Parkinson’s Disease Motor and Non-Motor Features Accompanying Insomnia and Excessive Daytime Sleepiness Symptoms, a Large Population-Based Study

Abstract

Insomnia and excessive daytime sleepiness are the most common sleep disturbances in Parkinson’s disease. This study aims at better understanding how severity of PD motor and non-motor features and dopaminergic treatments contribute to these sleep symptoms in the first decade of PD. Data from a community-based cohort of PD patients was used to model cross-sectional PD-related risk factors for insomnia and EDS sleep scores using linear regression models adjusted for age, gender, and PD duration. Longitudinal changes in sleep scores were assessed with paired t-tests. For 481 patients who completed the MOS-Sleep questionnaire at least once, high levodopa daily doses (500mg+) and severe autonomic and complex non-motor symptoms (depression, anxiety, apathy, hallucinations and dopamine dysregulation syndrome) were associated with both EDS and insomnia symptoms. Higher total motor UPDRS and especially tremor sub-scores and motor complications were associated only with insomnia, while axial/posture/gait and body bradykinesia UPDRS sub-scores were associated only with EDS. In 156 patients, with a second sleep measure on average after 2.2 years of follow-up, only EDS scores increased over time. Groups defined by worse PD features severity at first follow-up (UPDRS 35+, PD duration 6.5+ years, or LED 500mg+) had larger average increases in EDS score over time. These findings provide evidence that motor and non-motor dysfunction in PD are associated with insomnia and EDS symptoms, but specific features and level of severity affect sleep symptoms differently. Motor manifestations related to tremor and dyskinesia are associated with sleep quantity and quality, measured by insomnia symptoms, while axial motor features are related to EDS symptoms.