Abstract
The non-motor features of Parkinson’s disease (PD) are increasingly being recognised. This review deals with the spectrum of sleep disorders associated with PD, which have a multifactorial aetiology and can significantly have an impact on the quality of life of patients and their carers. Some sleep disorders represent a prodromal phase of PD, with REM sleep behaviour disorder (RBD) being of particular interest in this regard, whereas others become more common as the disease advances. Understanding the pathophysiology of these sleep disturbances will hopefully lead to new treatment opportunities in the future. The recent discovery of the glymphatic system for removal of waste products from the brain has also raised the possibility that sleep disruption may cause or accelerate the underlying disease process.
Highlights
Parkinson’s disease (PD) affects 1–2% of adults aged over 65 years and is the second most common degenerative brain disorder
The pathophysiology of sleep disorders in PD is likely to be multifactorial and secondary to PD nocturnal features, underlying neuronal damage, and side effects of PD medications [11]. This varied aetiology is evident with insomnia, where sleep disruption can be caused by difficulty in moving in bed at night, tremor, neuropsychiatric symptoms or pain
Changes in sleep architecture due to underlying damage to key regions involved in sleep regulation are likely to account, at least in part, for the difficulties that PD patients experience in getting to and staying asleep
Summary
Parkinson’s disease (PD) affects 1–2% of adults aged over 65 years and is the second most common degenerative brain disorder. The pathophysiology of sleep disorders in PD is likely to be multifactorial and secondary to PD nocturnal features, underlying neuronal damage, and side effects of PD medications [11] This varied aetiology is evident with insomnia, where sleep disruption can be caused by difficulty in moving in bed at night (often due to nocturnal wearing off), tremor, neuropsychiatric symptoms or pain. Changes in sleep architecture due to underlying damage to key regions involved in sleep regulation are likely to account, at least in part, for the difficulties that PD patients experience in getting to and staying asleep Several of these brain regions (e.g. locus coeruleus, hypothalamus, amygdala, thalamus, pedunculopontine nucleus) have been shown to be affected by Lewy body pathology in post-mortem studies [30]. Studies are underway to assess its benefit in neuropsychiatric and neurodegenerative disorders including Parkinson’s disease (ClinicalTrials.gov Identifier: NCT02729714)
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