INSOMNIA IN PARKINSON’S DISEASE AND ITS IMPACT ON QUALITY OF LIFE

Abstract

OBJECTIVES: The impact of sleep disorders on quality of life of patients with Parkinson’s disease (PD) is underestimated. The significant role in the pathophysiology of sleep disorders belongs to the neurodegeneration of brain systems that regulate sleep-wake cycle and motor, affective, sensor and urine disorders. PURPOSE OF STUDY: to assess the prevalence of insomnia, its connection with motor, neuropsychological disturbances and its impact on quality of life in different stages of Parkinson’s disease (PD). PATIENTS AND METHODS: One hundred and eighty eight (188) patients (95 females and 93 males) with Parkinson’s disease without dementia were examined. The mean age was 62, 36±0,6 years, stage of Parkinson’s disease was 2,46±0,7 according Hoen and Yahr scale, PD duration consisted 5,9±3,9 years. We used the following tests and scales for accessment of motor and neuropsychiatric functions: Hoehn and Yahr scale, UPDRS (part “Motor Examination” and “Activities of Daily Living”), Beck’s depression Inventory, the Spielberger State-Trait Anxiety Inventory, sleep scales, the Epworth sleepiness scale, fatigue scale (FSPD-16), cognitive functions scale in PD Stroop test, the Lille apathy rating scale, SE Starkstein apathy scale, quality of life questionnaire in PD (QoLPD-39). Statistical analysis was performed using software package Statistica 8.0 with estimation of Student’s t-test, chi-square criteria and Pearson’s correlation matrix. RESULTS: Sleep onset insomnia was detected in 34% of patients, middle insomnia (awakening and sleep fragmentation) was revealed in 86% of patients and early awakening was seen in 48% of patients. Women more frequently had sleep onset disorders, nocturnal awakenings, and unpleasant dreams. We revealed correlation between frequency of sleep disorders and severity and duration of PD and correlation between insomnia severity and disease stage when insomnia appeared. We precised the relationship between middle insomnia and postsomnia disorders. Multimodal sleep disorders correlate with severity of motor, affective, sensor and urine disturbances. Sleep disorders were shown to impact on quality of life in different stages of disease. CONCLUSIONS: affecting quality of life sleep disorders are seen in most patients with PD. The heterogeneity of sleep disorders and pathophysiological aspects require differential approach to the management of insomnia in patients with PD.