibit neither neural asymmetry nor motor laterality pre- and post-DBS. There was a significant negative correlation between the motor laterality and sleep EEG asymmetry. CONCLUSIONS Our results suggest evidence for a local use-dependent modulation of SWE as a result of the lateralized pathological motor profile. More bilateral motor symptoms and optimized treatment contribute to diminished sleep EEG asymmetry. SIGNIFICANCE These novel findings about the association between symptomatic motor laterality and sleep neural asymmetry may provide targeted therapeutic insights.
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Affiliation(s)
- Georgia Sousouri
- Child Development Centre, University Children's Hospital, Zürich, Switzerland; Department of Health Sciences and Technology, ETH Zürich, Switzerland; Center of Competence Sleep & Health Zurich, University of Zürich, Zürich, Switzerland
| | - Christian R Baumann
- Department of Neurology, University Hospital Zürich, University of Zürich, Zürich, Switzerland; Center of Competence Sleep & Health Zurich, University of Zürich, Zürich, Switzerland
| | - Lukas L Imbach
- Department of Neurology, University Hospital Zürich, University of Zürich, Zürich, Switzerland
| | - Reto Huber
- Child Development Centre, University Children's Hospital, Zürich, Switzerland; Department of Child and Adolescent Psychiatry and Psychotherapy, Psychiatric Hospital Zürich, Zürich, Switzerland; Center of Competence Sleep & Health Zurich, University of Zürich, Zürich, Switzerland
| | - Esther Werth
- Department of Neurology, University Hospital Zürich, University of Zürich, Zürich, Switzerland; Center of Competence Sleep & Health Zurich, University of Zürich, Zürich, Switzerland.
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17
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Schreiner SJ, Imbach LL, Valko PO, Maric A, Maqkaj R, Werth E, Baumann CR, Baumann-Vogel H. Reduced Regional NREM Sleep Slow-Wave Activity Is Associated With Cognitive Impairment in Parkinson Disease. Front Neurol 2021; 12:618101. [PMID: 33679584 PMCID: PMC7933203 DOI: 10.3389/fneur.2021.618101] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Accepted: 01/25/2021] [Indexed: 12/20/2022] Open
Abstract
Growing evidence implicates a distinct role of disturbed slow-wave sleep in neurodegenerative diseases. Reduced non-rapid eye movement (NREM) sleep slow-wave activity (SWA), a marker of slow-wave sleep intensity, has been linked with age-related cognitive impairment and Alzheimer disease pathology. However, it remains debated if SWA is associated with cognition in Parkinson disease (PD). Here, we investigated the relationship of regional SWA with cognitive performance in PD. In the present study, 140 non-demented PD patients underwent polysomnography and were administered the Montréal Cognitive Assessment (MoCA) to screen for cognitive impairment. We performed spectral analysis of frontal, central, and occipital sleep electroencephalography (EEG) derivations to measure SWA, and spectral power in other frequency bands, which we compared to cognition using linear mixed models. We found that worse MoCA performance was associated with reduced 1–4 Hz SWA in a region-dependent manner (F2, 687 =11.67, p < 0.001). This effect was driven by reduced regional SWA in the lower delta frequencies, with a strong association of worse MoCA performance with reduced 1–2 Hz SWA (F2, 687 =18.0, p < 0.001). The association of MoCA with 1–2 Hz SWA (and 1–4 Hz SWA) followed an antero-posterior gradient, with strongest, weaker, and absent associations over frontal (rho = 0.33, p < 0.001), central (rho = 0.28, p < 0.001), and occipital derivations, respectively. Our study shows that cognitive impairment in PD is associated with reduced NREM sleep SWA, predominantly in lower delta frequencies (1–2 Hz) and over frontal regions. This finding suggests a potential role of reduced frontal slow-wave sleep intensity in cognitive impairment in PD.
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Affiliation(s)
- Simon J Schreiner
- Department of Neurology, University Hospital Zurich, University of Zurich, Zurich, Switzerland.,Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland.,Sleep & Health Zurich, University of Zurich, Zurich, Switzerland
| | - Lukas L Imbach
- Department of Neurology, University Hospital Zurich, University of Zurich, Zurich, Switzerland.,Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Philipp O Valko
- Department of Neurology, University Hospital Zurich, University of Zurich, Zurich, Switzerland.,Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland.,Sleep & Health Zurich, University of Zurich, Zurich, Switzerland
| | - Angelina Maric
- Department of Neurology, University Hospital Zurich, University of Zurich, Zurich, Switzerland.,Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland.,Sleep & Health Zurich, University of Zurich, Zurich, Switzerland
| | - Rina Maqkaj
- Department of Neurology, University Hospital Zurich, University of Zurich, Zurich, Switzerland.,Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Esther Werth
- Department of Neurology, University Hospital Zurich, University of Zurich, Zurich, Switzerland.,Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland.,Sleep & Health Zurich, University of Zurich, Zurich, Switzerland
| | - Christian R Baumann
- Department of Neurology, University Hospital Zurich, University of Zurich, Zurich, Switzerland.,Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland.,Sleep & Health Zurich, University of Zurich, Zurich, Switzerland
| | - Heide Baumann-Vogel
- Department of Neurology, University Hospital Zurich, University of Zurich, Zurich, Switzerland.,Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland
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18
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Lajoie AC, Lafontaine AL, Kaminska M. The Spectrum of Sleep Disorders in Parkinson Disease: A Review. Chest 2020; 159:818-827. [PMID: 32956712 DOI: 10.1016/j.chest.2020.09.099] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Revised: 09/02/2020] [Accepted: 09/11/2020] [Indexed: 12/23/2022] Open
Abstract
There is increasing interest in the effects of sleep and sleep disturbances on the brain, particularly in relation to aging and neurodegenerative processes. Parkinson disease (PD) is the second most common neurodegenerative disorder, with growing prevalence worldwide. Sleep disorders, including sleep-disordered breathing (SDB), are among the most frequent non-motor manifestations of PD. They can substantially impair quality of life and possibly affect the course of the disease. This article reviews the etiology, implications, and management of sleep disturbances in PD, such as excessive daytime sleepiness, insomnia, restless legs syndrome, rapid eye movement sleep behavior disorder, and SDB. Also briefly explored is the potential role of sleep disorders, including SDB, in the progression of neurodegeneration.
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Affiliation(s)
- Annie C Lajoie
- Respiratory Epidemiology and Clinical Research Unit, McGill University Health Centre, Montreal, Canada
| | | | - Marta Kaminska
- Respiratory Epidemiology and Clinical Research Unit, McGill University Health Centre, Montreal, Canada; Respiratory Division & Sleep Laboratory, McGill University Health Centre, Montreal, Canada.
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19
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Zhang Y, Ren R, Sanford LD, Yang L, Zhou J, Tan L, Li T, Zhang J, Wing YK, Shi J, Lu L, Tang X. Sleep in Parkinson's disease: A systematic review and meta-analysis of polysomnographic findings. Sleep Med Rev 2020; 51:101281. [PMID: 32135452 DOI: 10.1016/j.smrv.2020.101281] [Citation(s) in RCA: 71] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2019] [Revised: 01/21/2020] [Accepted: 01/23/2020] [Indexed: 02/08/2023]
Abstract
Polysomnographic studies have been conducted to explore sleep changes in Parkinson's disease (PD), but the relationships between sleep disturbances and PD are imperfectly understood. We conducted a systematic review of the literature exploring polysomnographic differences between PD patients and controls in EMBASE, MEDLINE, All EBM databases, CINAHL, and PsycIFNO. 67 studies were identified for systematic review, 63 of which were used for meta-analysis. Meta-analyses revealed significant reductions in total sleep time, sleep efficiency, N2 percentage, slow wave sleep, rapid eye movement sleep (REM) percentage, and increases in wake time after sleep onset, N1 percentage, REM latency, apnea hypopnea index, and periodic limb movement index in PD patients compared with controls. There were no remarkable differences in sleep continuity or sleep architecture between PD patients with and without REM sleep behavior disorder (RBD). Our study suggests that PD patients have poor sleep quality and quantity. Sex, age, disease duration, presence of RBD, medication status, cognitive impairment, and adaptation night are factors that contributed to heterogeneity between studies.
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Affiliation(s)
- Ye Zhang
- Sleep Medicine Center, Department of Respiratory and Critical Care Medicine, Mental Health Center, Translational Neuroscience Center, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, China
| | - Rong Ren
- Sleep Medicine Center, Department of Respiratory and Critical Care Medicine, Mental Health Center, Translational Neuroscience Center, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, China
| | - Larry D Sanford
- Sleep Research Laboratory, Center for Integrative Neuroscience and Inflammatory Diseases, Department of Pathology and Anatomy, Eastern Virginia Medical School, Norfolk, VA, USA.
| | - Linghui Yang
- Sleep Medicine Center, Department of Respiratory and Critical Care Medicine, Mental Health Center, Translational Neuroscience Center, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, China
| | - Junying Zhou
- Sleep Medicine Center, Department of Respiratory and Critical Care Medicine, Mental Health Center, Translational Neuroscience Center, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, China
| | - Lu Tan
- Sleep Medicine Center, Department of Respiratory and Critical Care Medicine, Mental Health Center, Translational Neuroscience Center, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, China
| | - Taomei Li
- Sleep Medicine Center, Department of Respiratory and Critical Care Medicine, Mental Health Center, Translational Neuroscience Center, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, China
| | - Jihui Zhang
- Department of Psychiatry, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong Special Administrative Region of China
| | - Yun-Kwok Wing
- Department of Psychiatry, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong Special Administrative Region of China
| | - Jie Shi
- National Institute on Drug Dependence, Peking University Sixth Hospital, Peking University, Beijing 100191, China
| | - Lin Lu
- National Institute on Drug Dependence, Peking University Sixth Hospital, Peking University, Beijing 100191, China
| | - Xiangdong Tang
- Sleep Medicine Center, Department of Respiratory and Critical Care Medicine, Mental Health Center, Translational Neuroscience Center, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, China.
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