Parasomnias in Parkinson’s disease

Abstract

Sleep disturbances in patients with Parkinson’s disease (PD) are common. PD patients complain of insomnia and fragmented nocturnal sleep. Occurrence of different parasomnias have been largely overlooked and we have not found previous systematic studies on parasomnias. We studied occurrence of parasomnias and their association with other symptoms in PD patients. A structured questionnaire was sent to 1447 patients who were randomly selected from the registry of the Finnish Parkinson Association. The response rate of 59,0%. The questionnaire covered demographic items, and it included questions derived from the Basic Nordic Sleep Questionnaire and items about different parasomnias. The most common parasomnias occurring at least weekly were sleep talking (21.4%), nightmares (17.0%), hallucinations (11.2%), and bruxism (4.6%). At least monthly occurring parasomnias included night terrors (8.3%) and sleep walking (3.1%). Among other sleep related phenomena nocturnal sweating occurred weekly in 28.8%, nocturia (>3 times nightly) in 15.8% and bedwetting monthly in 28.5%. The prevalence of REM sleep behavior disorder (RBD) evaluated by the Marburg RBDSQ ⩾6 was 36.7%. Association of RBD with NREMsleep parasomnia (parasomnia overlap disorder) was found in 18.2% of all participants. Adjusted logistic regression analysis showed weekly nightmares (OR 7.1; 95% CI 3.2–15.5) and weekly sleep talking (OR 7.1; 95% CI 3.8–13.4) predicting the presence of RBD. In Parkinson’s disease the prevalence of RBD is overrepresented and it is often associated with other parasomnias. More attention should be paid to the detection and treatment of parasomnias. This study was supported by the Finnish Parkinson Foundation.