Non-pharmacological therapies for sleep disturbances in people with Parkinson's disease: A systematic review

Acute and cumulative effects of hypoxia exposure in people with Parkinson's disease: A scoping review and evidence map

Hypoxia exposure may promote neuroprotection for people with Parkinson's disease (PwPD). However, to implement hypoxia in practical settings and direct future research, it is necessary to organize the current knowledge about hypoxia responses/effects in PwPD. Thus, the present scoping review elucidates the evidence about hypoxia exposure applied to PwPD. Following the PRISMA Extension for Scoping Reviews, papers were searched in PubMed/NCBI, Web of Science, and Scopus (descriptors: Parkinson and hypoxia, mountain, or altitude). We included original articles published in English until August 12, 2023. Eight studies enrolled participants with early to moderate stages of disease. Acute responses demonstrated that PwPD exposed to normobaric hypoxia presented lower hypoxia ventilatory responses (HVR), perceptions of dyspnea, and sympathetic activations. Cumulative exposure to hypobaric hypoxia (living high; 7 days; altitude not reported) induced positive effects on motor symptoms (hypokinesia) and perceptions of PwPD (quality of life and living with illness). Normobaric hypoxia (isocapnic rebreathe, 14 days, three times/day of 5-7 min at 8-10 % of O2) improved HVR. The included studies reported no harmful effects. Although these results demonstrate the effectiveness and safety of hypoxia exposure applied to PwPD, we also discuss the methodological limitations of the selected experimental design (no randomized controlled trials), the characterization of the hypoxia doses, and the range of symptoms investigated. Thus, despite the safety of both normobaric hypoxia and hypobaric hypoxia for early to moderate levels of disease, the current literature is still incipient, limiting the use of hypoxia exposure in practical settings.

The Park Sleep subtype in Parkinson's disease: from concept to clinic

INTRODUCTION

The heterogeneity of Parkinson's disease (PD) is evident from descriptions of non-motor (NMS) subtypes and Park Sleep, originally identified by Sauerbier et al. 2016, is one such clinical subtype associated with the predominant clinical presentation of sleep dysfunctions including excessive daytime sleepiness (EDS), along with insomnia.

AREAS COVERED

A literature search was conducted using the PubMed, Medline, Embase, and Web of Science databases, accessed between 1 February 2023 and 28 March 2023. In this review, we describe the clinical subtype of Park Sleep and related 'tests' ranging from polysomnography to investigational neuromelanin MRI brain scans and some tissue-based biological markers.

EXPERT OPINION

Cholinergic, noradrenergic, and serotonergic systems are dominantly affected in PD. Park Sleep subtype is hypothesized to be associated primarily with serotonergic deficit, clinically manifesting as somnolence and narcoleptic events (sleep attacks), with or without rapid eye movement behavior disorder (RBD). In clinic, Park Sleep recognition may drive lifestyle changes (e.g. driving) along with therapy adjustments as Park Sleep patients may be sensitive to dopamine D3 active agonists, such as ropinirole and pramipexole. Specific dashboard scores based personalized management options need to be implemented and include pharmacological, non-pharmacological, and lifestyle linked advice.

The association between sleep deficits and sedentary behavior in people with mild Parkinson disease

Purpose: Sleep deficits are a common nonmotor symptom of Parkinson disease (PD). People with mild PD also achieve less physical activity (PA) than healthy older adults (HOA), but the relationship between sleep and PA in PD is unclear. This study examined associations between sleep and PA in participants with PD and HOA.Materials and Methods: Secondary analysis of a prospective observational study. Participants wore a commercially available activity monitor for two weeks. Wilcoxon Rank-Sum tests compared nighttime sleep, wakenings after sleep onset, number of wakenings, naps, step count, and PA intensity between PD and HOA groups. Age-adjusted regression models calculated associations between nighttime sleep and PA.Results: Per day, participants with PD slept 75 fewer minutes (p < 0.01), took 5,792 fewer steps (p < 0.001), achieved less PA at all intensities, and had 32% more sedentary time (p < 0.001) compared to HOA. Thirty minutes more sleep was associated with 26 fewer sedentary minutes for HOA (p = 0.01) and 25 fewer sedentary minutes for the PD group (p < 0.001).Conclusions: Sleep and PA are reduced in mild PD compared to HOA. Both groups demonstrated similar associations between reduced sleep and increased sedentary behavior. Results may encourage providers to screen for sleep deficits when promoting PA.IMPLICATIONS FOR REHABILITATIONThe use of a wrist-worn commercial activity and sleep monitor was well tolerated by both healthy older adults and people with mild Parkinson Disease in this study.People with mild Parkinson Disease slept less and were less active than a group of healthy older adults.Less sleep was associated with more sedentary behavior in both groups.The relationship between poor sleep and sedentary behavior in mild Parkinson Disease suggests that rehabilitation interventions may be optimized by targeting both physical activity and sleep deficits.

The impact of exercise on sleep in people with Parkinson's disease a scoping review

While high intensity exercise is associated with improvement of both motor and non-motor symptoms in Parkinson's disease (PD), there is limited evidence on its impact on sleep disturbances in PD. This scoping review aims to provide a preliminary statement of the potential size and scope of available evidence for the interaction between exercise and sleep in people with PD. Research to date on non-motor symptoms of PD is broad, with scarce information regarding specific effects of exercise on sleep. A systematic literature search was conducted through three phases. Fifteen articles met the inclusion criteria for this study. Resistive exercise and multimodal exercise programs were frequently studied and found to improve sleep and decrease sleep-related disorders. These findings suggest that exercise programs may improve sleep and other non-motor symptoms of PD. The research was inconclusive when comparing the effects of high and low intensity exercises. Further research on the interaction between exercise and sleep in PD may have implications for rehabilitative therapy interventions.

Pharmacological and Non-pharmacological Treatments of Sleep Disorders in Parkinson's Disease

Sleep disorders are one of the most common non-motor symptoms in Parkinson's disease (PD). It can cause a notable decrease in quality of life and functioning in PD patients, as well as place a huge burden on both patients and caregivers. The most cited sleep disorders in PD included insomnia, restless legs syndrome (RLS), rapid eye movement (REM), sleep behavior disorders (RBD), excessive daytime sleepiness (EDS) and sleep disordered breathing (SDB), which can appear alone or several at the same time. In this review, we listed the recommended pharmacological treatments for common sleep disorders in PD, and discussed the recommended dosages, benefits and side effects of relative drugs. We also discussed non-pharmacological treatments to improve sleep quality, including sleep hygiene education, exercise, deep brain stimulation, cognitive behavior therapy and complementary therapies. We tried to find proper interventions for different types of sleep disorders in PD, while minimizing relative side effects.