Abstract
Previous studies conducted among patients with Parkinson disease (PD) reported that parasomnias other than rapid eye movement (REM) sleep behavior disorder (RBD), particularly sleepwalking (SW), are associated with PD severity. However, it remains unclear whether the presence of SW is associated with altered odds of having PD in a population-based study. To evaluate whether probable SW, either alone or co-occurring with probable RBD, is associated with higher odds of PD in men. This cross-sectional study included 25 694 men from the Health Professionals Follow-up Study, a population-based cohort of male health professionals in the US with information on probable SW and probable RBD. Data collection took place between January 2012 and June 2018, and data analysis took place from July 2020 to October 2020. Probable SW and probable RBD were measured by questions adapted from the Mayo Sleep Questionnaire in 2012. PD, confirmed after review of medical records by a movement disorder specialist. Of the 25 694 studied men (mean [SD] age, 75.6 [7.4] years), 223 (0.9%) had probable SW, 2720 (10.6%) had probable RBD, and 257 (1.0%) had PD. After adjusting for potential confounders (eg, age, smoking, caffeine intake, chronic disease status, and other sleep disorders), compared with individuals without probable SW and probable RBD, participants with probable SW, probable RBD, and both probable SW and probable RBD had higher odds of PD, (probable SW: odds ratio [OR], 4.80; 95% CI, 1.61-14.26; probable RBD: OR, 6.36; 95% CI, 4.83-8.37; both probable SW and probable RBD: OR, 8.44; 95% CI, 3.90-18.27). In this cross-sectional study of a male population, probable sleep parasomnias, including both SW and RBD, were associated with higher odds of having PD. PD-related neurodegeneration may impair arousal regulation during sleep.
Highlights
Parkinson disease (PD) is the fastest-growing neurological disease in prevalence, disability, and deaths globally since 1990.1 PD is a movement disorder, but several nonmotor features have been frequently observed among patients with PD, which may be associated with progressive neurodegeneration.[2]
After adjusting for potential confounders, compared with individuals without probable SW and probable rapid eye movement sleep behavior disorder (RBD), participants with probable SW, probable RBD, and both probable SW and probable RBD had higher odds of PD
In additional studies of patients with PD, the presence of non-rapid eye movement (REM) parasomnias was associated with worse symptoms, cognitive impairment, and depression,[7,8] which could be associated with dysfunction of arousal and motor control.[4,8]
Summary
Parkinson disease (PD) is the fastest-growing neurological disease in prevalence, disability, and deaths globally since 1990.1 PD is a movement disorder, but several nonmotor features have been frequently observed among patients with PD, which may be associated with progressive neurodegeneration.[2]. Parkinson Disease Among Men With Sleepwalking and REM Sleep Behavior Disorder. Rapid eye movement (REM) sleep behavior disorder (RBD) is one of the most extensively studied nonmotor features of PD.[2,3] Small case series and descriptive studies conducted among patients with PD have suggested that sleepwalking (SW), a parasomnia that emanates from non-REM sleep (usually slow-wave sleep), appeared to have a high prevalence in patients with PD (approximately 10%).[4,5] Given that SW is generally considered a rare condition in adults (1.0%-2.3%, according to a meta-analysis6), this prevalence in patients with PD appears unusually high, but to our knowledge, no study to date has included a group of individuals without PD in direct comparison for risk estimation. In additional studies of patients with PD, the presence of non-REM parasomnias was associated with worse symptoms, cognitive impairment, and depression,[7,8] which could be associated with dysfunction of arousal and motor control.[4,8] we conducted a cross-sectional study using data from the Health Professionals Follow-Up Study (HPFS) to examine the association between probable SW and probable RBD, measured by a validated questionnaire, and PD in more than 25 000 US men
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