1
|
Wang RF, Li YP, Zhang HY, Xu SS, Wang Z, Han XM, Liu BP. Sleep benefit in patients with Parkinson's disease is associated with the dopamine transporter expression in putamen. Brain Res 2023; 1802:148173. [PMID: 36460060 DOI: 10.1016/j.brainres.2022.148173] [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: 06/07/2022] [Revised: 11/07/2022] [Accepted: 11/20/2022] [Indexed: 11/30/2022]
Abstract
PURPOSE Sleep benefit (SB) is a well-known phenomenon in patients with Parkinson's disease (PD); however, the mechanisms underlying this phenomenon remain unclear. This study aimed to evaluate whether the SB phenomenon in PD patients is associated with dopamine transporter (DAT) expression levels in the striatum. METHODS The data of 125 PD patients were collected and divided into SB (n = 61) and non-SB (nSB) groups (n = 54) depending on whether they had SB or not. DAT expression on both sides of the striatum in PD patients was measured using 2b-carbomethoxy-3b-(4-trimethylstannylphenyl) tropane (11C-CFT) positron emission tomography imaging. The clinical variables, sleep scores, and striatum 11C-CFT uptake index of PD patients between the SB and nSB groups were compared. The associations of clinical variables, sleep scores, and striatum 11C-CFT uptake index with the SB variable were analyzed using logistic regression analysis. A receiver operating characteristic (ROC) curve was used to evaluate the diagnostic value of the striatum 11C-CFT uptake index in distinguishing SB patients from nSB patients. RESULTS The tremor subtype ratio (P = 0.011), levodopa equivalent daily dose (LEDD) (P < 0.001), sleep efficiency score (P = 0.025), habitual sleep efficiency (P = 0.012), and night sleep duration (P = 0.005) in the SB group were significantly different from those in the nSB group. The 11C-CFT uptake index in both the contralateral and ipsilateral striata in the SB group was significantly higher than that in the nSB group (P < 0.05). The binary logistic regression showed that SB variables were significantly and independently associated with tremor subtype (P = 0.048), LEDD (P = 0.021), sleep duration at night (P = 0.035), 11C-CFT uptake index in the contralateral (P = 0.013) and ipsilateral (P = 0.019) putamen in PD patients after correction for important clinical confounders. ROC analysis showed that the 11C-CFT uptake index on the onset side of the putamen had a high capacity (AUC: 0.916) to distinguish SB patients from nSB patients with high sensitivity (83.33 %) and specificity (88.89 %). CONCLUSION DAT expression in the putamen was associated with the SB phenomenon in PD patients, and the putamen DAT expression level could predict the SB phenomenon in PD patients.
Collapse
Affiliation(s)
- Rui-Fang Wang
- Department of Nuclear Medicine, The First Affiliated Hospital of Zhengzhou University, Henan Medical Key Laboratory of Molecular Imaging, Zhengzhou, Henan 450052, China
| | - Yan-Peng Li
- Department of Nuclear Medicine, The First Affiliated Hospital of Zhengzhou University, Henan Medical Key Laboratory of Molecular Imaging, Zhengzhou, Henan 450052, China
| | - Han-Yue Zhang
- Department of Nuclear Medicine, The First Affiliated Hospital of Zhengzhou University, Henan Medical Key Laboratory of Molecular Imaging, Zhengzhou, Henan 450052, China
| | - Sha-Sha Xu
- Department of Nuclear Medicine, The First Affiliated Hospital of Zhengzhou University, Henan Medical Key Laboratory of Molecular Imaging, Zhengzhou, Henan 450052, China
| | - Zhuo Wang
- Department of Nuclear Medicine, The First Affiliated Hospital of Zhengzhou University, Henan Medical Key Laboratory of Molecular Imaging, Zhengzhou, Henan 450052, China
| | - Xing-Min Han
- Department of Nuclear Medicine, The First Affiliated Hospital of Zhengzhou University, Henan Medical Key Laboratory of Molecular Imaging, Zhengzhou, Henan 450052, China
| | - Bao-Ping Liu
- Department of Nuclear Medicine, The First Affiliated Hospital of Zhengzhou University, Henan Medical Key Laboratory of Molecular Imaging, Zhengzhou, Henan 450052, China.
| |
Collapse
|
2
|
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.
Collapse
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.
| |
Collapse
|
3
|
Ratti PL, Faraci F, Hackethal S, Mascheroni A, Ferlito C, Caverzasio S, Amato N, Choe EK, Luo Y, Nunes-Ferreira PE, Galati S, Puiatti A, Kaelin-Lang A. A New Prospective, Home-Based Monitoring of Motor Symptoms in Parkinson's Disease. JOURNAL OF PARKINSONS DISEASE 2020; 9:803-809. [PMID: 31476169 PMCID: PMC6839495 DOI: 10.3233/jpd-191662] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background: Subjective symptoms, which are retrospectively assessed during clinical interviews in the office, may be influenced by patient recall in Parkinson’s disease (PD). Prospective collection of subjective data might be an effective tool to overcome this bias. Objective: We investigated the correspondence between prospectively and retrospectively assessed motor symptoms in PD. Methods: Forty-two consecutive patients (9 females, 67±9.8 years old) with mild to moderate PD reported their symptoms four times a day for two weeks, using the “SleepFit” application (app) for tablets. This app incorporates a new Visual Analogue Scale assessing global mobility (m-VAS), and the Scales for Outcome in Parkinson Assessment Diary Card (SCOPA-DC). At day 14, the Movement Disorders Society Unified Parkinson’s Disease Rating Scale (MDS-UPDRS) parts II and IV questionnaires were completed at the hospital. Agreement (root mean square difference) and the tendency to under- or overestimate their symptoms by patients (relative difference after normalization) were calculated to compare prospectively vs. retrospectively collected information. Results: Although agreement was good for overall scores (m-VAS: 10.0%; SCOPA-DC: 18.3%), and for single motor symptoms (involuntary movements, hand dexterity, walking, changing position; each <20%), some individuals with more advanced disease, higher fatigue or worse sleep quality showed poor symptom recall in retrospect. Moreover, a subgroup of patients (16.7%) either over- or underestimated symptom severity. Conclusions: Regular, prospective monitoring of motor symptoms is suitable in PD patients. SleepFit might be a useful tool in routine practice to identify patients tending to under- or overestimate their symptoms, and for their follow-up.
Collapse
Affiliation(s)
- Pietro-Luca Ratti
- Neurocenter of Southern Switzerland, Regional Hospital of Lugano, Lugano, Switzerland.,Clinical Neurophysiology Unit, Department of Neurology, Pierre Zobda-Quitman Hospital, University Hospitals of Martinique, Fort-de-France, Martinique, France
| | - Francesca Faraci
- Institute of Information Technology and Networking, University of Applied Sciences and Arts of Southern Switzerland (SUPSI) - Galleria 2, Manno, Switzerland
| | - Sandra Hackethal
- Neurocenter of Southern Switzerland, Regional Hospital of Lugano, Lugano, Switzerland
| | - Alessandro Mascheroni
- Institute of Information Technology and Networking, University of Applied Sciences and Arts of Southern Switzerland (SUPSI) - Galleria 2, Manno, Switzerland
| | - Clara Ferlito
- Neurocenter of Southern Switzerland, Regional Hospital of Lugano, Lugano, Switzerland
| | - Serena Caverzasio
- Neurocenter of Southern Switzerland, Regional Hospital of Lugano, Lugano, Switzerland
| | - Ninfa Amato
- Neurocenter of Southern Switzerland, Regional Hospital of Lugano, Lugano, Switzerland
| | - Eun Kyoung Choe
- College of Information Studies, University of Maryland, College Park, MD, USA
| | - Yuhan Luo
- College of Information Studies, University of Maryland, College Park, MD, USA
| | | | - Salvatore Galati
- Neurocenter of Southern Switzerland, Regional Hospital of Lugano, Lugano, Switzerland
| | - Alessandro Puiatti
- Institute of Information Technology and Networking, University of Applied Sciences and Arts of Southern Switzerland (SUPSI) - Galleria 2, Manno, Switzerland
| | - Alain Kaelin-Lang
- Neurocenter of Southern Switzerland, Regional Hospital of Lugano, Lugano, Switzerland.,Faculty of Biomedical Sciences, University of Southern Switzerland, Lugano, Switzerland.,Medical faculty, University of Bern, Switzerland
| |
Collapse
|
4
|
Stefani A, Högl B. Sleep in Parkinson's disease. Neuropsychopharmacology 2020; 45:121-128. [PMID: 31234200 PMCID: PMC6879568 DOI: 10.1038/s41386-019-0448-y] [Citation(s) in RCA: 99] [Impact Index Per Article: 24.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Revised: 05/26/2019] [Accepted: 06/13/2019] [Indexed: 11/09/2022]
Abstract
Sleep disturbances are common in Parkinson's disease and comprise the entire spectrum of sleep disorders. On the one hand regulation of sleep and wakefulness is affected in Parkinson's disease, leading to the development of disorders, such as insomnia and daytime sleepiness. While on the other hand control of motor activity during sleep is impaired, with subsequent manifestation of parasomnias (mainly REM sleep behavior disorders, but also, albeit more rarely, sleepwalking, and overlap parasomnia). Restless legs syndrome has been reported to be frequent in patients with Parkinson's disease, although there is no consensus on whether it is more frequent in Parkinson's disease than in the general population. The same is true for sleep-related breathing disorders. Regarding the diagnosis of sleep disorders in patients with Parkinson's disease, one of the main challenges is correctly identifying excessive daytime sleepiness as there are many potential confounding factors, for example it is necessary to distinguish sleep-related breathing disorders from medication effects, and to distinguish restless legs syndrome from the concomitant presence of potential mimics specific to Parkinson's disease, such as akathisia, nocturnal leg cramps, nocturnal hypokinesia, early morning dystonia, etc. The correct diagnosis of REM sleep behavior disorder is also not always easy, and video-polysomnography should be performed in order to exclude mimic-like movements at the end of sleep apneas or violent periodic leg movements of sleep. These aspects and specific considerations about diagnosis and treatment of sleep disorders in patients with Parkinson's disease will be reviewed.
Collapse
Affiliation(s)
- Ambra Stefani
- Department of Neurology, Medical University Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria.
| | - Birgit Högl
- Department of Neurology, Medical University Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
| |
Collapse
|
5
|
Rui Z, Qingling C, Xinyue Z, Xin Z, Weihong L. The related factors of sleep benefit in Parkinson's disease: A systematic review and meta-analysis. PLoS One 2019; 14:e0212951. [PMID: 30856190 PMCID: PMC6411108 DOI: 10.1371/journal.pone.0212951] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Accepted: 02/12/2019] [Indexed: 11/20/2022] Open
Abstract
Background Sleep benefit (SB) refers to the poorly understood phenomenon in Parkinson’s disease (PD) in which patients wake up in the morning with improved motor function. Although previous studies have suggested that several related factors are associated with SB, this relationship remains controversial. Objective This systematic review and meta-analysis aimed to identify the possible related factors of SB in PD. Methods We searched PubMed, EMBASE and WanFang databases to collect eligible articles. We calculated pooled estimates of odds ratios (ORs) or the mean deviation (MD) with 95% confidence intervals. Results We found 3 related factors associated with SB: the duration of PD (MD 1.22, 95% CI: 0.21–2.23), sleep efficiency (MD -4.48,95% CI: -7.24- -2.44), and on-state MDS-UPDRS-Ⅲ total score (MD 3.05, 95% CI: 0.53–5.57). Conclusion PD patients with SB are more likely to have a long duration of PD, a low sleep efficiency and a high MDS-UPDRS-Ⅲ total score. Our work helps obtain a better understanding of sleep SB in PD and its underlying mechanisms. More studies need to be conducted to evaluate the associations between clinical factors in PD and the SB phenomenon.
Collapse
Affiliation(s)
- Zhong Rui
- Department of Neurology, The First Hospital of Jilin University, Chang Chun, Ji Lin Provence, China
| | - Chen Qingling
- Digestive Department, The First Hospital of Jilin University, Chang Chun, Ji Lin Provence, China
| | - Zhang Xinyue
- Department of Neurology, The First Hospital of Jilin University, Chang Chun, Ji Lin Provence, China
| | - Zhang Xin
- Department of Neurology, The First Hospital of Jilin University, Chang Chun, Ji Lin Provence, China
| | - Lin Weihong
- Department of Neurology, The First Hospital of Jilin University, Chang Chun, Ji Lin Provence, China
- * E-mail:
| |
Collapse
|
6
|
Lee W, Evans AH, Williams DR. Objective Measurement and Characterization of Sleep Benefit in Parkinson's Disease. Mov Disord Clin Pract 2017; 4:590-596. [PMID: 30363502 DOI: 10.1002/mdc3.12489] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2016] [Revised: 02/27/2017] [Accepted: 03/08/2017] [Indexed: 01/30/2023] Open
Abstract
Background Sleep benefit (SB) in Parkinson's disease refers to improved motor symptoms upon waking despite an entire night without medications. Although it was first proposed 30 years ago, this phenomenon proved difficult to investigate, and its true prevalence and underlying mechanisms remain unclear. Objective This study aimed to identify and quantify SB through measurement of motor function using a validated smartphone application and to identify disease characteristics that predicted SB. Methods Ninety-two patients recruited from 2 Movement Disorder Services were clinically assessed at home using a validated smartphone application. Each patient was tested in the on-state, at the end of dose, and on waking (before medications) 3 times. Differences between the 3 states were used to determine the impact of sleep and levodopa on motor function. SB was considered to be a "measurable improvement in parkinsonism from the end of dose." Results The morning waking motor function of 20 patients (22%) improved compared with the end-of-dose function, with 9 patients demonstrating superior function compared with their on-state. No clinical features predicted SB. Although all participants subjectively reported motor fluctuations, only 35 patients (38%) demonstrated an objective improvement with levodopa. Patients who had SB more often demonstrated objective motor fluctuations compared with those who did not (65% vs. 31%; P = 0.008). Conclusions SB is a genuine motor phenomenon: 1 in 5 patients have a measurable improvement in motor function on waking. It remains questionable whether this improvement is a direct effect of sleep. Until its underlying mechanism is better understood, it is more appropriate to refer to this phenomenon as simply morning improvement or diurnal fluctuation of motor symptoms.
Collapse
Affiliation(s)
- Will Lee
- Neuroscience Department The Alfred Hospital Melbourne Victoria Australia.,Van Cleef Roet Centre for Nervous Diseases Monash University The Alfred Hospital Melbourne Victoria Australia
| | - Andrew H Evans
- Neurology Department The Royal Melbourne Hospital Parkville Victoria Australia
| | - David R Williams
- Neuroscience Department The Alfred Hospital Melbourne Victoria Australia.,Van Cleef Roet Centre for Nervous Diseases Monash University The Alfred Hospital Melbourne Victoria Australia
| |
Collapse
|
7
|
van Gilst MM, Cramer IC, Bloem BR, Overeem S, Faber MJ. A grounded theory study on the influence of sleep on Parkinson's symptoms. BMC Res Notes 2016; 9:299. [PMID: 27283443 PMCID: PMC4901477 DOI: 10.1186/s13104-016-2114-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2016] [Accepted: 06/01/2016] [Indexed: 11/30/2022] Open
Abstract
Background Upon awaking, many Parkinson’s patients experience an improved mobility, a phenomenon known as ‘sleep benefit’. Despite the potential clinical relevance, no objective correlates of sleep benefit exist. The discrepancy between the patients’ subjective experience of improvement in absence of objective changes is striking, and raises questions about the nature of sleep benefit. We aimed to clarify what patients reporting subjective sleep benefit, actually experience when waking up. Furthermore, we searched for factors associated with subjective sleep benefit. Methods Using a standardized topic list, we interviewed 14 Parkinson patients with unambiguous subjective sleep benefit, selected from a larger questionnaire-based cohort. A grounded theory approach was used to analyse the data. Results A subset of the participants described a temporary decrease in their Parkinson motor symptoms after sleep. Others did experience beneficial effects which were, however, non-specific for Parkinson’s disease (e.g. feeling ‘rested’). The last group misinterpreted the selection questionnaire and did not meet the definition of sleep benefit for various reasons. There were no general sleep-related factors that influenced the presence of sleep benefit. Factors mentioned to influence functioning at awakening were mostly stress related. Conclusions The group of participants convincingly reporting sleep benefit in the selection questionnaire appeared to be very heterogeneous, with only a portion of them describing sleep benefit on motor symptoms. The group of participants actually experiencing motor sleep benefit may be much smaller than reported in the literature so far. Future studies should employ careful inclusion criteria, which could be based on our reported data.
Collapse
Affiliation(s)
- Merel M van Gilst
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, PO Box 9101, 6500 HB, Nijmegen, The Netherlands.,Sleep Medicine Centre Kempenhaeghe, Heeze, The Netherlands.,Eindhoven University of Technology, Eindhoven, The Netherlands
| | - Iris C Cramer
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, PO Box 9101, 6500 HB, Nijmegen, The Netherlands
| | - Bastiaan R Bloem
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, PO Box 9101, 6500 HB, Nijmegen, The Netherlands
| | - Sebastiaan Overeem
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, PO Box 9101, 6500 HB, Nijmegen, The Netherlands. .,Sleep Medicine Centre Kempenhaeghe, Heeze, The Netherlands. .,Eindhoven University of Technology, Eindhoven, The Netherlands.
| | - Marjan J Faber
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, PO Box 9101, 6500 HB, Nijmegen, The Netherlands.,Radboud Institute for Health Sciences, Scientific Institute for Quality of Healthcare, Radboud University Medical Center, Nijmegen, The Netherlands
| |
Collapse
|
8
|
van Gilst MM, van Mierlo P, Bloem BR, Overeem S. Quantitative Motor Performance and Sleep Benefit in Parkinson Disease. Sleep 2015; 38:1567-73. [PMID: 25902811 DOI: 10.5665/sleep.5048] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2014] [Accepted: 03/26/2015] [Indexed: 11/03/2022] Open
Abstract
STUDY OBJECTIVES Many people with Parkinson disease experience "sleep benefit": temporarily improved mobility upon awakening. Here we used quantitative motor tasks to assess the influence of sleep on motor functioning in Parkinson disease. DESIGN Eighteen Parkinson patients with and 20 without subjective sleep benefit and 20 healthy controls participated. Before and directly after a regular night sleep and an afternoon nap, subjects performed the timed pegboard dexterity task and quantified finger tapping task. Subjective ratings of motor functioning and mood/vigilange were included. Sleep was monitored using polysomnography. RESULTS On both tasks, patients were overall slower than healthy controls (night: F2,55 = 16.938, P < 0.001; nap: F2,55 = 15.331, P < 0.001). On the pegboard task, there was a small overall effect of night sleep (F1,55 = 9.695, P = 0.003); both patients and controls were on average slightly slower in the morning. However, in both tasks there was no sleep*group interaction for nighttime sleep nor for afternoon nap. There was a modest correlation between the score on the pegboard task and self-rated motor symptoms among patients (rho = 0.233, P = 0.004). No correlations in task performance and mood/vigilance or sleep time/efficiency were found. CONCLUSIONS A positive effect of sleep on motor function is commonly reported by Parkinson patients. Here we show that the subjective experience of sleep benefit is not paralleled by an actual improvement in motor functioning. Sleep benefit therefore appears to be a subjective phenomenon and not a Parkinson-specific reduction in symptoms.
Collapse
Affiliation(s)
- Merel M van Gilst
- Radboud University Medical Centre, Donders Institute for Brain, Cognition and Behaviour, Department of Neurology, Nijmegen, the Netherlands
| | | | - Bastiaan R Bloem
- Radboud University Medical Centre, Donders Institute for Brain, Cognition and Behaviour, Department of Neurology, Nijmegen, the Netherlands
| | - Sebastiaan Overeem
- Radboud University Medical Centre, Donders Institute for Brain, Cognition and Behaviour, Department of Neurology, Nijmegen, the Netherlands.,Sleep Medicine Centre Kempenhaeghe, Heeze, the Netherlands.,Eindhoven University of Technology, Eindhoven, the Netherlands
| |
Collapse
|