A Polysomnographic Study of Parkinson's Disease Sleep Architecture.

Daniel Martinez-Ramirez,Roger Walz,Zhongxing Peng-Chen,Sol De Jesus,Mayela Rodríguez-Violante,Michael S. Okun,Vanessa Alatriste-Booth,Amin Cervantes-Arriaga

doi:10.1155/2015/570375

Daniel Martinez-Ramirez, Roger Walz + Show 6 more

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https://doi.org/10.1155/2015/570375

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Abstract

Sleep disturbance is a common nonmotor phenomenon in Parkinson's disease (PD) affecting patient's quality of life. In this study, we examined the association between clinical characteristics with sleep disorders and sleep architecture patterns in a PD cohort. Patients underwent a standardized polysomnography study (PSG) in their “on medication” state. We observed that male gender and disease duration were independently associated with obstructive sleep apnea (OSA). Only lower levodopa equivalent dose (LED) was associated with periodic limb movement disorders (PLMD). REM sleep behavior disorder (RBD) was more common among older patients, with higher MDS-UPDRS III scores, and LED. None of the investigated variables were associated with the awakenings/arousals (A/A). Sleep efficiency was predicted by amantadine usage and age, while sleep stage 1 was predicted by dopamine agonists and Hoehn & Yahr severity. The use of MAO-B inhibitors and MDS-UPDRS part III were predictors of sleep stages 2 and 3. Age was the only predictor of REM sleep stage and gender for total sleep time. We conclude that sleep disorders and architecture are poorly predictable by clinical PD characteristics and other disease related factors must also be contributing to these sleep disturbances.

Highlights

Sleep disturbance is a common nonmotor phenomenon in Parkinson’s disease (PD) patients with a prevalence reported to vary from 40% to 90% [1]
Dopaminergic therapy was carefully documented as follows: 76.4% were receiving levodopa therapy, 81.8% were on a dopamine agonist, and 60% were on polytherapy
A cross-sectional study of 55 PD patients was conducted at the National Institute of Neurology and Neurosurgery (NINN)-Movement Disorders Clinic revealing a poor to fair association between clinical characteristics with sleep disorders and sleep architecture, with models explaining only 7% to 21% of the variation of the clinical variables

Summary

Introduction

Sleep disturbance is a common nonmotor phenomenon in Parkinson’s disease (PD) patients with a prevalence reported to vary from 40% to 90% [1]. Sleep patterns and architecture change over time in the aging brain and are thought to decrease in both quality and quantity in the elderly population. The neurodegenerative disease process involves multiple motor and nonmotor networks thought to contribute to the degeneration of normal sleep cycles beyond that seen in aging alone. The potential result of this degeneration is an increased severity in sleep dysfunction and a heterogeneity in sleep disturbance clinical presentations in the PD patient [1, 2]. Proper vigilance is necessary as the coexistence of disrupted sleep in PD affects quality of life, motor symptoms, cognitive function, and caregiver burden

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