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Dubessy AL, Arnulf I. Sleepiness in neurological disorders. Rev Neurol (Paris) 2023; 179:755-766. [PMID: 37598089 DOI: 10.1016/j.neurol.2023.07.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2023] [Revised: 07/18/2023] [Accepted: 07/19/2023] [Indexed: 08/21/2023]
Abstract
Sleepiness is a frequent and underrecognized symptom in neurological disorders, that impacts functional outcomes and quality of life. Multiple and potentially additive factors might contribute to sleepiness in neurological disorders, including sleep quality alterations, circadian rhythm disorders, drugs, and sleep disorders including sleep apnea or central disorders of hypersomnolence. Physician awareness of the possible symptoms of hypersomnolence, and associated causes is of crucial importance to allow proper identification and treatment of underlying causes. This review first provides a brief overview on clinical aspects of excessive daytime sleepiness, and diagnosis tools, then examines its frequency and mechanisms in various neurological disorders, including neurodegenerative disorders, multiple sclerosis, autoimmune encephalitis, epilepsy, and stroke.
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Affiliation(s)
- A-L Dubessy
- Saint Antoine Hospital, Assistance publique des Hôpitaux de Paris (AP-HP), Paris, France.
| | - I Arnulf
- Sleep Disorder Unit, Pitié-Salpêtrière Hospital and Sorbonne University, Paris, France; National Reference Network for Orphan Diseases: Narcolepsy and Rare Hypersomnias, Paris, France
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2
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Zolfaghari S, Thomann AE, Lewandowski N, Trundell D, Lipsmeier F, Pagano G, Taylor KI, Postuma RB. Self-Report versus Clinician Examination in Early Parkinson's Disease. Mov Disord 2021; 37:585-597. [PMID: 34897818 PMCID: PMC9299700 DOI: 10.1002/mds.28884] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Revised: 11/09/2021] [Accepted: 11/22/2021] [Indexed: 11/19/2022] Open
Abstract
Background Evaluating the discrepancies between patient‐reported measures and clinician examination has implications for formulating individual treatment regimens. Objective This study investigated the association between health outcomes and level of self‐reported motor‐related function impairment relative to clinician‐examined motor signs. Methods Recently diagnosed PD patients were evaluated using the Parkinson's Progression Marker Initiative (PPMI, N = 420) and the PASADENA phase II clinical trial (N = 316). We calculated the average normalized difference between each participant's part II and III MDS‐UPDRS (Movement Disorder Society Unified Parkinson's Disease Rating Scale) scores. Individuals with score differences <25th or >75th percentiles were labeled as low‐ and high‐self‐reporters, respectively (those between ranges were labeled intermediate‐self‐reporters). We compared a wide range of clinical/biomarker readouts among these three groups, using Kruskal–Wallis nonparametric and Pearson's χ2 tests. Spearman's correlations were tested for associations between MDS‐UPDRS subscales. Results In both cohorts, high‐self‐reporters reported the largest impairment/symptom experience for most motor and nonmotor patient‐reported variables. By contrast, these high‐self‐reporters were similar to or less impaired on clinician‐examined and biomarker measures. Patient‐reported nonmotor symptoms on MDS‐UPDRS part IB showed the strongest positive correlation with self‐reported motor‐related impairment (PPMI rs = 0.54, PASADENA rs = 0.52). This correlation was numerically stronger than the part II and clinician‐examined MDS‐UPDRS part III correlation (PPMI rs = 0.38, PASADENA rs = 0.28). Conclusion Self‐reported motor‐related impairments reflect not only motor signs/symptoms but also other self‐reported nonmotor measures. This may indicate (1) a direct impact of nonmotor symptoms on motor‐related functioning and/or (2) the existence of general response tendencies in how patients self‐rate symptoms. Our findings suggest further investigation into the suitability of MDS‐UPDRS II to assess motor‐related impairments. © 2021 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society
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Affiliation(s)
- Sheida Zolfaghari
- Integrated Program in Neuroscience, McGill University, Montreal, Quebec, Canada.,Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
| | - Alessandra E Thomann
- Roche Pharma Research and Early Development, Neuroscience and Rare Diseases Discovery and Translational Area, Basel, Switzerland
| | | | - Dylan Trundell
- Roche Products Limited, Welwyn Garden City, United Kingdom
| | - Florian Lipsmeier
- Roche Pharma Research and Early Development, pRED Informatics, Roche Innovation Center, Basel, Switzerland
| | - Gennaro Pagano
- Roche Pharma Research and Early Development, Neuroscience and Rare Diseases Discovery and Translational Area, Basel, Switzerland.,King's College London, London, United Kingdom
| | - Kirsten I Taylor
- Roche Pharma Research and Early Development, Neuroscience and Rare Diseases Discovery and Translational Area, Basel, Switzerland
| | - Ronald B Postuma
- Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada.,Department of Neurology and Neurosurgery, McGill University, Montreal, Quebec, Canada.,Centre for Advanced Research in Sleep Medicine, Hôpital du Sacré-Coeur de Montréal, Montreal, Quebec, Canada
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3
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Valko PO, Hunziker S, Graf K, Werth E, Baumann CR. Sleep-wake misperception. A comprehensive analysis of a large sleep lab cohort. Sleep Med 2021; 88:96-103. [PMID: 34742039 DOI: 10.1016/j.sleep.2021.10.023] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Revised: 10/04/2021] [Accepted: 10/13/2021] [Indexed: 11/16/2022]
Abstract
OBJECTIVES Sleep-wake misperception has mainly been reported in insomnia patients. Conversely, the present study aimed to assess the prevalence and correlates of sleep-wake misperception in a large cohort of patients with various sleep-wake disorders, all diagnosed along the third version of the International Classification of Sleep Disorders. METHODS We retrospectively included 2738 patients examined by polysomnography, who in addition estimated upon awakening their total sleep time, sleep onset latency and Wake after sleep onset (WASO). We computed subjective-objective mismatch by the formula (subjective - objective value)/objective value ×100; negative and positive values indicated under- and overestimation, respectively. RESULTS In the entire sample, the magnitude of under- and overestimation of total sleep time was similar, but varied significantly between diagnostic groups, with insomnia and insufficient sleep syndrome showing the most pronounced underestimation and REM parasomnia and circadian rhythm disorders showing the most pronounced overestimation of total sleep time. In all diagnostic categories, a majority tended to overestimate their sleep onset latency and to underestimate the amount of WASO. Younger age was independently correlated with underestimation of total sleep time and WASO, and with overestimation of sleep onset latency. Overestimation of sleep onset latency independently correlated to an increased latency to N3 sleep stage on polysomnography. CONCLUSIONS While sleep-wake misperception is highly prevalent in all sleep-wake disorders, significant differences exist in magnitude of under- and overestimation between distinct diagnostic groups.
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Affiliation(s)
- Philipp O Valko
- Department of Neurology, Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Switzerland; Sleep & Health Zurich, University Hospital Zurich, University of Zurich, Switzerland.
| | - Schirin Hunziker
- Department of Neurology, Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Switzerland
| | - Kevin Graf
- Department of Neurology, Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Switzerland
| | - Esther Werth
- Department of Neurology, Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Switzerland; Sleep & Health Zurich, University Hospital Zurich, University of Zurich, Switzerland
| | - Christian R Baumann
- Department of Neurology, Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Switzerland; Sleep & Health Zurich, University Hospital Zurich, University of Zurich, Switzerland
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4
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Staunton H, Kelly K, Newton L, Leddin M, Rodriguez-Esteban R, Chaudhuri KR, Weintraub D, Postuma RB, Martinez-Martin P. A Patient-Centered Conceptual Model of Symptoms and Their Impact in Early Parkinson's Disease: A Qualitative Study. JOURNAL OF PARKINSONS DISEASE 2021; 12:137-151. [PMID: 34657850 PMCID: PMC8842769 DOI: 10.3233/jpd-202457] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Background: Individuals with Parkinson’s disease (PD) develop a significant disease burden over time that contributes to a progressive decline in health-related quality of life. There is a paucity of qualitative research to understand symptoms and impacts in individuals with early-stage PD (i.e., Hoehn and Yahr stage 1–2 and ≤2 years since diagnosis). Objective: The collection of qualitative data to inform the selection of clinical outcome assessments for clinical trials is advocated by regulators. This patient-centered, multistage study sought to create a conceptual model of symptoms and their impact for individuals with early-stage PD. Methods: Symptoms and impacts of PD were gathered from a literature review of qualitative research, a quantitative social media listening analysis, and qualitative patient concept elicitation interviews (n = 35). Clinical experts provided input to validate and finalize the concepts. Results: The final conceptual model consisted of 27 symptoms categorized into ‘motor’ or ‘non-motor’ domains, and 39 impacts divided into five domains. Most frequently reported symptoms in early-stage PD were ‘tremors’ (89%), ‘stiffness and rigidity’, and ‘fatigue’ (69%, both). Most frequently reported impacts included ‘anxiety’ (74%), ‘eating and drinking’ (71%), followed by ‘exercise/sport’ and ‘relationship with family/family life’ (66%, both). Conclusion: This study provides initial insights relating to the symptom and impact burden of early-stage PD patients. The conceptual model can be used to help researchers to develop and select optimal patient-centered outcomes to measure treatment benefit in clinical trials. These findings could inform future qualitative research and the development of outcomes specifically for early-stage PD patients.
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Affiliation(s)
| | - Kim Kelly
- Clinical Outcomes Solutions, Tucson, AZ, USA
| | | | - Mathias Leddin
- Roche Innovation Center Basel, F. Hoffmann-La Roche Ltd, Basel, Switzerland
| | | | - K Ray Chaudhuri
- Parkinson Foundation Centre Kings College Hospital and Institute of Psychiatry, Psychology and Neuroscience, King's College Londons, London, UK
| | - Daniel Weintraub
- Department of Psychiatry, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA.,Parkinson's Disease Research, Education and Clinical Center, Philadelphia Veterans Affairs Medical Center, Philadelphia, PA, USA
| | - Ronald B Postuma
- Department of Neurology, Montreal Neurological Institute, Montreal, Canada
| | - Pablo Martinez-Martin
- Center for Networked Biomedical Research in Neurodegenerative Diseases (CIBERNED), Carlos III Institute of Health, Madrid, Spain
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5
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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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6
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Gottlieb E, Khlif MS, Bird L, Werden E, Churchward T, Pase MP, Egorova N, Howard ME, Brodtmann A. Sleep architectural dysfunction and undiagnosed obstructive sleep apnea after chronic ischemic stroke. Sleep Med 2021; 83:45-53. [PMID: 33991892 DOI: 10.1016/j.sleep.2021.04.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Revised: 03/22/2021] [Accepted: 04/08/2021] [Indexed: 11/27/2022]
Abstract
OBJECTIVE/BACKGROUND Sleep-wake dysfunction is bidirectionally associated with the incidence and evolution of acute stroke. It remains unclear whether sleep disturbances are transient post-stroke or are potentially enduring sequelae in chronic stroke. Here, we characterize sleep architectural dysfunction, sleep-respiratory parameters, and hemispheric sleep in ischemic stroke patients in the chronic recovery phase compared to healthy controls. PATIENTS/METHODS Radiologically confirmed ischemic stroke patients (n = 28) and matched control participants (n = 16) were tested with ambulatory polysomnography, bi-hemispheric sleep EEG, and demographic, stroke-severity, mood, and sleep-circadian questionnaires. RESULTS Twenty-eight stroke patients (22 men; mean age = 69.61 ± 7.4 years) were cross-sectionally evaluated 4.1 ± 0.9 years after mild-moderate ischemic stroke (baseline NIHSS: 3.0 ± 2.0). Fifty-seven percent of stroke patients (n = 16) exhibited undiagnosed moderate-to-severe obstructive sleep apnea (apnea-hypopnea index >15). Despite no difference in total sleep or wake after sleep onset, stroke patients had reduced slow-wave sleep time (66.25 min vs 99.26 min, p = 0.02), increased time in non-rapid-eye-movement (NREM) stages 1-2 (NREM-1: 48.43 vs 28.95, p = 0.03; NREM-2: 142.61 vs 115.87, p = 0.02), and a higher arousal index (21.46 vs 14.43, p = 0.03) when compared to controls. Controlling for sleep apnea severity did not attenuate the magnitude of sleep architectural differences between groups (NREM 1-3=ηp2 >0.07). We observed no differences in ipsilesionally versus contralesionally scored sleep architecture. CONCLUSIONS Fifty-seven percent of chronic stroke patients had undiagnosed moderate-severe obstructive sleep apnea and reduced slow-wave sleep with potentially compensatory increases in NREM 1-2 sleep relative to controls. Formal sleep studies are warranted after stroke, even in the absence of self-reported history of sleep-wake pathology.
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Affiliation(s)
- Elie Gottlieb
- The Florey Institute of Neuroscience and Mental Health, Melbourne, VIC, Australia; University of Melbourne, Melbourne, VIC, Australia.
| | - Mohamed S Khlif
- The Florey Institute of Neuroscience and Mental Health, Melbourne, VIC, Australia; University of Melbourne, Melbourne, VIC, Australia
| | - Laura Bird
- The Florey Institute of Neuroscience and Mental Health, Melbourne, VIC, Australia; University of Melbourne, Melbourne, VIC, Australia
| | - Emilio Werden
- The Florey Institute of Neuroscience and Mental Health, Melbourne, VIC, Australia; University of Melbourne, Melbourne, VIC, Australia
| | - Thomas Churchward
- Institute for Breathing and Sleep, Melbourne, VIC, Australia; Austin Health, Heidelberg, VIC, Australia
| | - Matthew P Pase
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, VIC, Australia; Harvard T.H. Chan School of Public Health, Harvard University, MA, USA
| | - Natalia Egorova
- The Florey Institute of Neuroscience and Mental Health, Melbourne, VIC, Australia; University of Melbourne, Melbourne, VIC, Australia; Melbourne School of Psychological Sciences, University of Melbourne, Melbourne, VIC, Australia
| | - Mark E Howard
- University of Melbourne, Melbourne, VIC, Australia; Institute for Breathing and Sleep, Melbourne, VIC, Australia; Austin Health, Heidelberg, VIC, Australia
| | - Amy Brodtmann
- The Florey Institute of Neuroscience and Mental Health, Melbourne, VIC, Australia; University of Melbourne, Melbourne, VIC, Australia
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7
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Gottlieb E, Churilov L, Werden E, Churchward T, Pase MP, Egorova N, Howard ME, Brodtmann A. Sleep-wake parameters can be detected in patients with chronic stroke using a multisensor accelerometer: a validation study. J Clin Sleep Med 2021; 17:167-175. [PMID: 32975195 DOI: 10.5664/jcsm.8812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES Sleep-wake dysfunction is bidirectionally associated with the pathogenesis and evolution of stroke. Longitudinal and prospective measurement of sleep after chronic stroke remains poorly characterized because of a lack of validated objective and ambulatory sleep measurement tools in neurological populations. This study aimed to validate a multisensor sleep monitor, the SenseWear Armband (SWA), in patients with ischemic stroke and control patients using at-home polysomnography. METHODS Twenty-eight radiologically confirmed patients with ischemic stroke (aged 69.61 ± 7.35 years; mean = 4.1 years poststroke) and 16 control patients (aged 73.75 ± 7.10 years) underwent overnight at-home polysomnography in tandem with the SWA. Lin's concordance correlation coefficient and reduced major axis regressions were employed to assess concordance of SWA vs polysomnography-measured total sleep time, sleep efficiency, sleep onset latency, and wake after sleep onset. Subsequently, data were converted to 30-second epochs to match at-home polysomnography. Epoch-by-epoch agreement between SWA and at-home polysomnography was estimated using crude agreement, Cohen's kappa, sensitivity, and specificity. RESULTS Total sleep time was the most robustly quantified sleep-wake variable (concordance correlation coefficient = 0.49). The SWA performed poorest for sleep measures requiring discrimination of wakefulness (sleep onset latency; concordance correlation coefficient = 0.16). The sensitivity of the SWA was high (95.90%) for patients with stroke and for control patients (95.70%). The specificity of the SWA was fair-moderate for patients with stroke (40.45%) and moderate for control patients (45.60%). Epoch-by-epoch agreement rate was fair (78%) in patients with stroke and fair (74%) in controls. CONCLUSIONS The SWA shows promise as an ambulatory tool to estimate macro parameters of sleep-wake; however, agreement at an epoch level is only moderate-fair. Use of the SWA warrants caution when it is used as a diagnostic tool or in populations with significant sleep-wake fragmentation.
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Affiliation(s)
- Elie Gottlieb
- The Florey Institute of Neuroscience and Mental Health, Melbourne, Victoria, Australia.,University of Melbourne, Melbourne, Victoria, Australia
| | | | - Emilio Werden
- The Florey Institute of Neuroscience and Mental Health, Melbourne, Victoria, Australia.,University of Melbourne, Melbourne, Victoria, Australia
| | - Thomas Churchward
- Institute for Breathing and Sleep, Melbourne, Victoria, Australia.,Austin Health, Heidelberg, Victoria, Australia
| | - Matthew P Pase
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Victoria, Australia.,Harvard T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts
| | - Natalia Egorova
- The Florey Institute of Neuroscience and Mental Health, Melbourne, Victoria, Australia.,Melbourne School of Psychological Sciences, University of Melbourne, Melbourne, Victoria, Australia
| | - Mark E Howard
- University of Melbourne, Melbourne, Victoria, Australia.,Institute for Breathing and Sleep, Melbourne, Victoria, Australia.,Austin Health, Heidelberg, Victoria, Australia.,Co-senior authors
| | - Amy Brodtmann
- The Florey Institute of Neuroscience and Mental Health, Melbourne, Victoria, Australia.,University of Melbourne, Melbourne, Victoria, Australia.,Co-senior authors
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8
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Feng H, Chen L, Liu Y, Chen X, Wang J, Yu MWM, Huang B, Li SX, Chau SWH, Chan JWY, Chen J, Mok VCT, Wing YK, Zhang J. Rest‐Activity Pattern Alterations in Idiopathic
REM
Sleep Behavior Disorder. Ann Neurol 2020; 88:817-829. [DOI: 10.1002/ana.25853] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Revised: 07/17/2020] [Accepted: 07/19/2020] [Indexed: 01/22/2023]
Affiliation(s)
- Hongliang Feng
- Sleep Assessment Unit, Department of Psychiatry, Faculty of Medicine The Chinese University of Hong Kong Shatin, Hong Kong China
| | - Lauren Chen
- Sleep Assessment Unit, Department of Psychiatry, Faculty of Medicine The Chinese University of Hong Kong Shatin, Hong Kong China
| | - Yaping Liu
- Sleep Assessment Unit, Department of Psychiatry, Faculty of Medicine The Chinese University of Hong Kong Shatin, Hong Kong China
| | - Xinru Chen
- Sleep Assessment Unit, Department of Psychiatry, Faculty of Medicine The Chinese University of Hong Kong Shatin, Hong Kong China
| | - Jing Wang
- Sleep Assessment Unit, Department of Psychiatry, Faculty of Medicine The Chinese University of Hong Kong Shatin, Hong Kong China
| | - Mandy Wai Man Yu
- Sleep Assessment Unit, Department of Psychiatry, Faculty of Medicine The Chinese University of Hong Kong Shatin, Hong Kong China
| | - Bei Huang
- Sleep Assessment Unit, Department of Psychiatry, Faculty of Medicine The Chinese University of Hong Kong Shatin, Hong Kong China
| | - Shirley Xin Li
- Department of Psychology The University of Hong Kong Shatin, Hong Kong China
- The State Key Laboratory of Brain and Cognitive Sciences The University of Hong Kong, Pokfulam Hong Kong China
| | - Steven Wai Ho Chau
- Sleep Assessment Unit, Department of Psychiatry, Faculty of Medicine The Chinese University of Hong Kong Shatin, Hong Kong China
| | - Joey Wing Yan Chan
- Sleep Assessment Unit, Department of Psychiatry, Faculty of Medicine The Chinese University of Hong Kong Shatin, Hong Kong China
| | - Jie Chen
- Sleep Assessment Unit, Department of Psychiatry, Faculty of Medicine The Chinese University of Hong Kong Shatin, Hong Kong China
| | - Vincent Chung Tong Mok
- Margaret K.L. Cheung Research Centre in Management of Parkinsonism, Gerald Choa Neuroscience Centre, Lui Che Woo Institute of Innovative Medicine, Division of Neurology, Department of Medicine and Therapeutics The Chinese University of Hong Kong Shatin, Hong Kong China
| | - Yun Kwok Wing
- Sleep Assessment Unit, Department of Psychiatry, Faculty of Medicine The Chinese University of Hong Kong Shatin, Hong Kong China
| | - Jihui Zhang
- Sleep Assessment Unit, Department of Psychiatry, Faculty of Medicine The Chinese University of Hong Kong Shatin, Hong Kong China
- Guangdong Mental Health Center, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences Guangzhou Guangdong China
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10
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Sobreira-Neto MA, Pena-Pereira MA, Sobreira EST, Chagas MHN, Almeida CMOD, Fernandes RMF, Tumas V, Eckeli AL. Obstructive sleep apnea and Parkinson's disease: characteristics and associated factors. ARQUIVOS DE NEURO-PSIQUIATRIA 2019; 77:609-616. [DOI: 10.1590/0004-282x20190098] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Accepted: 05/26/2019] [Indexed: 02/07/2023]
Abstract
ABSTRACT Obstructive sleep apnea (OSA) occurs in up to 66% of Parkinson's disease (PD) patients, higher than in the general population. Although it is more prevalent, the relationship between OSA and PD remains controversial, with some studies confirming and others denying the relationship of OSA with some risk factors and symptoms in patients with PD. Objective: To determine the factors associated with OSA in PD patients com DP. Methods: A cross-sectional study was performed with 88 consecutive patients with PD from the outpatient clinic. Participants underwent clinical interviews with neurologists and a psychiatrist, assessment using standardized scales (Epworth Sleepiness Scale, Parkinson's Disease Questionnaire, Pittsburgh Sleep Quality Index and, for individuals with a diagnosis of restless legs syndrome/Willis-Ekbom disease, the International Restless Legs Syndrome Rating Scale), and video-polysomnography. Results: Individuals with PD and OSA were older and had less insomnia than those with PD without OSA. Regarding the polysomnographic variables, we observed a lower percentage of stage N3 sleep, a higher arousal index, and a higher oxygen desaturation index in those individuals with OSA, relative to those without OSA. In the multivariate analysis, only the percentage of stage N3 sleep and the oxygen desaturation index were significantly different. Besides this, most of the PD patients with OSA had a correlation with sleeping in the supine position (58% of OSA individuals). Conclusion: The PD patients showed a high prevalence of OSA, with the supine position exerting a significant influence on the OSA in these patients, and some factors that are associated with OSA in the general population did not seem to have a greater impact on PD patients.
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11
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Nodel MR, Shevtsova KV, Kovrov GV, Yakhno NN. Nighttime sleep disorders in patients with daytime sleepiness in Parkinson s disease. NEUROLOGY, NEUROPSYCHIATRY, PSYCHOSOMATICS 2018. [DOI: 10.14412/2074-2711-2018-4-23-29] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Daytime sleepiness is one of the clinically significant non-motor manifestations of Parkinson's disease (PD). One of its insufficiently studied aspects is a relationship between daytime sleepiness and nighttime sleep disorders.Objective:to clarify the clinical characteristics of PD in patients with different types of daytime sleepiness and to estimate of the ratio of daytime sleepiness to clinical and polysomnographic characteristics of nighttime sleep in patients with advanced stages of PD.Patients and methods. The investigation included 110 patients (56 men and 54 women) (mean age, 63.78+0.6 years) with PD (Hoehn and Yahr stage 2.6+0.2; disease duration, 6.3+3.2 years) without dementia. All the patients received therapy with levodopa at a mean daily dose of 667.8 mg; 98 of them had the drug in combination with dopamine receptor agonists at a stable dose. The unified PD rating scale, the PD sleep scale (PDSS), and the Epworth sleepiness scale (ESS) were applied. Nocturnal polysomnography (PSG) and the multiple sleep latency test (MSLT) were performed.Results and discussion. There was daytime sleepiness in 44% of the patients: permanent sleepiness in 15%, sudden daytime sleep attacks (along with low daytime sleepiness (ESS) in 14%, and permanent drowsiness concurrent with sleep attacks in 15%. The PSG findings showed a decrease in sleep efficiency, an increase in the duration of the first stage of sleep, a reduction in the duration of the second and third sleep stages, an extension of rapid eye movement (REM) sleep latency, and frequent awakenings (sleep fragmentation). PSG also demonstrated REM sleep behavior disorders (RBD) in half of the examinees.Patients with sleep attacks differed from those with permanent drowsiness without sleep attacks with more severe sleep disorders (PDSS) and shorter sleep latency (MSLT). Patients with the RBD phenomenon had shorter sleep latency (MTLS) than those without this parasomnia. Patients with moderate or severe sleepiness (ESS scores of >10) differed from those with milder drowsiness (ESS scores of 410) and a lower representation of the third sleep stage.Conclusion.There is evidence for the association of daytime sleepiness in PD with reduced efficiency, changes in the nighttime sleep pattern, and RBD.
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Affiliation(s)
- M. R. Nodel
- I.M. Sechenov First Moscow State Medical University (Sechenov University), Ministry of Health of Russia; N.I. Pirogov Russian National Research Medical University, Ministry of Health of Russia
| | - K. V. Shevtsova
- I.M. Sechenov First Moscow State Medical University (Sechenov University), Ministry of Health of Russia
| | - G. V. Kovrov
- I.M. Sechenov First Moscow State Medical University (Sechenov University), Ministry of Health of Russia
| | - N. N. Yakhno
- I.M. Sechenov First Moscow State Medical University (Sechenov University), Ministry of Health of Russia
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12
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Abstract
Efforts to develop neuroprotective therapy for Parkinson disease (PD) are focusing on the early stages of disease, which offer the best opportunity to intervene. Early PD can be divided into preclinical, prodromal and clinical stages; in this Review, we focus on the prodromal stage and markers that can be used to identify prodromal PD. We consider the necessary properties of a marker, before providing an overview of the proven and potential markers of prodromal PD, including clinical nonmotor markers, clinical motor markers, neuroimaging markers and tissue biomarkers. Markers for which the ability to predict conversion to PD is supported by the strongest evidence include olfactory loss, REM sleep behaviour disorder and constipation. Markers with the highest diagnostic strength include REM sleep behaviour disorder, dopaminergic imaging and subtle motor parkinsonism. The lead time - the period between the appearance of a marker and conversion to PD - is highly variable between markers, ranging from 5 years for impaired motor performance to >20 years for autonomic symptoms. The cost of screening for these markers also varies dramatically: some require just questionnaires, whereas others require sophisticated scanning techniques. Finally, we summarize how prodromal and risk markers can be combined to estimate the probability that an individual has prodromal PD, with a focus on the International Parkinson Disease and Movement Disorders Society (MDS) Prodromal Parkinson Criteria.
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Affiliation(s)
- Ronald B Postuma
- Department of Neurology, L7-305 Montreal General Hospital, 1650 Cedar Avenue, Montreal H3G1A4, Canada
| | - Daniela Berg
- Department of Neurology, Christian-Albrechts-University of Kiel, Arnold-Heller-Straße 3, 24105 Kiel, Germany.,Department of neurodegeneration, Hertie Institute of Clinical Brain Research, Hoppe, Seyler-Straße 3, 72076 Tübingen, Germany
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13
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Pahwa R, Isaacson SH, Torres-Russotto D, Nahab FB, Lynch PM, Kotschet KE. Role of the Personal KinetiGraph in the routine clinical assessment of Parkinson’s disease: recommendations from an expert panel. Expert Rev Neurother 2018; 18:669-680. [DOI: 10.1080/14737175.2018.1503948] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Rajesh Pahwa
- Department of Neurology, University of Kansas Medical Center, Kansas City, KS, USA
| | - Stuart H. Isaacson
- Parkinson’s Disease and Movement Disorders Center of Boca Raton, Boca Raton, FL, USA
| | | | - Fatta B. Nahab
- Department of Neurosciences, University of California San Diego, La Jolla, CA, USA
| | | | - Katya E. Kotschet
- Florey Neuroscience Institute, University of Melbourne, Parkville, Australia
- Department of Neurology, St Vincent’s Hospital, Fitzroy, Australia
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14
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Maier F, Prigatano GP. Impaired Self-Awareness of Motor Disturbances in Parkinson's Disease. Arch Clin Neuropsychol 2018; 32:802-809. [PMID: 29028874 DOI: 10.1093/arclin/acx094] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2017] [Accepted: 09/13/2017] [Indexed: 01/01/2023] Open
Abstract
Traditionally, anosognosia for cognitive or motor impairments in patients with Parkinson's disease (PD) was viewed as unlikely unless the patient was demented. More recent research has suggested that a portion of non-demented PD patients (30%-50%) in fact have impaired subjective awareness (ISA) of their motor impairments (ISAm). This empirical finding has implications for the clinical neuropsychological examination of PD patients and raises theoretical questions relevant to the broader study of anosognosia seen in other patient groups. The purpose of this paper is to primarily review our own research in this area and to summarize research findings of other investigators who have examined ISA in PD patients. Our secondary goal is to demonstrate the relevance of assessing ISA when conducting a neuropsychological examination of PD patients. Our findings suggest ISAm in PD patients is related to motor signs of right hemispheric dysfunction, but the brain imaging correlates of ISA for hypokinesias appear different than those obtained for ISA for dyskinesia in this patient group.
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Affiliation(s)
- Franziska Maier
- Department of Neurology, University of Marburg, Marburg, Germany.,Klinik und Poliklinik für Neurologie, Universitätsklinikum Köln (AöR), Cologne, Germany
| | - George P Prigatano
- Department of Clinical Neuropsychology, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ, USA
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15
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Abstract
Excessive daytime sleepiness is defined as the inability to maintain wakefulness during waking hours, resulting in unintended lapses into sleep. It is important to distinguish sleepiness from fatigue. The evaluation of a sleep patient begins with a careful clinical assessment that includes a detailed sleep history, medical and psychiatric history, a review of medications, as well as a social and family history. Physical examination should include a general medical examination with careful attention to the upper airway and the neurologic examination. Appropriate objective testing with a polysomnogram and a multiple sleep latency test if needed will help confirm the diagnosis and direct the appropriate treatment plan.
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Affiliation(s)
- Renee Monderer
- Sleep-Wake Disorders Center, Department of Neurology, Montefiore Medical Center, Albert Einstein College of Medicine, 111 East 210(th) Street, Bronx, NY 10467, USA.
| | - Imran M Ahmed
- Sleep-Wake Disorders Center, Department of Neurology, Montefiore Medical Center, Albert Einstein College of Medicine, 111 East 210(th) Street, Bronx, NY 10467, USA
| | - Michael Thorpy
- Sleep-Wake Disorders Center, Department of Neurology, Montefiore Medical Center, Albert Einstein College of Medicine, 111 East 210(th) Street, Bronx, NY 10467, USA
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16
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Postuma RB, Gagnon JF, Pelletier A, Montplaisir JY. Insomnia and somnolence in idiopathic RBD: a prospective cohort study. NPJ Parkinsons Dis 2017; 3:9. [PMID: 28649609 PMCID: PMC5445588 DOI: 10.1038/s41531-017-0011-7] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2016] [Revised: 02/02/2017] [Accepted: 02/11/2017] [Indexed: 12/28/2022] Open
Abstract
Although some sleep disorders are markers of prodromal Parkinson's disease and dementia with Lewy bodies, it is unclear whether insomnia and somnolence can predict disease. We assessed a large cohort of patients with idiopathic rapid eye movement sleep behavior disorder and age/sex matched controls, comparing the Epworth sleepiness scale, the Insomnia Severity Index, the Pittsburgh Sleep Quality Index, and polysomnographic variables. In those with repeated scales, we assessed change over time. Finally, we assessed whether sleep abnormalities predicted defined neurodegenerative disease. The 151 patients (age = 65.9, 75% male) completed sleep scales and were included. Epworth scores were similar between patients and controls (7.0+/-4.6 vs. 7.2+/-4.7, p = 0.77), and did not progress with time (change = +0.46+/-2.1, p = 0.45). Epworth scores were similar between those who developed neurodegenerative disease and those remaining disease-free (6.7+/-4.4 vs. 7.1+/-4.7, p = 0.70). Pittsburgh Index scores were higher in patients than controls (7.2+/-3.8 vs. 4.9+/-3.4, p = 0.004), mainly driven by the sleep disturbance/medication components (reflecting rapid eye movement sleep behavior disorder symptoms/treatment). Baseline Pittsburgh scores did not predict conversion to neurodegeneration, although sleep duration increased over time in those converting to neurodegenerative disease (+0.88+/-1.32 h, p = 0.014). Insomnia index scores were higher in patients than controls (10.0+/-5.5 vs. 6.35+/-4.66, p < 0.001), but declined over time (-1.43+/-5.09, p = 0.029) particularly in those converting to neurodegenerative disease. Finally, on polysomnogram, those with increased tonic rapid eye movement had higher risk of developing defined neurodegenerative disease (HR = 1.88, p = 0.039). In summary, we found that somnolence and insomnia do not predict neurodegeneration in idiopathic rapid eye movement sleep behavior disorder. As neurodegeneration progresses through prodromal stages, patients may have increasing sleep drive and duration.
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Affiliation(s)
- Ronald B. Postuma
- Department of Neurology, McGill University, Montreal General Hospital, Montreal, QC Canada
- Centre d’étude du sommeil et des rythmes biologiques, Hôpital du Sacré-Cœur de Montréal Montréal, 5400 Boul. Gouin Ouest, Montréal, H4J 1C5 QC Canada
| | - Jean-François Gagnon
- Centre d’étude du sommeil et des rythmes biologiques, Hôpital du Sacré-Cœur de Montréal Montréal, 5400 Boul. Gouin Ouest, Montréal, H4J 1C5 QC Canada
- Department of Psychology, Université du Québec à Montréal, Montreal, QC Canada
| | - Amelie Pelletier
- Centre d’étude du sommeil et des rythmes biologiques, Hôpital du Sacré-Cœur de Montréal Montréal, 5400 Boul. Gouin Ouest, Montréal, H4J 1C5 QC Canada
| | - Jacques Y. Montplaisir
- Centre d’étude du sommeil et des rythmes biologiques, Hôpital du Sacré-Cœur de Montréal Montréal, 5400 Boul. Gouin Ouest, Montréal, H4J 1C5 QC Canada
- Department of Psychiatry, Université de Montréal, Montreal, QC Canada
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17
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Pandey S, Bajaj BK, Wadhwa A, Anand KS. Impact of sleep quality on the quality of life of patients with Parkinson's disease: a questionnaire based study. Clin Neurol Neurosurg 2016; 148:29-34. [PMID: 27372436 DOI: 10.1016/j.clineuro.2016.06.014] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2015] [Revised: 06/17/2016] [Accepted: 06/18/2016] [Indexed: 10/21/2022]
Abstract
OBJECTIVE Poor sleep quality contributes to the inferior quality of life of patients with Parkinson's disease (PD) despite appropriate treatment of motor symptoms. The literature about the impact of sleep quality on quality of life of patients with PD is as yet sparse. MATERIAL AND METHODS One hundred patients of PD diagnosed as per UK Brain Bank criteria were assessed for severity and stage of PD using UPDRS and modified Hoehn &Yahr scales. The quality of sleep was assessed by Pittsburgh Sleep Quality Index and excessive daytime somnolence (EDS) was evaluated using Epworth Sleepiness Scale. Parkinson's Disease Questionnaire -39 (PDQ-39) was used to determine quality of life of the patients. Comorbid depression and anxiety were assessed using Inventory of Depressive Symptoms-Self Rated and Hamilton Anxiety Rating Scale. Pearson's correlation and multiple linear regressions were used to analyze relation of sleep quality with quality of life of patients. RESULTS Fifty patients had poor sleep quality. EDS was present in only 9 patients. Co-morbid depression and anxiety were present in 52 and 34 patients respectively. While the motor severity assessed by UPDRS-III was observed to adversely affect quality of life, it did not negatively impact quality of sleep. Higher score on UPDRS-total and UPDRS IV suggesting advanced disease correlated with poor sleep quality. Depression and anxiety were significantly more frequent in patients with poor sleep quality (p<0.01). Patients with poor sleep quality had worse quality of life (r=0.338, p<0.05). Depression and anxiety were also observed to have significant negative impact on quality of life of PD patients (p<0.01). Poor sleep quality was not found to be an independent predictor of quality of life using multiple linear regression analysis. CONCLUSION Poor sleep quality along with comorbid depression, anxiety and advanced stage of disease is associated with poor quality of life.
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Affiliation(s)
- Shweta Pandey
- Department of Neurology, Postgraduate Institute of Medical Education & Research, Dr. RML Hospital, New Delhi, 110001, India
| | - Bhupender Kumar Bajaj
- Department of Neurology, Postgraduate Institute of Medical Education & Research, Dr. RML Hospital, New Delhi, 110001, India.
| | - Ankur Wadhwa
- Department of Neurology, Postgraduate Institute of Medical Education & Research, Dr. RML Hospital, New Delhi, 110001, India
| | - Kuljeet Singh Anand
- Department of Neurology, Postgraduate Institute of Medical Education & Research, Dr. RML Hospital, New Delhi, 110001, India
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18
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Klingelhoefer L, Rizos A, Sauerbier A, McGregor S, Martinez-Martin P, Reichmann H, Horne M, Chaudhuri KR. Night-time sleep in Parkinson's disease - the potential use of Parkinson's KinetiGraph: a prospective comparative study. Eur J Neurol 2016; 23:1275-88. [PMID: 27160044 DOI: 10.1111/ene.13015] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2015] [Accepted: 03/02/2016] [Indexed: 12/01/2022]
Abstract
BACKGROUND AND PURPOSE Night-time sleep disturbances are important non-motor symptoms and key determinants of health-related quality of life (HRQoL) in patients with Parkinson's disease (PD). The Parkinson's KinetiGraph (PKG) can be used as an objective measure of different motor states and periods of immobility may reflect episodes of sleep. Our aim was to evaluate whether PKG can be used as an objective marker of disturbed night-time sleep in PD. METHODS In this prospective comparative study, data from PKG recordings over six consecutive 24 h periods are compared with Hauser diaries and scales focusing on motor state, sleep and HRQoL in PD patients. Thirty-three 'non-sleepy' PD patients (PD-NS) were compared with 30 PD patients presenting with excessive daytime sleepiness (PD-EDS). The groups were matched for age, gender and Hoehn and Yahr state. RESULTS In the PD-EDS group subjective sleep reports correlated with the PKG's parameters for quantity and quality night-time sleep, but not in the PD-NS group. There were no significant correlations of the night-time sleep quantity parameters of the Hauser diary with subjective sleep perception, neither in the PD-EDS nor in the PD-NS group. CONCLUSIONS This first PKG based study of night-time sleep in PD suggests that PKG could be used to provide an easy to use and rough evaluation of aspects of night-time sleep and one that could flag patients where polysomnography may be required. In sleepy PD patients for instance, quantity and quality PKG parameters correlate with different aspects of sleep such as insomnia, parasomnia and restless legs syndrome.
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Affiliation(s)
- L Klingelhoefer
- Department of Neurology, Technical University Dresden, Dresden, Germany.,Biomedical Research Unit, Department of Neurology, National Parkinson Foundation International Centre of Excellence, King's College Hospital and King's College, London, UK
| | - A Rizos
- Biomedical Research Unit, Department of Neurology, National Parkinson Foundation International Centre of Excellence, King's College Hospital and King's College, London, UK
| | - A Sauerbier
- Biomedical Research Unit, Department of Neurology, National Parkinson Foundation International Centre of Excellence, King's College Hospital and King's College, London, UK
| | - S McGregor
- Centre for Clinical Neurosciences and Neurological Research, St Vincent's Hospital Melbourne, Fitzroy, Vic., Australia
| | - P Martinez-Martin
- National Centre of Epidemiology and CIBERNED, Carlos III Institute of Health, Madrid, Spain
| | - H Reichmann
- Department of Neurology, Technical University Dresden, Dresden, Germany
| | - M Horne
- Centre for Clinical Neurosciences and Neurological Research, St Vincent's Hospital Melbourne, Fitzroy, Vic., Australia.,Florey Institute for Neuroscience and Mental Health, University of Melbourne, Parkville, Vic., Australia
| | - K R Chaudhuri
- Biomedical Research Unit, Department of Neurology, National Parkinson Foundation International Centre of Excellence, King's College Hospital and King's College, London, UK
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19
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Babkina OV, Poluektov MG, Levin OS. Heterogeneity of excessive daytime sleepiness in Parkinson’s disease. Zh Nevrol Psikhiatr Im S S Korsakova 2016; 116:60-70. [DOI: 10.17116/jnevro20161166260-70] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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20
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Ehrminger M, Leu-Semenescu S, Cormier F, Corvol JC, Vidailhet M, Debellemaniere E, Brice A, Arnulf I. Sleep aspects on video-polysomnography in LRRK2 mutation carriers. Mov Disord 2015; 30:1839-43. [PMID: 26468079 DOI: 10.1002/mds.26412] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2015] [Revised: 07/21/2015] [Accepted: 07/31/2015] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND Rapid eye movement sleep behavior disorder and sleepiness precede or accompany idiopathic Parkinson's disease (PD), but their presence in subjects with leucine-rich repeat kinase 2 mutations is unknown. METHODS Ten patients with leucine-rich repeat kinase 2-associated PD, four healthy leucine-rich repeat kinase 2 mutation carriers, 20 patients with idiopathic PD, and 12 healthy controls underwent clinical assessments and a nighttime video-polysomnography. RESULTS No sleep changes, no rapid eye movement sleep behavior disorder, or rapid eye movement sleep without atonia was found in the 14 subjects with leucine-rich repeat kinase 2mutations compared with controls, whereas 41% of patients with idiopathic PD had rapid eye movement sleep behavior disorder. Eventually, 20% of patients with leucine-rich repeat kinase 2-associated PD had abnormal periodic leg movements, a frequency similar to the idiopathic PD group frequency. CONCLUSIONS The sleep phenotype in leucine-rich repeat kinase 2 mutations parallels that of idiopathic PD, except for absent rapid eye movement sleep behavior disorder here in the presymptomatic and symptomatic stages.
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Affiliation(s)
- Mickael Ehrminger
- Ecole Normale Supérieure, Paris, France.,AP-HP, Hôpital Pitié-Salpêtrière, Sleep Disorders unit and Neurology Department, F-75013, Paris, France
| | - Smaranda Leu-Semenescu
- AP-HP, Hôpital Pitié-Salpêtrière, Sleep Disorders unit and Neurology Department, F-75013, Paris, France.,Sorbonne Universitiés, UPMC Univ Paris 06, UMR_S1127, ICM, F-75013, Paris, France.,INSERM, UMR_S1127 and CIC-1422, ICM, F-75013, Paris, France.,CNRS, UMR_7225, ICM, F-75005, Paris, France
| | - Florence Cormier
- AP-HP, Hôpital Pitié-Salpêtrière, Sleep Disorders unit and Neurology Department, F-75013, Paris, France.,Sorbonne Universitiés, UPMC Univ Paris 06, UMR_S1127, ICM, F-75013, Paris, France.,INSERM, UMR_S1127 and CIC-1422, ICM, F-75013, Paris, France.,CNRS, UMR_7225, ICM, F-75005, Paris, France
| | - Jean-Christophe Corvol
- AP-HP, Hôpital Pitié-Salpêtrière, Sleep Disorders unit and Neurology Department, F-75013, Paris, France.,Sorbonne Universitiés, UPMC Univ Paris 06, UMR_S1127, ICM, F-75013, Paris, France.,INSERM, UMR_S1127 and CIC-1422, ICM, F-75013, Paris, France.,CNRS, UMR_7225, ICM, F-75005, Paris, France
| | - Marie Vidailhet
- AP-HP, Hôpital Pitié-Salpêtrière, Sleep Disorders unit and Neurology Department, F-75013, Paris, France.,Sorbonne Universitiés, UPMC Univ Paris 06, UMR_S1127, ICM, F-75013, Paris, France.,INSERM, UMR_S1127 and CIC-1422, ICM, F-75013, Paris, France.,CNRS, UMR_7225, ICM, F-75005, Paris, France
| | - Eden Debellemaniere
- Sorbonne Universitiés, UPMC Univ Paris 06, UMR_S1127, ICM, F-75013, Paris, France.,INSERM, UMR_S1127 and CIC-1422, ICM, F-75013, Paris, France.,CNRS, UMR_7225, ICM, F-75005, Paris, France
| | - Alexis Brice
- AP-HP, Hôpital Pitié-Salpêtrière, Sleep Disorders unit and Neurology Department, F-75013, Paris, France.,Sorbonne Universitiés, UPMC Univ Paris 06, UMR_S1127, ICM, F-75013, Paris, France.,INSERM, UMR_S1127 and CIC-1422, ICM, F-75013, Paris, France.,CNRS, UMR_7225, ICM, F-75005, Paris, France
| | - Isabelle Arnulf
- AP-HP, Hôpital Pitié-Salpêtrière, Sleep Disorders unit and Neurology Department, F-75013, Paris, France.,Sorbonne Universitiés, UPMC Univ Paris 06, UMR_S1127, ICM, F-75013, Paris, France.,INSERM, UMR_S1127 and CIC-1422, ICM, F-75013, Paris, France.,CNRS, UMR_7225, ICM, F-75005, Paris, France
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21
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Arnulf I, Neutel D, Herlin B, Golmard JL, Leu-Semenescu S, Cochen de Cock V, Vidailhet M. Sleepiness in Idiopathic REM Sleep Behavior Disorder and Parkinson Disease. Sleep 2015; 38:1529-35. [PMID: 26085299 DOI: 10.5665/sleep.5040] [Citation(s) in RCA: 66] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2014] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE To determine whether patients with idiopathic and symptomatic RBD were sleepier than controls, and if sleepiness in idiopathic RBD predicted earlier conversion to Parkinson disease. METHODS The Epworth Sleepiness Scale (ESS) and its determinants were compared at the time of a video-polysomnography for an RBD diagnosis in patients with idiopathic RBD, in patients with Parkinson disease, and in controls. Whether sleepiness at time of RBD diagnosis predicted an earlier conversion to neurodegenerative diseases was retrospectively analyzed in the followed-up patients. RESULTS The 75 patients with idiopathic RBD were sleepier (ESS: 7.8 ± 4.6) at the time of RBD diagnosis than 74 age- and sex-matched controls (ESS: 5.0 ± 3.6, P < 0.0001). They reached the levels of 114 patients with Parkinson disease (ESS: 8.7 ± 4.8), whether they had (n = 78) or did not have (n = 36) concomitant RBD. The severity of sleepiness in idiopathic RBD correlated with younger age, but not with sleep measures. Among the 69 patients with idiopathic RBD who were followed up for a median 3 years (1-15 years), 16 (23.2%) developed parkinsonism (n = 6), dementia (n = 6), dementia plus parkinsonism (n = 2), and multiple system atrophy (n = 2). An ESS greater than 8 at time of RBD diagnosis predicted a shorter time to phenoconversion to parkinsonism and dementia, from RBD onset, and from RBD diagnosis (when adjusted for age and time between RBD onset and diagnosis). CONCLUSIONS Sleepiness is associated with idiopathic REM sleep behavior disorder and predicts more rapid conversion to parkinsonism and dementia, suggesting it is an early marker of neuronal loss in brainstem arousal systems.
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Affiliation(s)
- Isabelle Arnulf
- Sorbonne Universities, UPMC Univ Paris 06, Paris, France.,Brain Research Institute (CRICM - UPMC-Paris6), Paris, France.,Sleep Disorders Unit, Pitié-Salpêtrière University Hospital, Paris, France
| | - Dulce Neutel
- Sleep Disorders Unit, Pitié-Salpêtrière University Hospital, Paris, France
| | - Bastien Herlin
- Sleep Disorders Unit, Pitié-Salpêtrière University Hospital, Paris, France
| | - Jean-Louis Golmard
- Department of Biostatistics, Salpêtrière Hospital, ER4, Sorbonne Universites, UPMC Univ Paris 06, Paris, France
| | - Smaranda Leu-Semenescu
- Brain Research Institute (CRICM - UPMC-Paris6), Paris, France.,Sleep Disorders Unit, Pitié-Salpêtrière University Hospital, Paris, France
| | | | - Marie Vidailhet
- Sorbonne Universities, UPMC Univ Paris 06, Paris, France.,Brain Research Institute (CRICM - UPMC-Paris6), Paris, France
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22
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Nguyen-Michel VH, Lévy PP, Pallanca O, Kinugawa K, Banica-Wolters R, Sebban C, Mariani J, Fournier E, Arnulf I. Underperception of Naps in Older Adults Referred for a Sleep Assessment: An Insomnia Trait and a Cognitive Problem? J Am Geriatr Soc 2015; 63:2001-7. [DOI: 10.1111/jgs.13660] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- Vi-Huong Nguyen-Michel
- Functional Explorations Unit for the Elderly; Département Hospitalo Universitaire, Fight Against Ageing and Stress; Paris France
- Geriatric Department; Consultation and Investigation Center for the Elderly; Paris France
| | - Pierre-P Lévy
- Public Health Department; Assistance Publique - Hôpitaux de Paris; Groupe Hospitalier de l'Est Parisien; Paris France
- Epidemiology of Allergic and Respiratory Diseases Team; Unité Mixte de Recherche en Santé 1136; Sorbonne Universités; Université Pierre et Marie Curie; Paris France
- Epidemiology of Allergic and Respiratory Diseases Team; Inserm U 1136; Paris France
| | - Olivier Pallanca
- Department of Clinical Neurophysiology; Insomnia Investigation Center; Assistance Publique - Hôpitaux de Paris; Groupe Hospitalier Pitié-Salpêtrière-Charles Foix; Paris France
| | - Kiyoka Kinugawa
- Functional Explorations Unit for the Elderly; Département Hospitalo Universitaire, Fight Against Ageing and Stress; Paris France
- Geriatric Department; Consultation and Investigation Center for the Elderly; Paris France
- Biological Adaptation and Ageing Team Brain Development, Repair and Aging; Unité Mixte de Recherche 8256; Sorbonne Universités; Université Pierre et Marie Curie; Paris France
- Biological Adaptation and Ageing Team Brain Development, Repair and Aging; Unité Mixte de Recherche 8256; Centre National de la Recherche Scientifique; Paris France
| | | | - Claude Sebban
- Functional Explorations Unit for the Elderly; Département Hospitalo Universitaire, Fight Against Ageing and Stress; Paris France
| | - Jean Mariani
- Functional Explorations Unit for the Elderly; Département Hospitalo Universitaire, Fight Against Ageing and Stress; Paris France
- Biological Adaptation and Ageing Team Brain Development, Repair and Aging; Unité Mixte de Recherche 8256; Sorbonne Universités; Université Pierre et Marie Curie; Paris France
- Biological Adaptation and Ageing Team Brain Development, Repair and Aging; Unité Mixte de Recherche 8256; Centre National de la Recherche Scientifique; Paris France
| | - Emmanuel Fournier
- Functional Explorations Unit for the Elderly; Département Hospitalo Universitaire, Fight Against Ageing and Stress; Paris France
- Department of Clinical Neurophysiology; Insomnia Investigation Center; Assistance Publique - Hôpitaux de Paris; Groupe Hospitalier Pitié-Salpêtrière-Charles Foix; Paris France
- Sorbonne Universités; Université Pierre et Marie Curie; Paris France
| | - Isabelle Arnulf
- Sorbonne Universités; Université Pierre et Marie Curie; Paris France
- Sleep Disorders Unit; National Reference Center for Narcolepsy, Hypersomnia and Kleine-Levin Syndrome; Assistance Publique - Hôpitaux de Paris; Groupe Hospitalier Pitié-Salpêtrière-Charles Foix; Paris France
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23
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Pont-Sunyer C, Iranzo A, Gaig C, Fernández-Arcos A, Vilas D, Valldeoriola F, Compta Y, Fernández-Santiago R, Fernández M, Bayés A, Calopa M, Casquero P, de Fàbregues O, Jaumà S, Puente V, Salamero M, José Martí M, Santamaría J, Tolosa E. Sleep Disorders in Parkinsonian and Nonparkinsonian LRRK2 Mutation Carriers. PLoS One 2015; 10:e0132368. [PMID: 26177462 PMCID: PMC4503402 DOI: 10.1371/journal.pone.0132368] [Citation(s) in RCA: 59] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2015] [Accepted: 06/14/2015] [Indexed: 12/21/2022] Open
Abstract
Objective In idiopathic Parkinson disease (IPD) sleep disorders are common and may antedate the onset of parkinsonism. Based on the clinical similarities between IPD and Parkinson disease associated with LRRK2 gene mutations (LRRK2-PD), we aimed to characterize sleep in parkinsonian and nonmanifesting LRRK2 mutation carriers (NMC). Methods A comprehensive interview conducted by sleep specialists, validated sleep scales and questionnaires, and video-polysomnography followed by multiple sleep latency test (MSLT) assessed sleep in 18 LRRK2-PD (17 carrying G2019S and one R1441G mutations), 17 NMC (11 G2019S, three R1441G, three R1441C), 14 non-manifesting non-carriers (NMNC) and 19 unrelated IPD. Results Sleep complaints were frequent in LRRK2-PD patients; 78% reported poor sleep quality, 33% sleep onset insomnia, 56% sleep fragmentation and 39% early awakening. Sleep onset insomnia correlated with depressive symptoms and poor sleep quality. In LRRK2-PD, excessive daytime sleepiness (EDS) was a complaint in 33% patients and short sleep latencies on the MSLT, which are indicative of objective EDS, were found in 71%. Sleep attacks occurred in three LRRK2-PD patients and a narcoleptic phenotype was not observed. REM sleep behavior disorder (RBD) was diagnosed in three LRRK2-PD. EDS and RBD were always reported to start after the onset of parkinsonism in LRRK2-PD. In NMC, EDS was rarely reported and RBD was absent. When compared to IPD, sleep onset insomnia was more significantly frequent, EDS was similar, and RBD was less significantly frequent and less severe in LRRK2-PD. In NMC, RBD was not detected and sleep complaints were much less frequent than in LRRK2-PD. No differences were observed in sleep between NMC and NMNC. Conclusions Sleep complaints are frequent in LRRK2-PDand show a pattern that when compared to IPD is characterized by more frequent sleep onset insomnia, similar EDS and less prominent RBD. Unlike in IPD, RBD and EDS seem to be not markers of the prodromal stage of LRRK2-PD.
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Affiliation(s)
- Claustre Pont-Sunyer
- Parkinson’s Disease and Movement Disorders Unit, Neurology Service, Hospital Clinic de Barcelona, Universitat de Barcelona, Institut d’Investigacions BiomediquesAugust Pi I Sunyer (IDIBAPS), Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED), Barcelona, Spain
| | - Alex Iranzo
- MultidisciplinarySleepDisordersUnit, Neurology Service, Hospital Clinic de Barcelona, Universitat de Barcelona, Institut d’Investigacions BiomediquesAugust Pi I Sunyer (IDIBAPS), Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED), Barcelona, Spain
- * E-mail:
| | - Carles Gaig
- MultidisciplinarySleepDisordersUnit, Neurology Service, Hospital Clinic de Barcelona, Universitat de Barcelona, Institut d’Investigacions BiomediquesAugust Pi I Sunyer (IDIBAPS), Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED), Barcelona, Spain
| | - Ana Fernández-Arcos
- MultidisciplinarySleepDisordersUnit, Neurology Service, Hospital Clinic de Barcelona, Universitat de Barcelona, Institut d’Investigacions BiomediquesAugust Pi I Sunyer (IDIBAPS), Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED), Barcelona, Spain
| | - Dolores Vilas
- Parkinson’s Disease and Movement Disorders Unit, Neurology Service, Hospital Clinic de Barcelona, Universitat de Barcelona, Institut d’Investigacions BiomediquesAugust Pi I Sunyer (IDIBAPS), Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED), Barcelona, Spain
| | - Francesc Valldeoriola
- Parkinson’s Disease and Movement Disorders Unit, Neurology Service, Hospital Clinic de Barcelona, Universitat de Barcelona, Institut d’Investigacions BiomediquesAugust Pi I Sunyer (IDIBAPS), Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED), Barcelona, Spain
| | - Yaroslau Compta
- Parkinson’s Disease and Movement Disorders Unit, Neurology Service, Hospital Clinic de Barcelona, Universitat de Barcelona, Institut d’Investigacions BiomediquesAugust Pi I Sunyer (IDIBAPS), Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED), Barcelona, Spain
| | - Ruben Fernández-Santiago
- Laboratory of Neurodegenerative Disorders, Department of Clinical and Experimental Neurology, Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Hospital Clínic de Barcelona, Universitat de Barcelona, Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED), Barcelona, Spain
| | - Manel Fernández
- Laboratory of Neurodegenerative Disorders, Department of Clinical and Experimental Neurology, Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Hospital Clínic de Barcelona, Universitat de Barcelona, Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED), Barcelona, Spain
| | | | - Matilde Calopa
- NeurologyService, Hospital Universitari de Bellvitge, Barcelona, Spain
| | | | - Oriol de Fàbregues
- Neurology Service, Hospital Universitari Vall D’Hebron, Barcelona, Spain
| | - Serge Jaumà
- NeurologyService, Hospital Universitari de Bellvitge, Barcelona, Spain
| | - Victor Puente
- Neurology Service, Hospital Del Mar, Barcelona, Spain
| | | | - Maria José Martí
- Parkinson’s Disease and Movement Disorders Unit, Neurology Service, Hospital Clinic de Barcelona, Universitat de Barcelona, Institut d’Investigacions BiomediquesAugust Pi I Sunyer (IDIBAPS), Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED), Barcelona, Spain
| | - Joan Santamaría
- MultidisciplinarySleepDisordersUnit, Neurology Service, Hospital Clinic de Barcelona, Universitat de Barcelona, Institut d’Investigacions BiomediquesAugust Pi I Sunyer (IDIBAPS), Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED), Barcelona, Spain
| | - Eduard Tolosa
- Parkinson’s Disease and Movement Disorders Unit, Neurology Service, Hospital Clinic de Barcelona, Universitat de Barcelona, Institut d’Investigacions BiomediquesAugust Pi I Sunyer (IDIBAPS), Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED), Barcelona, Spain
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Salawu F, Olokoba A. Excessive daytime sleepiness and unintended sleep episodes associated with Parkinson's disease. Oman Med J 2015; 30:3-10. [PMID: 25829994 DOI: 10.5001/omj.2015.02] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2012] [Accepted: 12/07/2014] [Indexed: 12/20/2022] Open
Abstract
This article looks at the issues of excessive daytime sleepiness and unintended sleep episodes in patients with Parkinson's disease (PD) and explores the reasons why patients might suffer from these symptoms, and what steps could be taken to manage them. During the last decade, understanding of sleep/wake regulation has increased. Several brainstem nuclei and their communication pathways in the ascending arousing system through the hypothalamus and thalamus to the cortex play key roles in sleep disorders. Insomnia is the most common sleep disorder in PD patients, and excessive daytime sleepiness is also common. Excessive daytime sleepiness affects up to 50% of PD patients and a growing body of research has established this sleep disturbance as a marker of preclinical and premotor PD. It is a frequent and highly persistent feature in PD, with multifactorial underlying pathophysiology. Both age and disease-related disturbances of sleep-wake regulation contribute to hypersomnia in PD. Treatment with dopamine agonists also contribute to excessive daytime sleepiness. Effective management of sleep disturbances and excessive daytime sleepiness can greatly improve the quality of life for patients with PD.
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Affiliation(s)
- Fatai Salawu
- Department of Medicine, Federal Medical Centre, Yola, Nigeria
| | - Abdulfatai Olokoba
- Department of General Internal Medicine, University of Ilorin Teaching Hospital, Ilorin. Nigeria
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Anang JBM, Gagnon JF, Bertrand JA, Romenets SR, Latreille V, Panisset M, Montplaisir J, Postuma RB. Predictors of dementia in Parkinson disease: a prospective cohort study. Neurology 2014; 83:1253-60. [PMID: 25171928 DOI: 10.1212/wnl.0000000000000842] [Citation(s) in RCA: 277] [Impact Index Per Article: 27.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
OBJECTIVE We investigated an array of possible markers of early dementia in Parkinson disease. METHODS We performed a comprehensive assessment of autonomic, sleep, psychiatric, visual, olfactory, and motor manifestations in 80 patients with Parkinson disease who were dementia-free at baseline. After 4.4 years' follow-up, patients were evaluated for dementia. Predictive variables were assessed using logistic regression adjusting for disease duration, follow-up duration, age, and sex. RESULTS Of 80 patients, 27 (34%) developed dementia. Patients destined to develop dementia were older and more often male (odds ratio [OR] = 3.64, p = 0.023). Those with baseline mild cognitive impairment had increased dementia risk (OR = 22.5, p < 0.001). REM sleep behavior disorder at baseline dramatically increased dementia risk (OR = 49.7, p = 0.001); however, neither daytime sleepiness nor insomnia predicted dementia. Higher baseline blood pressure increased dementia risk (OR = 1.37 per 10 mm Hg, p = 0.032). Orthostatic blood pressure drop was strongly associated with dementia risk (OR = 1.84 per 10 mm Hg, p < 0.001); having a systolic drop of >10 mm Hg increased dementia odds 7-fold (OR = 7.3, p = 0.002). Abnormal color vision increased dementia risk (OR = 3.3, p = 0.014), but olfactory dysfunction did not. Among baseline motor variables, proportion of gait involvement (OR = 1.12, p = 0.023), falls (OR = 3.02, p = 0.042), and freezing (OR = 2.63, p = 0.013), as well as the Purdue Pegboard Test (OR = 0.67, p = 0.049) and alternate tap test (OR = 0.97, p = 0.033) predicted dementia. CONCLUSION Cardiovascular autonomic dysfunction, REM sleep behavior disorder, color discrimination ability, and gait dysfunction strongly predict development of dementia in Parkinson disease.
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Affiliation(s)
- Julius B M Anang
- From the Department of Neurology and Neurosurgery (J.B.M.A., S.R.R., R.B.P.), McGill University, Montreal; Centre d'Études Avancées en Médecine du Sommeill (J.-F.G., J.-A.B., V.L., M.P., J.M., R.B.P.), Hôpital du Sacré-coeur de Montréal; Department of Psychology (J.-F.G., J.-A.B.), Université du Québec à Montréal; and Department of Psychiatry (J.M.), Université de Montreal, Canada
| | - Jean-Francois Gagnon
- From the Department of Neurology and Neurosurgery (J.B.M.A., S.R.R., R.B.P.), McGill University, Montreal; Centre d'Études Avancées en Médecine du Sommeill (J.-F.G., J.-A.B., V.L., M.P., J.M., R.B.P.), Hôpital du Sacré-coeur de Montréal; Department of Psychology (J.-F.G., J.-A.B.), Université du Québec à Montréal; and Department of Psychiatry (J.M.), Université de Montreal, Canada.
| | - Josie-Anne Bertrand
- From the Department of Neurology and Neurosurgery (J.B.M.A., S.R.R., R.B.P.), McGill University, Montreal; Centre d'Études Avancées en Médecine du Sommeill (J.-F.G., J.-A.B., V.L., M.P., J.M., R.B.P.), Hôpital du Sacré-coeur de Montréal; Department of Psychology (J.-F.G., J.-A.B.), Université du Québec à Montréal; and Department of Psychiatry (J.M.), Université de Montreal, Canada
| | - Silvia Rios Romenets
- From the Department of Neurology and Neurosurgery (J.B.M.A., S.R.R., R.B.P.), McGill University, Montreal; Centre d'Études Avancées en Médecine du Sommeill (J.-F.G., J.-A.B., V.L., M.P., J.M., R.B.P.), Hôpital du Sacré-coeur de Montréal; Department of Psychology (J.-F.G., J.-A.B.), Université du Québec à Montréal; and Department of Psychiatry (J.M.), Université de Montreal, Canada
| | - Veronique Latreille
- From the Department of Neurology and Neurosurgery (J.B.M.A., S.R.R., R.B.P.), McGill University, Montreal; Centre d'Études Avancées en Médecine du Sommeill (J.-F.G., J.-A.B., V.L., M.P., J.M., R.B.P.), Hôpital du Sacré-coeur de Montréal; Department of Psychology (J.-F.G., J.-A.B.), Université du Québec à Montréal; and Department of Psychiatry (J.M.), Université de Montreal, Canada
| | - Michel Panisset
- From the Department of Neurology and Neurosurgery (J.B.M.A., S.R.R., R.B.P.), McGill University, Montreal; Centre d'Études Avancées en Médecine du Sommeill (J.-F.G., J.-A.B., V.L., M.P., J.M., R.B.P.), Hôpital du Sacré-coeur de Montréal; Department of Psychology (J.-F.G., J.-A.B.), Université du Québec à Montréal; and Department of Psychiatry (J.M.), Université de Montreal, Canada
| | - Jacques Montplaisir
- From the Department of Neurology and Neurosurgery (J.B.M.A., S.R.R., R.B.P.), McGill University, Montreal; Centre d'Études Avancées en Médecine du Sommeill (J.-F.G., J.-A.B., V.L., M.P., J.M., R.B.P.), Hôpital du Sacré-coeur de Montréal; Department of Psychology (J.-F.G., J.-A.B.), Université du Québec à Montréal; and Department of Psychiatry (J.M.), Université de Montreal, Canada
| | - Ronald B Postuma
- From the Department of Neurology and Neurosurgery (J.B.M.A., S.R.R., R.B.P.), McGill University, Montreal; Centre d'Études Avancées en Médecine du Sommeill (J.-F.G., J.-A.B., V.L., M.P., J.M., R.B.P.), Hôpital du Sacré-coeur de Montréal; Department of Psychology (J.-F.G., J.-A.B.), Université du Québec à Montréal; and Department of Psychiatry (J.M.), Université de Montreal, Canada.
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Ataide M, Franco CMR, Lins OG. Daytime sleepiness and Parkinson's disease: the contribution of the multiple sleep latency test. SLEEP DISORDERS 2014; 2014:767181. [PMID: 25126427 PMCID: PMC4121261 DOI: 10.1155/2014/767181] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/20/2014] [Revised: 06/02/2014] [Accepted: 06/20/2014] [Indexed: 12/04/2022]
Abstract
Background. Sleep disorders are major nonmotor manifestations of patients with Parkinson's disease (PD), and excessive daytime sleepiness (EDS) is one of the most common symptoms. Objective. We reviewed a current literature concerning major factors that influence EDS in PD patients, using Multiple Sleep Latency Test (MSLT). Methods. A Medline search found 23 studies. Results. The presence of EDS was observed in 12.7% to 47% in patients without complaints of daytime sleepiness and 47% to 66.7% with complaints of daytime sleepiness. Despite being recognized by several authors, major factors that influence EDS, such as severity of motor symptoms, use of dopaminergic medications, and associated sleep disturbances, presented contradictory data. Conclusions. Available data suggest that the variability of the results may be related to the fact that it was conducted with a small sample size, not counting the neuropathological heterogeneity of the disease. Thus, before carrying out longitudinal studies with significant samples, careful analysis should be done by assigning a specific agent on the responsibility of EDS in PD patients.
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Affiliation(s)
- Marcelo Ataide
- Pós-Graduação em Neuropsiquiatria e Ciências do Comportamento, Universidade Federal de Pernambuco, Recife, PE, Brazil
| | | | - Otavio Gomes Lins
- Pós-Graduação em Neuropsiquiatria e Ciências do Comportamento, Universidade Federal de Pernambuco, Recife, PE, Brazil
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Daytime sleep in Parkinson's disease measured by episodes of immobility. Parkinsonism Relat Disord 2014; 20:578-83. [DOI: 10.1016/j.parkreldis.2014.02.011] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2013] [Revised: 01/03/2014] [Accepted: 02/12/2014] [Indexed: 11/22/2022]
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Abstract
PURPOSE OF REVIEW The aim is to review sleep disturbances in different movement disorders, mainly Parkinson's disease, and highlight current concepts on merging the boundaries between movement disorders and dissociative states of being. RECENT FINDINGS Since the observation that rapid eye movement sleep behavior disorder (RBD) may be an early marker of neurodegeneration, many studies focused on this disorder for the opportunity to explore the pathogenetic mechanisms underlying movement disorder and future neuroprotective therapies. It is also increasingly evident that this disorder is a possible marker for incoming dementia and for a general worst prognosis. Mechanisms of excessive daytime sleepiness in Parkinson's disease are still to be clarified and, if the role of hypocretin neuron loss is still doubtful, attention is moving to the role of monoaminergic system disruption. The role of dopamine in circadian rhythm regulation is opening new scenarios, namely the disruption of clock genes expression. Finally, the close relationship between sleep and movement disorder is emerging also in primarly sleep disorders. SUMMARY Recent studies provided new insights into the links between sleep and movement disorder that may simplify the diagnostic process and shed light on the underlying pathophysiological mechanisms.
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Affiliation(s)
- Maria P Giannoccaro
- IRCCS Istituto delle Scienze Neurologiche, University of Bologna, Bologna, Italy
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Daytime sleepiness in Parkinson's disease: perception, influence of drugs, and mood disorder. SLEEP DISORDERS 2014; 2014:939713. [PMID: 24587912 PMCID: PMC3920819 DOI: 10.1155/2014/939713] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/07/2013] [Accepted: 10/31/2013] [Indexed: 12/02/2022]
Abstract
Parkinson's disease (PD) is associated with sleep complaints as excessive daytime sleepiness (EDS) and several factors have been implicated in the genesis of these complaints. Objective. To correlate the subjective perception of EDS with variables as the severity of the motor symptoms, medications, and the presence of depressive symptoms. Materials and Methods. A cross-sectional study, using specific scales as Epworth sleepiness scale (ESS), Beck depression inventory (iBeck) and Hoehn and Yahr (HY), in 42 patients with PD. Results. The patients had a mean age of 61.2 ± 11.3 years and mean disease duration of 4.96 ± 3.3 years. The mean ESS was 7.5 ± 4.7 and 28.6% of patients reached a score of abnormally high value (>10). There was no association with gender, disease duration, and dopamine agonists. Patients with EDS used larger amounts of levodopa (366.7 ± 228.0 versus 460.4 ± 332.25 mg, P = 0.038), but those who had an iBeck >20 reached lower values of ESS than the others (5.9 ± 4.1 versus 9.3 ± 4.8, P = 0.03). Conclusions. EDS was common in PD patients, being related to levodopa intake. Presence of depressed mood may influence the final results of self-assessment scales for sleep disorders.
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Doxepin and cognitive behavioural therapy for insomnia in patients with Parkinson's disease -- a randomized study. Parkinsonism Relat Disord 2013; 19:670-5. [PMID: 23561946 DOI: 10.1016/j.parkreldis.2013.03.003] [Citation(s) in RCA: 114] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2013] [Revised: 02/24/2013] [Accepted: 03/11/2013] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Although a variety of pharmacologic and non-pharmacologic treatments are effective for insomnia in the general population, insomnia in Parkinson's disease differs in important ways and may need different treatments. No studies have conclusively demonstrated effective insomnia treatments in Parkinson's disease. METHODS We conducted a three-arm six-week randomized pilot study assessing non-pharmacologic treatment (cognitive behavioural therapy with bright light therapy) or doxepin (10 mg daily), compared to an inactive placebo in Parkinson's patients with insomnia. Sleep outcomes included insomnia scales, clinical global impression, sleep diaries and actigraphy. Secondary outcomes included motor severity, fatigue, depression and quality of life. RESULTS 18 patients were randomized, 6 to each group. Compared to placebo, doxepin improved the Insomnia Severity Index (-9 ± 5.4 vs. -2 ± 3.9, p = 0.03), the SCOPA-night score (-5.2 ± 1.5 vs. -2.3 ± 2.8, p = 0.049), the Pittsburgh Sleep Quality Index-sleep disturbances subscale (-0.5 ± 0.5 vs 0.2 ± 0.4, p = 0.02), and both patient and examiner-rated clinical global impression of change (1.7 ± 0.8 vs. 0.5 ± 0.8, p = 0.03 and 1.4 ± 0.5 vs. 0.3 ± 0.5, p = 0.003). On secondary outcomes doxepin reduced the fatigue severity scale (p = 0.02) and improved scores on the Montreal Cognitive Assessment (p = 0.007). Non-pharmacological treatment reduced the Insomnia Severity Index (-7.8 ± 3.8 vs. -2.0 ± 3.9, p = 0.03), and the examiner-reported clinical global impression of change (p = 0.006), but was associated with decline in Parkinson Disease Questionnaire-39. There were no changes in other primary and secondary outcomes, including actigraphy outcomes. Adverse events were comparable in all groups. CONCLUSION Doxepin and non-pharmacologic treatment substantially improved insomnia in Parkinson's disease. These potential benefits must be replicated in a full confirmatory randomized controlled trial.
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Postuma RB, Lang AE, Munhoz RP, Charland K, Pelletier A, Moscovich M, Filla L, Zanatta D, Rios Romenets S, Altman R, Chuang R, Shah B. Caffeine for treatment of Parkinson disease: a randomized controlled trial. Neurology 2012; 79:651-8. [PMID: 22855866 DOI: 10.1212/wnl.0b013e318263570d] [Citation(s) in RCA: 188] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE Epidemiologic studies consistently link caffeine, a nonselective adenosine antagonist, to lower risk of Parkinson disease (PD). However, the symptomatic effects of caffeine in PD have not been adequately evaluated. METHODS We conducted a 6-week randomized controlled trial of caffeine in PD to assess effects upon daytime somnolence, motor severity, and other nonmotor features. Patients with PD with daytime somnolence (Epworth >10) were given caffeine 100 mg twice daily ×3 weeks, then 200 mg twice daily ×3 weeks, or matching placebo. The primary outcome was the Epworth Sleepiness Scale score. Secondary outcomes included motor severity, sleep markers, fatigue, depression, and quality of life. Effects of caffeine were analyzed with Bayesian hierarchical models, adjusting for study site, baseline scores, age, and sex. RESULTS Of 61 patients, 31 were randomized to placebo and 30 to caffeine. On the primary intention-to-treat analysis, caffeine resulted in a nonsignificant reduction in Epworth Sleepiness Scale score (-1.71 points; 95% confidence interval [CI] -3.57, 0.13). However, somnolence improved on the Clinical Global Impression of Change (+0.64; 0.16, 1.13, intention-to-treat), with significant reduction in Epworth Sleepiness Scale score on per-protocol analysis (-1.97; -3.87, -0.05). Caffeine reduced the total Unified Parkinson's Disease Rating Scale score (-4.69 points; -7.7, -1.6) and the objective motor component (-3.15 points; -5.50, -0.83). Other than modest improvement in global health measures, there were no changes in quality of life, depression, or sleep quality. Adverse events were comparable in caffeine and placebo groups. CONCLUSIONS Caffeine provided only equivocal borderline improvement in excessive somnolence in PD, but improved objective motor measures. These potential motor benefits suggest that a larger long-term trial of caffeine is warranted. CLASSIFICATION OF EVIDENCE This study provides Class I evidence that caffeine, up to 200 mg BID for 6 weeks, had no significant benefit on excessive daytime sleepiness in patients with PD.
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Affiliation(s)
- Ronald B Postuma
- Department of Neurology, McGill University, Montreal General Hospital, Montreal, Canada.
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Abstract
SUMMARY Parkinson’s disease (PD) patients demonstrate a variety of sleep/wake complaints. Some of these are associated with dopaminergic dysfunction, some presumed to arise from nondopaminergic PD pathology, some from PD treatments and, in some, the etiologies are multifactorial or unknown. Optimal management of sleep/wake problems requires a good understanding of sleep/wake principals in the PD population, as there are few controlled trials to dictate therapy. In this article, we review the main causes of sleep/wake disorders in PD patients, namely sleep fragmentation, excessive daytime sleepiness, restless legs syndrome, periodic limb movement of sleep, rapid eye movement sleep behavioral disorder and sleep apnea. Available therapies and management recommendations for each disorder are given particular emphasis.
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Affiliation(s)
- Raja Mehanna
- Parkinson’s Disease Center & Movement Disorders Clinic, Department of Neurology, Baylor College of Medicine, Houston, TX, USA
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Trenkwalder C, Kohnen R, Högl B, Metta V, Sixel-Döring F, Frauscher B, Hülsmann J, Martinez-Martin P, Chaudhuri KR. Parkinson's disease sleep scale--validation of the revised version PDSS-2. Mov Disord 2011; 26:644-52. [PMID: 21312275 DOI: 10.1002/mds.23476] [Citation(s) in RCA: 243] [Impact Index Per Article: 18.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2010] [Revised: 09/07/2010] [Accepted: 09/17/2010] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND The previous Parkinson's disease sleep scale (PDSS) is a 15-item visual analogue scale that assesses the profile of nocturnal disturbances in Parkinson's disease (PD) patients. OBJECTIVE To extend the scale so that it becomes a frequency measure scale with five categories and encompasses unmet needs such as restless legs syndrome, akinesia, pain, and sleep apnea. METHODS For validation of the PDSS-2, PD patients' ratings and investigators' interviews were compared to ratings from a semistructured interview with a caregiver/partner, and to related scales. PDSS-2 was repeated for test-retest-reliability after 1-3 days. RESULTS A total of 113 PD patients showed a mean (SD) total score of 16.5 (±8.9) (range: 2-40) indicating mild to moderate sleep disturbances. PDSS-2 item-total correlation for proving internal consistency was satisfactory (correlations >0.30). From a factor analysis, three subscales were derived: (1) "motor problems at night," (2) "PD symptoms at night" and (3) "disturbed sleep." The alpha coefficient for the total score was 0.73, for subscales 0.47 to 0.66. The test-retest-reliability intra-class-coefficient for the total score was 0.80, with 0.69 and 0.77 within the subscales. For discriminative validity, significant differences were found in the PDSS-2 total score depending on CGI and Hoehn and Yahr severity levels. A comparison between caregivers' and patients' ratings was carried out. CONCLUSION The PDSS-2, with an extended spectrum of nocturnal disabilities and easier use for patients, is a reliable, valid, precise, and potentially treatment-responsive tool for measuring sleep disorders in PD.
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Högl B, Arnulf I, Comella C, Ferreira J, Iranzo A, Tilley B, Trenkwalder C, Poewe W, Rascol O, Sampaio C, Stebbins GT, Schrag A, Goetz CG. Scales to assess sleep impairment in Parkinson's disease: critique and recommendations. Mov Disord 2010; 25:2704-16. [PMID: 20931631 DOI: 10.1002/mds.23190] [Citation(s) in RCA: 173] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/03/2023] Open
Abstract
There is a broad spectrum of sleep disturbances observed in Parkinson's disease (PD). A variety of scales have been applied to the evaluation of PD sleep and wakefulness, but only a small number have been assessed specifically for clinimetric properties in the PD population. The movement disorder society has commissioned this task force to examine these scales and to assess their use in PD. A systematic literature review was conducted to explore the use of sleep scales in PD and to determine which scales qualified for a detailed critique. The task force members, all of whom have extensive experience in assessing sleep in PD reviewed each of the scales using a structured proforma. Scales were categorized into recommended, suggested and listed according to predefined criteria. A total of 48 potential scales were identified from the search and reviewed. Twenty-nine were excluded because they did not meet review criteria or were variations of scales already included, leaving 19 scales that were critiqued and rated by the task force based on the rating criteria. Only six were found to meet criteria for recommendation or suggestion by the task force: the PD sleep scale (PDSS) and the Pittsburgh sleep quality index (PSQI) are recommended for rating overall sleep problems to screen and to measure severity, the SCOPA-sleep (SCOPA) is recommended for rating overall sleep problems both to screen and to measure severity, and for rating daytime sleepiness; the Epworth sleepiness scale (ESS) is recommended for rating daytime sleepiness to screen and to measure severity; the inappropriate sleep composite score (ISCS) is suggested for rating severe daytime sleepiness or sleep attacks to screen and to measure severity; and the Stanford sleepiness scale (SSS) is suggested for rating sleepiness and to measure severity at a specific moment. The task force does not recommend the development of new scales, but emphasizes the need for educational efforts to train physicians in sleep interview techniques and polysomnography.
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Affiliation(s)
- Birgit Högl
- Department of Neurology, Innsbruck Medical University, Innsbruck, Austria.
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Abstract
Excessive daytime sleepiness is a disabling and vital problem in patients with PD. It affects around 33% patients and culminates in sleep attacks (without prodroma) in 1 to 4% of the patients. When monitored, short, narcolepsy-like naps with abnormal intrusion of REM sleep during daytime (and hypnagogic hallucinations as wakeful dreams) are observed in 33-41% patients, while other patients display naps with non REM sleep. Although insomnia, sleep apnea and periodic leg movements are common in these patients, there is no clear link between the night events and the level of sleepiness. Patients treated with dopamine agonists are two to three fold more exposed to sleep attacks than those on levodopa, with large variability between patients. Sleepiness may exist, to a lesser degree, before the onset of parkinsonism and before the use of dopamine agents, suggesting that other, disease-dependant factors contribute to the sleepiness. Most arousal systems are indeed damaged in PD brains, including the locus coeruleus (noradrenalin), the pedunculo-pontine nucleus and the basal forebrain (acetylcholine), the median raphe (serotonin), and the lateral hypothalamus (orexin), while histamine dopamine arousal system are normal. Treating patients with stimulants such as modafinil is only partially efficacious, while trials of anti-H3 drugs and sodium oxybate seem more active. Eventually, the recent stimulation of the pedunculopontine nucleus has stimulant or sedative effects in patients, depending on the frequency of stimulation. These results provide new insights into the mechanisms of arousal in PD.
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Affiliation(s)
- Isabelle Arnulf
- Sleep Disorders Unit and Inserm UMR 975, Pitié-Salpêtrière Hospital, Assistance Publique Hôpitaux de Paris, Paris 6 University, Paris, France.
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Lim SY, Lang AE. The nonmotor symptoms of Parkinson's disease-An overview. Mov Disord 2010; 25 Suppl 1:S123-30. [DOI: 10.1002/mds.22786] [Citation(s) in RCA: 117] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
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Löhle M, Storch A, Reichmann H. Beyond tremor and rigidity: non-motor features of Parkinson’s disease. J Neural Transm (Vienna) 2009; 116:1483-92. [DOI: 10.1007/s00702-009-0274-1] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2009] [Accepted: 07/17/2009] [Indexed: 10/20/2022]
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Monaca C. [Sleep disorders and parkinsonian syndromes]. Rev Neurol (Paris) 2008; 164:F253-62. [PMID: 19268188 DOI: 10.1016/s0035-3787(08)75126-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- C Monaca
- Service de Neurophysiologie Clinique, Hôpital Roger Salengro, CHRU de Lille, Lille.
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Möller JC, Unger M, Stiasny-Kolster K, Kaussner Y, Penzel T, Oertel WH, Hemmeter U. Continuous sleep EEG monitoring in PD patients with and without sleep attacks. Parkinsonism Relat Disord 2008; 15:238-41. [PMID: 18619893 DOI: 10.1016/j.parkreldis.2008.05.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2008] [Revised: 05/15/2008] [Accepted: 05/22/2008] [Indexed: 10/21/2022]
Abstract
The pathogenesis of sleep attacks in Parkinson's disease (PD) is still unresolved. We investigated seven matched pairs of PD patients with and without a history of sleep attacks using continuous sleep EEG recording. According to the event marker altogether 12 sleep attacks were identified in three patients with a history of sleep attacks. All sleep attacks were characterized by NREM stage 1 and 2 sleep, whereas no sleep onset REM episodes were recorded. Five sleep attacks fulfilled our criteria for microsleep episodes lasting less than 120 s. The cumulative duration of microsleep episodes during the day was 27.7+/-20 min in patients with a history of sleep attacks vs. 6.4+/-4.1 min in patients without a history of sleep attacks (p=0.03), i.e., the majority of microsleep episodes were not perceived by the patients. In summary, our study suggests that sleep attacks are intrusions of NREM stage 1 and 2 sleep into wakefulness and can be identical to microsleep episodes. Future studies should systematically address the awareness of short sleep episodes in patients with PD and other disorders with increased daytime sleepiness.
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Affiliation(s)
- Jens Carsten Möller
- Department of Neurology, Philipps-University Marburg, Rudolf-Bultmann-Strasse 8, 35039 Marburg, Germany.
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Affiliation(s)
- Thomas Freedom
- Sleep Disorders Center, Evanston Nothwestern Healthcare, Evanston Hospital, Evanston, Illinois, USA
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Trenkwalder C, Högl B. Sleep in Parkinson syndromes. HANDBOOK OF CLINICAL NEUROLOGY 2007; 83:365-76. [PMID: 18808922 DOI: 10.1016/s0072-9752(07)83015-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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Ghorayeb I, Loundou A, Auquier P, Dauvilliers Y, Bioulac B, Tison F. A nationwide survey of excessive daytime sleepiness in Parkinson's disease in France. Mov Disord 2007; 22:1567-72. [PMID: 17534963 DOI: 10.1002/mds.21541] [Citation(s) in RCA: 64] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
To determine the prevalence of excessive daytime sleepiness (EDS) and that of dozing and sudden onset of sleep episodes (SOS) while driving in ambulatory patients with Parkinson's disease (PD) in France, a national sample of private and public neurologists was asked to recruit the first 10 consecutive nondemented PD patients. Each patient completed a questionnaire including the Epworth Sleepiness Scale (ESS) and the likelihood of dozing off and experiencing SOS episodes behind the wheel. Clinical and demographic data were collected. One thousand six hundred and twenty-five patients with PD were included in the survey. Twenty-nine percent of the patients suffered from EDS (ESS score>or=10) but only 0.8% declared a high chance of dozing while driving and 0.5% reported totally unpredictable SOS episodes while driving. Risk factors for EDS were male gender, reduced activity of daily living, and a high daily levodopa equivalent dosage. Risk factors for SOS episodes while driving were an ESS score>or=10, male gender, and low Hoehn and Yahr staging. EDS is common in ambulatory patients with PD and is a major risk factor for dozing and for SOS episodes behind the wheel in patients who drive.
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Affiliation(s)
- Imad Ghorayeb
- Service d'Explorations Fonctionnelles du Système Nerveux, Hôpital Pellegrin, Bordeaux, France.
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Abstract
Patients with Parkinson's disease and parkinsonian syndromes (eg, dementia with Lewy body disease, multisystem atrophy, and Shy-Drager syndrome) suffer from daytime sleepiness. This sleepiness is common and very real, often approaching levels observed in the prototypical disorder of sudden-onset sleep, namely narcolepsy/cataplexy. Physicians need to be vigilant in assessing parkinsonian patients for sleepiness because treatment can dramatically enhance quality of life and prevent the significant morbidity and mortality that attends daytime sleepiness. Male patients with advanced disease, cognitive impairment, drug-induced psychosis, and orthostatic hypotension are most at risk for developing pathologic sleepiness. Because primary sleep disorders can coexist with parkinsonism (eg, sleep apnea, insufficient or interrupted sleep), these potential causes should be carefully assessed with polysomnography and treated appropriately. Dopaminomimetics exacerbate sleepiness in a small subset of patients in a dose-dependent fashion. Nonetheless, the primary pathologies involved in parkinsonism appear to be the greatest contributors to daytime sleepiness. Sleepiness in parkinsonism, especially a narcolepsy-like phenotype, may necessitate treatment with wake-promoting agents such as bupropion, modafinil, or traditional psychostimulants.
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Affiliation(s)
- David B Rye
- Department of Neurology, Emory University School of Medicine, 101 Woodruff Circle, WMRB-Suite 6000, PO Drawer V, Atlanta, GA 30322, USA.
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Abstract
Excessive daytime sleepiness (EDS) can affect 20-50% of patients with Parkinson's disease (PD), whereas sleep attacks (SA), which are sleep episodes without prodroma, seem infrequent. EDS is associated with more advanced disease, higher doses of levodopa-equivalent, and sometimes the use of dopamine agonists. Patients at risk for SA have higher Epworth sleepiness scores (ESS) (although an important subset of patients under-score on this scale) and a more frequent use of ergot or non-ergot dopamine agonists. Polysomnography is a valuable tool in patients with PD, because sleep apnea may occur in 20% of patients, whereas a specific narcolepsy-like phenotype, identified on multiple-sleep latency tests, occurs in patients with most severe EDS; this suggests a lesion in sleep-wake systems. Removal or replacement of a recently introduced dopamine agonist may offer some relief for EDS. If not, the adjunction of modafinil has a good benefit-risk ratio in patients with PD. EDS (and sometimes the narcolepsy-like phenotype) may also affect patients with atypical parkinsonism, such as dementia with Lewy bodies, multiple-system atrophy, and progressive supranuclear palsy.
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Affiliation(s)
- Isabelle Arnulf
- Fédération des Pathologies du Sommeil, Hôpital Pitié-Salpêtrière, 47-83 Boulevard de l'Hôpital, 75651 Paris Cedex 13, France.
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Abstract
Depression, dementia, and physiologic changes contribute to the high prevalence of sleep disturbances in patients with Parkinson's disease (PD). Antiparkinsonian drugs also play a role in insomnia by increasing daytime sleepiness and affecting motor symptoms and depression. Common types of sleep disturbances in PD patients include nocturnal sleep disruption and excessive daytime sleepiness, restless legs syndrome, rapid eye movement sleep behavior disorder, sleep apnea, sleep walking and sleep talking, nightmares, sleep terrors, and panic attacks. A thorough assessment should include complete medical and psychiatric histories, sleep history, and a 1- to 2-week sleep diary or Epworth Sleepiness Scale evaluation. Polysomnography or actigraphy may also be indicated. Treatment should address underlying factors such as depression or anxiety. Hypnotic therapy for sleep disturbances in PD patients should be approached with care because of the risks of falling, agitation, drowsiness, and hypotension. Behavioral interventions may also be useful.
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Affiliation(s)
- Michael J Thorpy
- Sleep-Wake Disorders Center, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA
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Grigg-Damberger MM. Sleep in aging and neurodegenerative diseases. SUPPLEMENTS TO CLINICAL NEUROPHYSIOLOGY 2004; 57:508-20. [PMID: 16106652 DOI: 10.1016/s1567-424x(09)70390-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Affiliation(s)
- Madeleine M Grigg-Damberger
- Department of Neurology, University of New Mexico School of Medicine, 915 Camino de Salud NE, ACC-2, Albuquerque, NM 87131, USA.
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