Sleep disorders in Parkinson’s disease

Article

Opinion statement

Sleep disorders in Parkinson’s disease (PD) are frequent and have numerous etiologies. Both nighttime sleep disturbances and daytime sleepiness can occur. The key to effective treatment is appropriate diagnosis. A careful interview of the patient and his or her bed partner provides direction for additional evaluations. Referral to a sleep specialist for quantitative studies is necessary to evaluate for rapid eye movement (REM) sleep behavior disorder, sleep apnea, periodic limb movements, and other sleep disorders. Excessive daytime sleepiness may be attributed to interrupted nighttime sleep or daytime medications (particularly the dopamine agonists) or it may be intrinsic to PD. When the diagnosis is established, treatment is directed toward the primary sleep disturbance. Fragmented sleep due to recurrence of PD symptoms may improve with the use of long-acting preparations of carbidopa/levodopa. Sleep apnea is treated using continuous positive airway pressure, and REM sleep behavior disorder may improve using pharmacologic interventions, although controlled trials are lacking. Restless legs syndrome and periodic limb movements during sleep are treated with direct dopaminergic agonists at bedtime. Excessive daytime sleepiness related to the use of direct dopaminergic agonists may improve with dosage reduction or discontinuation. Stimulants such as modafinil may provide modest benefit.

References and Recommended Reading

  1. 1.
    Hely MA, Morris JG, Reid WG, Trafficante R: Sydney Multicenter Study of Parkinson’s disease: non—L-doparesponsive problems dominate at 15 years. Mov Disord 2005, 20:190–199.PubMedCrossRefGoogle Scholar
  2. 2.
    Kumar S, Bhatia M, Behari M: Sleep disorders in Parkinson’s disease. Mov Disord 2002, 17:775–781.PubMedCrossRefGoogle Scholar
  3. 3.
    Brodsky MA, Godbold J, Roth T, Olanow CW: Sleepiness in Parkinson’s disease: a controlled study. Mov Disord 2003, 18:668–672.PubMedCrossRefGoogle Scholar
  4. 4.
    Dhawan V, Dhoat S, Williams AJ, et al.: The range and nature of sleep dysfunction in untreated Parkinson’s disease (PD). A comparative controlled clinical study using the Parkinson’s disease sleep scale and selective polysomnography. J Neurol Sci 2006, 248:158–162.PubMedCrossRefGoogle Scholar
  5. 5.
    Thannickal TC, Lai YY, Siegel JM: Hypocretin (orexin) cell loss in Parkinson’s disease. Brain 2007, 130:1586–1595.PubMedCrossRefGoogle Scholar
  6. 6.
    Wolters E, Braak H: Parkinson’s disease: premotor clinico-pathological correlations. J Neural Transm Suppl 2006:309–319.Google Scholar
  7. 7.
    Jellinger KA: Lewy body-related α-synucleinopathy in the aged human brain. J Neural Transm 2004, 111:1219–1235.PubMedCrossRefGoogle Scholar
  8. 8.
    Comella CL: Sleep disturbances and excessive daytime sleepiness in Parkinson disease: an overview. J Neural Transm Suppl 2006:349–355.Google Scholar
  9. 9.
    Gjerstad MD, Alves G, Wentzel-Larsen T, et al.: Excessive daytime sleepiness in Parkinson disease: Is it the drugs or the disease? Neurology 2006, 67:853–858.PubMedCrossRefGoogle Scholar
  10. 10.
    Tandberg E, Larsen JP, Karlsen K: Excessive daytime sleepiness and sleep benefit in Parkinson’s disease: a community-based study. Mov Disord 1999, 14:922–927.PubMedCrossRefGoogle Scholar
  11. 11.
    Shpirer I, Miniovitz A, Klein C, et al.: Excessive daytime sleepiness in patients with Parkinson’s disease: a polysomnography study. Mov Disord 2006, 21:1432–1438.PubMedCrossRefGoogle Scholar
  12. 12.
    Roth T, Rye DB, Borchert LD, et al.: Assessment of sleepiness and unintended sleep in Parkinson’s disease patients taking dopamine agonists. Sleep Med 2003, 4:275–280.PubMedCrossRefGoogle Scholar
  13. 13.
    Razmy A, Lang AE, Shaprio CM: Predictors of impaired daytime sleep and wakefulness in patients with Parkinson disease treated with older (ergot) vs newer (nonergot) dopamine agonists. Arch Neurol 2004, 61:97–102.PubMedCrossRefGoogle Scholar
  14. 14.
    Gjerstad MD, Wentzel-Larsen T, Aarsland D, Larsen JP: Insomnia in Parkinson’s disease: frequency and progression over time. J Neurol Neurosurg Psychiatry 2007, 78:476–479.PubMedCrossRefGoogle Scholar
  15. 15.
    Diederich NJ, Vaillant M, Leischen M, et al.: Sleep apnea syndrome in Parkinson’s disease. A case-control study in 49 patients. Mov Disord 2005, 20:1413–1418.PubMedCrossRefGoogle Scholar
  16. 16.
    Ondo WG, Vuong KD, Jankovic J: Exploring the relationship between Parkinson disease and restless legs syndrome. Arch Neurol 2002, 59:421–424.PubMedCrossRefGoogle Scholar
  17. 17.
    Dhawan V, Healy DG, Pal S, Chaudhuri KR: Sleep-related problems of Parkinson’s disease. Age Ageing 2006, 35:220–228.PubMedCrossRefGoogle Scholar
  18. 18.
    Gjerstad MD, Boeve B, Wentzel-Larsen T, et al.: Occurrence and clinical correlates of REM sleep behavior disorder in patients with Parkinson’s disease over time. J Neurol Neurosurg Psychiatry 2007 June 8 (Epub ahead of print).Google Scholar
  19. 19.
    Iranzo A, Molinuevo JL, Santamaria J, et al.: Rapid-eye-movement sleep behaviour disorder as an early marker for a neurodegenerative disorder: a descriptive study. Lancet Neurol 2006, 5:572–577.PubMedCrossRefGoogle Scholar
  20. 20.
    Vendette M, Gagnon JF, Decary A, et al.: REM sleep behavior disorder predicts cognitive impairment in Parkinson disease without dementia. Neurology 2007, 69:1843–1849.PubMedCrossRefGoogle Scholar
  21. 21.
    Manni R, Terzaghi M, Pacchetti C, Nappi G: Sleep disorders in Parkinson’s disease: facts and new perspectives. Neurol Sci 2007, 28(Suppl 1):S1–S5.PubMedCrossRefGoogle Scholar
  22. 22.
    Johns MW: A new method for measuring daytime sleepiness: the Epworth sleepiness scale. Sleep 1991, 14:540–545.PubMedGoogle Scholar
  23. 23.
    Hagell P, Broman JE: Measurement properties and hierarchical item structure of the Epworth Sleepiness Scale in Parkinson’s disease. J Sleep Res 2007, 16:102–109.PubMedCrossRefGoogle Scholar
  24. 24.
    Buysse DJ, Reynolds CF 3rd, Monk TH, et al.: The Pittsburgh Sleep Quality Index: a new instrument for psychiatric practice and research. Psychiatry Res 1989, 28:193–213.PubMedCrossRefGoogle Scholar
  25. 25.
    Chaudhuri KR, Pal S, DiMarco A, et al.: The Parkinson’s disease sleep scale: a new instrument for assessing sleep and nocturnal disability in Parkinson’s disease. J Neurol Neurosurg Psychiatry 2002, 73:629–635.PubMedCrossRefGoogle Scholar
  26. 26.
    Marinus J, Visser M, van Hilten JJ, et al.: Assessment of sleep and sleepiness in Parkinson disease. Sleep 2003, 26:1049–1054.PubMedGoogle Scholar
  27. 27.
    Stevens S, Comella CL, Stepanski EJ: Daytime sleepiness and alertness in patients with Parkinson disease. Sleep 2004, 27:967–972.PubMedGoogle Scholar
  28. 28.
    Hobson DE, Lang AE, Martin WR, et al.: Excessive daytime sleepiness and sudden-onset sleep in Parkinson disease: a survey by the Canadian Movement Disorders Group. JAMA 2002, 287:455–463.PubMedCrossRefGoogle Scholar
  29. 29.
    Eisensehr I, v Lindeiner H, Jäger M, Noachtar S: REM sleep behavior disorder in sleep-disordered patients with versus without Parkinson’s disease: Is there a need for polysomnography? J Neurol Sci 2001, 186:7–11.PubMedCrossRefGoogle Scholar
  30. 30.
    Iranzo A, Santamaria J: Severe obstructive sleep apnea/hypopnea mimicking REM sleep behavior disorder. Sleep 2005, 28:203–206.PubMedGoogle Scholar
  31. 31.
    Hogl B, Seppi K, Brandauer E, et al.: Increased daytime sleepiness in Parkinson’s disease: a questionnaire survey. Mov Disord 2003, 18:319–323.PubMedCrossRefGoogle Scholar
  32. 32.
    Maria B, Sophia S, Michalis M, et al.: Sleep breathing disorders in patients with idiopathic Parkinson’s disease. Respir Med 2003, 97:1151–1157.PubMedCrossRefGoogle Scholar
  33. 33.
    Arnulf I, Konofal E, Merino-Andreu M, et al.: Parkinson’s disease and sleepiness: an integral part of PD. Neurology 2002, 58:1019–1024.PubMedGoogle Scholar
  34. 34.
    Hening WA, Allen RP: Restless legs syndrome (RLS): the continuing development of diagnostic standards and severity measures. Sleep Med 2003, 4:95–97.PubMedCrossRefGoogle Scholar
  35. 35.
    Wetter TC, Collado-Seidel V, Pollmacher T, et al.: Sleep and periodic leg movement patterns in drug-free patients with Parkinson’s disease and multiple system atrophy. Sleep 2000, 23:361–367.PubMedGoogle Scholar
  36. 36.
    Consens FB, Chervin RD, Koeppe RA, et al.: Validation of a polysomnographic score for REM sleep behavior disorder. Sleep 2005, 28:993–997.PubMedGoogle Scholar
  37. 37.
    Adler CH, Caviness JN, Hentz JG, et al.: Randomized trial of modafinil for treating subjective daytime sleepiness in patients with Parkinson’s disease. Mov Disord 2003, 18:287–293.PubMedCrossRefGoogle Scholar
  38. 38.
    Ondo WG, Fayle R, Atassi F, Jankovic J: Modafinil for daytime somnolence in Parkinson’s disease: double blind, placebo controlled parallel trial. J Neurol Neurosurg Psychiatry 2005, 76:1636–1639.PubMedCrossRefGoogle Scholar
  39. 39.
    Mendonca DA, Menezes K, Jog MS: Methylphenidate improves fatigue scores in Parkinson disease: a randomized controlled trial. Mov Disord 2007, 22:2070–2076.PubMedCrossRefGoogle Scholar
  40. 40.
    Willis GL, Turner EJ: Primary and secondary features of Parkinson’s disease improve with strategic exposure to bright light: a case series study. Chronobiol Int 2007, 24:521–537.PubMedCrossRefGoogle Scholar
  41. 41.
    Paus S, Schmitz-Hubsch T, Wullner U, et al.: Bright light therapy in Parkinson’s disease: a pilot study. Mov Disord 2007, 22:1495–1498.PubMedCrossRefGoogle Scholar
  42. 42.
    Van den Kerchove M, Jacquy J, Gonce M, De Deyn PP: Sustained-release levodopa in parkinsonian patients with nocturnal disabilities. Acta Neurol Belg 1993, 93:32–39.PubMedGoogle Scholar
  43. 43.
    Stacy M: Sleep disorders in Parkinson’s disease: epidemiology and management. Drugs Aging 2002, 19:733–739.PubMedCrossRefGoogle Scholar
  44. 44.
    Baas HK, Schueler P: Efficacy of cabergoline in long-term use: results of three observational studies in 1,500 patients with Parkinson’s disease. Eur Neurol 2001, 46(Suppl 1):18–23.PubMedCrossRefGoogle Scholar
  45. 45.
    Comella CL, Morrissey M, Janko K: Nocturnal activity with nighttime pergolide in Parkinson disease: a controlled study using actigraphy. Neurology 2005, 64:1450–1451.PubMedGoogle Scholar
  46. 46.
    Reuter I, Ellis CM, Ray Chaudhuri K: Nocturnal subcutaneous apomorphine infusion in Parkinson’s disease and restless legs syndrome. Acta Neurol Scand 1999, 100:163–167.PubMedCrossRefGoogle Scholar
  47. 47.
    Abe K, Hikita T, Sakoda S: [A hypnotic drug for sleep disturbances in patients with Parkinson’s disease] [Japanese]. No To Shinkei 2005, 57:301–305.PubMedGoogle Scholar
  48. 48.
    Medeiros CA, Carvalhedo de Bruin RF, Lopes LA, et al.: Effect of exogenous melatonin on sleep and motor dysfunction in Parkinson’s disease. A randomized, double blind, placebo-controlled study. J Neurol 2007, 254:459–464.PubMedCrossRefGoogle Scholar
  49. 49.
    Cicolin A, Lopiano L, Zibetti M, et al.: Effects of deep brain stimulation of the subthalamic nucleus on sleep architecture in parkinsonian patients. Sleep Med 2004, 5:207–210.PubMedCrossRefGoogle Scholar
  50. 50.
    Ghorayeb I, Yekhlef F, Bioulac B, Tison F: Continuous positive airway pressure for sleep-related breathing disorders in multiple system atrophy: long-term acceptance. Sleep Med 2005, 6:359–362.PubMedCrossRefGoogle Scholar
  51. 51.
    Paulson GW: Restless legs syndrome. How to provide symptom relief with drug and nondrug therapies. Geriatrics 2000, 55:35–38, 43–44, 47–48.PubMedGoogle Scholar
  52. 52.
    Trenkwalder C, Paulus W, Walters AS: The restless legs syndrome. Lancet Neurol 2005, 4:465–475.PubMedCrossRefGoogle Scholar
  53. 53.
    Hogl B, Rothdach A, Wetter TC, Trenkwalder C: The effect of cabergoline on sleep, periodic leg movements in sleep, and early morning motor function in patients with Parkinson’s disease. Neuropsychopharmacology 2003, 28:1866–1870.PubMedCrossRefGoogle Scholar
  54. 54.
    Thorpy MJ, Adler CH: Parkinson’s disease and sleep. Neurol Clin 2005, 23:1187–1208.PubMedCrossRefGoogle Scholar
  55. 55.
    Schenck CH, Mahowald MW: Rapid eye movement sleep parasomnias [review]. Neurol Clin 2005, 23:1107–1126.PubMedCrossRefGoogle Scholar
  56. 56.
    Boeve BF, Silber MH, Ferman TJ: Melatonin for treatment of REM sleep behavior disorder in neurologic disorders: results in 14 patients. Sleep Med 2003, 4:281–284.PubMedCrossRefGoogle Scholar
  57. 57.
    Schmidt MH, Koshal VB, Schmidt HS: Use of pramipexole in REM sleep behavior disorder: results from a case series. Sleep Med 2006, 7:418–423.PubMedCrossRefGoogle Scholar
  58. 58.
    Ringman JM, Simmons JH: Treatment of REM sleep behavior disorder with donepezil: a report of three cases. Neurology 2000, 55:870–871.PubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2008

Authors and Affiliations

  1. 1.Department of Neurological SciencesRush University Medical CenterChicagoUSA

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