Abstract
Sleep disorders (SDs) are one of the most frequent non-motor symptoms of Parkinson’s disease (PD), usually increasing in frequency over the course of the disease and disability progression. SDs include nocturnal and diurnal manifestations such as insomnia, REM sleep behavior disorder, and excessive daytime sleepiness. The causes of SDs in PD are numerous, including the neurodegeneration process itself, which can disrupt the networks regulating the sleep–wake cycle and deplete a large number of cerebral amines possibly playing a role in the initiation and maintenance of sleep. Despite the significant prevalence of SDs in PD patients, few clinical trials on SDs treatment have been conducted. Our aim is to critically review the principal therapeutic options for the most common SDs in PD. The appropriate diagnosis and treatment of SDs in PD can lead to the consolidation of nocturnal sleep, the enhancement of daytime alertness, and the amelioration of the quality of life of the patients.
Highlights
Non-motor symptoms (NMSs) are present in almost all patients with Parkinson’s disease (PD) frequently preceding the onset of motor symptoms [1]
Diurnal manifestations include excessive daytime sleepiness (EDS) and sudden sleep attacks, which could be a consequence of nocturnal sleep impairment or dopaminergic treatment or, more interestingly, to the neurodegenerative process of PD itself dysregulating the circadian sleep–wake rhythm [4,5,6,7,8]
Restless legs syndrome is a sensorimotor disorder occurring in the evening or at night, characterized by an urge to move the legs usually associated with uncomfortable and unpleasant sensations in the legs relieved by movement (Table 2) [11]
Summary
Non-motor symptoms (NMSs) are present in almost all patients with Parkinson’s disease (PD) frequently preceding the onset of motor symptoms [1]. Reduced sleep efficiency and an increased number of awakenings characterize sleep in PD [4]. These disturbances are linked, on one side, to PD motor (akinesia, rigidity, and dystonia) and autonomic symptoms (nocturia) and, on the other side, to the presence of concomitant SDs such as REM sleep behavior disorder (RBD), restless legs syndrome (RLS), or breathing disorders such as obstructive sleep apnea (OSA) [5]. Diurnal manifestations include excessive daytime sleepiness (EDS) and sudden sleep attacks, which could be a consequence of nocturnal sleep impairment or dopaminergic treatment or, more interestingly, to the neurodegenerative process of PD itself dysregulating the circadian sleep–wake rhythm [4,5,6,7,8]. Our narrative review will discuss the available optimal therapeutic strategies, based on the literature data, to use in clinical practice
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