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Relationship between sleep disorders and other non-motor symptoms in Parkinson's disease

https://doi.org/10.1016/j.parkreldis.2013.07.026Get rights and content

Abstract

Background

The association between sleep disorders and other non-motor symptoms (NMS) in Parkinson's disease (PD) has been scarcely investigated.

Objective

To describe the prevalence of insomnia and hypersomnia in PD and analyze their relationship with other NMS.

Methods

Cross-sectional, multicenter study including 388 PD patients evaluated with Hoehn and Yahr, Clinical Impression of Severity Index for PD, Scales for Outcomes in Parkinson's Disease (SCOPA)-Sleep(S), SCOPA-Cognition, SCOPA-Psychiatric Complications, SCOPA-Autonomic, Hospital Anxiety and Depression Scale, and fatigue and pain visual analogue scales. Spearman correlation coefficients, Mann–Whitney test and multiple linear regression analysis were applied.

Results

Mean age (54% male) was 65.9 ± 11.2 years old, with disease duration of 8.1 ± 6.0 years and median HY = 2 (range: 1–5). Mean SCOPA-S nocturnal sleep (NS) was 5.4 ± 4.0 (range: 0–15), daytime sleepiness (DS) was 3.76 ± 3.04 (range: 0–15). Most of the sample declared nocturnal or daytime sleep problems (87.4%). Weak-to-moderate correlations were found between sleep disturbances and other NMS (range: 0.14–0.37). SCOPA-S subscales showed higher scores with the presence of most other NMS such as psychiatric complications and autonomic dysfunctions (p < 0.05). Regression models showed that fatigue, depression, urinary, cardiovascular, and thermoregulatory dysfunctions were significant determinants of SCOPA-NS score (variance: 23%); cognitive impairment, urinary, cardiovascular, and pupillomotor disorders influenced SCOPA-DS score (variance: 14%).

Conclusions

Insomnia and daytime sleepiness are extremely prevalent in PD. Depression, fatigue, cognitive impairment, cardiovascular, urinary and thermoregulatory dysfunctions may contribute to insomnia/hypersomnia. This is the first clinical study to relate cardiovascular and thermoregulatory dysfunctions with sleep in PD.

Introduction

Although Parkinson's disease (PD) is traditionally defined by the presence of motor symptoms, the relevance of non-motor symptoms (NMS), even before the onset of motor manifestations [1], has been progressively recognized. The array of NMS described in PD includes pain, fatigue, depression, anxiety, cognitive impairment, autonomic dysfunction and sleep disorders. Non-motor manifestations significantly contribute to symptoms' burden, disability, quality of life deterioration, and institutionalization of patients [2].

Sleep disorders in PD can consist of onset or maintenance insomnia, restless legs syndrome, vivid dreams, rapid eye movement sleep behavior disorder and excessive daytime sleepiness (EDS). They affect up to 60–90% of PD patients, with increasing prevalence as the disease progresses [3], [4], [5]. Several factors are thought to contribute to the presence and severity of sleep disorders: neuropathological changes related to the disease itself, age-related changes, nighttime motor symptoms, cognitive impairment, mood disorders, primary sleep disorders such as restless legs, periodic leg movements and obstructive sleep apnea, and side effects of PD treatment (mainly, levodopa and dopamine agonists). A few studies have suggested a relationship between sleep disorders and other NMS, but there is a lack of research specifically focusing on this question [4].

Thus, the main objective of the present study is to address this gap and analyze the link between two sleep disorders, insomnia and EDS, and other NMS in a large representative PD cohort. The prevalence of these disorders is also described.

Section snippets

Design

Multicenter, observational, cross-sectional study.

Sample

The sample was recruited in the framework of the ELEP (Longitudinal Parkinson's Disease Patient Study) [6], and included 388 patients, diagnosed with PD by a neurologist with expertise in movement disorders as per the United Kingdom PD Society Brain Bank modified criteria, aged ≥30 years at disease onset and having a main caregiver. Patients who did not fulfill the inclusion criteria, or whose limitations or comorbidities were barriers for

Results

The patient cohort (54% men) had a mean age of 65.9 ± 11.2 years old, with age at onset of 57.8 ± 12.1 years and disease duration of 8.1 ± 6.0 years. HY distribution was as follows: stage 1, 25% of the sample (97 subjects); stage 2, 49.5% (192); stage 3, 19.3% (75); stage 4, 4.6% (18); and stage 5, 0.5% (2). More than 70% of patients were on a combination of levodopa and agonist therapy, with mean total LED of 547 ± 372 mg (of which, agonist LED was 186 ± 166 mg). In total, 24 patients had

Discussion

This study informs about the declared prevalence of insomnia and daytime hypersomnia in a large PD cohort and characterizes their association with other NMS such as cognitive difficulties, psychiatric complications, mood disorders, pain, fatigue and dysautonomia. About 9 out of 10 patients reported some kind of insomnia, which is in line with previous studies [4]. Results showed a similarly high prevalence for EDS (87% of patients), differing from the previously reported 43% using the same

Acknowledgments

This study was partially funded by the Research Intramural Program of the Carlos III Institute of Health (EPY1271/05).

Members of the Longitudinal Parkinson's Disease Patient Study (Estudio Longitudinal de Pacientes con Enfermedad de Parkinson) – ELEP Group are:

M. Aguilar and P. Quilez-Ferrer (Mutua de Terrassa, Barcelona); M. Alvarez Sauco (Elche General Hospital, Alicante); A. Bayes (Teknon Clinic, Barcelona); M. Blazquez (Asturias Central Hospital, Oviedo); A. Bergareche (Bidasoa Hospital,

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    Sleep disorders are common and can develop at any stage of the disease. A variety of factors leads to sleep disorders like fragmented sleep due to nighttime rigidity or tremor, insomnia, restless legs syndrome (RLS), depression, changes in brainstem, bradykinesia, medication side effects, excessive daytime sleepiness (EDS) and nocturnal awakenings (Kurtis et al., 2013). Weight loss and malnutrition is another frequent and progressive process that start several years before the diagnosis of PD and get worse over time (Kashihara, 2006; Chen et al., 2003).

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