Abstract
Background and Purpose: Non-motor symptoms of Parkinson disease (PD) have a strong negative impact on the health-related quality of life (QoL) of patients with PD. Sleep disturbance is an important non-motor symptom because of its high prevalence. However, previous studies investigating the determinants of sleep quality in patients with PD have revealed inconsistent results. Our study evaluated the correlations between sleep quality in patients with PD and disease-related variables, medications used depression, anxiety, and QoL and identified the determinants of sleep disturbance in people with PD in Taiwan.Methods: A total of 134 patients with PD were recruited from the outpatient clinic. We examined the correlations between the Parkinson disease sleep scale-2 (PDSS-2) scores and different variables, namely the Unified Parkinson Disease Rating Scale, Parkinson disease questionnaire, Beck Depression Inventory, and Beck Anxiety Inventory (BAI). Logistic regression analysis was used to assess the potential predictive variables for sleep quality in patients with PD.Results: Among our participants, 47.8% were classified as poor sleepers (PDSS-2 = 15–60). Correlation analysis demonstrated that poor sleepers exhibited longer disease durations, higher levodopa equivalent daily doses (LEDDs), higher PD severity, more depression and anxiety symptoms, poorer QoL, more frequent unemployed status, higher hypnotics use, higher dependency for activities of daily living, more motor impairments, and more therapy-related complications. Logistic regression revealed that the LEDD was a significant predictive factor of sleep quality.Conclusion: Poor sleepers constituted approximately half of our patients with PD. The participants experienced more favorable sleep if they were currently working. Increased PD duration, severity, depression or anxiety symptoms, and doses of dopaminergic therapy were significantly associated with poor sleep quality. Continued working, attempts to treat comorbid anxiety or depression, and avoidance of overdosage of dopaminergic treatments may improve sleep quality in patients with PD.
Highlights
Non-motor symptoms of Parkinson disease (PD) have gained increasing research attention in recent years because they have a greater negative impact on quality of life (QoL) compared with motor disabilities [1] and exhibit a relatively poor response to dopaminergic therapy due to the diverse underlying mechanisms [2]
The results revealed significant differences in work status (P = 0.036), disease duration (P < 0.001), Beck Depression Inventory (BDI) (P < 0.001), Beck Anxiety Inventory (BAI) (P < 0.001), PDQ-39 (P < 0.001), Unified Parkinson Disease Rating Scale (UPDRS) (P < 0.001), Levodopa equivalent daily dosage (LEDD) (P < 0.001), levodopa dose (P < 0.001), and proportion of participants using hypnotics (P < 0.05)
The Hoehn and Yahr staging (H&Y) stage had a significant effect on sleep quality in these [B = 3.88, P =.036, and 95% confidence interval (CI) = 0.25– 7.51] after adjustment for the rest of the 9 covariates; that is, the higher the PD severity stage, the poorer the sleep quality
Summary
Non-motor symptoms of Parkinson disease (PD) have gained increasing research attention in recent years because they have a greater negative impact on quality of life (QoL) compared with motor disabilities [1] and exhibit a relatively poor response to dopaminergic therapy due to the diverse underlying mechanisms [2]. Previous studies that have used sleep scales, including the Parkinson Disease Sleep Scale (PDSS) [8], Pittsburgh Sleep Quality Index [9], and Scales for Outcomes in PD-Sleep [3], revealed inconsistent predictive factors associated with sleep in PD. These studies were mostly conducted in Western populations. Non-motor symptoms of Parkinson disease (PD) have a strong negative impact on the health-related quality of life (QoL) of patients with PD. Our study evaluated the correlations between sleep quality in patients with PD and disease-related variables, medications used depression, anxiety, and QoL and identified the determinants of sleep disturbance in people with PD in Taiwan
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