Abstract
ObjectExcessive daytime sleepiness (EDS) is common in Parkinson disease (PD), but the neural basis of EDS in PD is unclear. We aim to analyze the neural activity changes in PD-related EDS.MethodsIn the present study, 38 PD patients and 19 healthy controls underwent clinical assessments and resting state functional magnetic resonance imaging (MRI) at 3T. Patients were further classified into PD patients with EDS (n = 17) and PD patients without EDS (n = 21), according to the Epworth Sleepiness Scale (ESS) cutoff score with greater than 10 or less than 3. We evaluated all patients using PD-related motor and non-motor clinical scales. An analysis of covariance and post hoc two-sample t-tests were performed to examine between-groups differences of the amplitude of low-frequency fluctuations (ALFF) and functional connectivity (FC).ResultsWe found that, all PD-EDS subjects in our study were male. Compared with the control subjects, PD patients with EDS had decreased ALFF in the Pons and increased ALFF in the Frontal_Mid_Orb_L (p < 0.01, corrected). Moreover, PD patients with EDS showed decreased ALFF in the left posterior cingulate cortex (PCC) relative to PD without EDS, which was negatively correlated with the ESS score (p < 0.001). After that, the FC analysis with the left PCC region of interest showed reduced FC of the right PCC and right precuneus in PD with EDS compared with PD without EDS (p < 0.01, corrected).ConclusionWe hypothesized the wake-promoting pathways and the default mode network dysfunction underlying the EDS in male PD patients.
Highlights
Excessive daytime sleepiness (EDS) is a common feature of Parkinson disease (PD)
To address the association of EDS in PD patients and neural activity changes, we focused on resting state-functional MRI (rs-fMRI) combining the amplitude of low-frequency fluctuations (ALFF) with functional connectivity (FC) approaches
64 patients enrolled in the study were required to meet the following criteria: (1) meeting the diagnostic criteria for idiopathic PD according to the United Kingdom Parkinson Disease Society Brain Bank criteria; (2) without medical history of traumatic brain injury stroke, brain tumor, dementia, or psychiatric disorders; (3) without contraindications for magnetic resonance imaging (MRI) scan; (4) a Mini Mental State Examination (MMSE) score greater than 24; (5) not taking sedative and hypnotic medications; and (6) excluding sleep disorders such as insomnia, restless leg syndrome, narcolepsy, and obstructive sleep apnea that may contribute to EDS
Summary
Excessive daytime sleepiness (EDS) is a common feature of Parkinson disease (PD). It manifests as unintentional or inappropriate sleep, namely, inability to stay awake during the day. Previous studies found that EDS is a separate manifestation of Neurological Function Changes of EDS in PD. Regarding EDS in PD, several neuroimaging methods have been used to preliminarily explore cerebral changes, including structural magnetic resonance imaging (MRI) (Gama et al, 2010; Kato et al, 2012), diffusion tensor MRI (Matsui et al, 2006b; Chondrogiorgi et al, 2016), single photon emission computed tomography (SPECT) (Matsui et al, 2006a; Happe et al, 2007), and resting state-functional MRI (rs-fMRI) (Wen et al, 2016). Conflicting results existed among those researches due to the lack of healthy controls or the limitations of topical brain analysis
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