Journal of Neurology

, Volume 258, Issue 7, pp 1261–1267

Sleepwalking in Parkinson’s disease: a questionnaire-based survey

  • Michael Oberholzer
  • Rositsa Poryazova
  • Claudio L. Bassetti
Original Communication

Abstract

Sleepwalking (SW) corresponds to a complex sleep-associated behavior that includes locomotion, mental confusion, and amnesia. SW is present in about 10% of children and 2–3% of adults. In a retrospective series of 165 patients with Parkinson’s disease (PD), we found adult-onset (“de novo”) SW “de novo” in six (4%) of them. The aim of this study was to assess prospectively and systematically the frequency and characteristics of SW in PD patients. A questionnaire including items on sleep quality, sleep disorders, and specifically also SW and REM sleep behavior disorder (RBD), PD characteristics and severity, was sent to the members of the national PD patients organization in Switzerland. In the study, 36/417 patients (9%) reported SW, of which 22 (5%) had adult-onset SW. Patients with SW had significantly longer disease duration (p = 0.035), they reported more often hallucinations (p = 0.004) and nightmares (p = 0.003), and they had higher scores, suggestive for RBD in a validated questionnaire (p = 0.001). Patients with SW were also sleepier (trend to a higher Epworth Sleepiness Scale score, p = 0.055). Our data suggest that SW in PD patients is (1) more common than in the general population, and (2) is associated with RBD, nightmares, and hallucinations. Further studies including polysomnographic recordings are needed to confirm the results of this questionnaire-based analysis, to understand the relationship between SW and other nighttime wandering behaviors in PD, and to clarify the underlying mechanisms.

Keywords

Idiopathic Parkinson’s disease Sleepwalking Nighttime wandering REM sleep Behavior disorder Overlap parasomnia Hallucinations 

References

  1. 1.
    American Academy of Sleep Medicine (2005) International classification of sleep disorders: diagnostic and coding manual, 2nd edn. American Academy of Sleep Medicine, Westchester, IL, USAGoogle Scholar
  2. 2.
    Hublin C, Kaprio J, Partinen M, Heikkila K, Koskenvuo M (1997) Prevalence and genetics of sleepwalking: a population-based twin study. Neurology 48:177–181PubMedGoogle Scholar
  3. 3.
    Bassetti C (2009) Sleepwalking. In: Laureys S, Tononi G (eds) The neurology of consciousness: cognitive neuroscience and neuropathology. Academic Press, LondonGoogle Scholar
  4. 4.
    Bassetti C, Vella S, Donati F, Wielepp P, Weder B (2000) SPECT during sleepwalking. Lancet 356:484–485PubMedCrossRefGoogle Scholar
  5. 5.
    Gastaut H, Broughton R (1965) A clinical and polygraphic study of episodic phenomena during sleep. Rec Adv Biol Psychiatry 7:197–223Google Scholar
  6. 6.
    Terzaghi M, Sartori I, Tassi L et al (2009) Evidence of dissociated arousal states during NREM parasomnia from an intracerebral neurophysiological study. Sleep 32:409–412PubMedGoogle Scholar
  7. 7.
    Constantino AEA, Waters C (2002) Somnambulismus in Parkinson’s disease: another sleep disorder to deal with. Neurology 58(Suppl 3):A432 (Abstract)Google Scholar
  8. 8.
    De Cock VC, Vidailhet M, Leu S et al (2007) Restoration of normal motor control in Parkinson’s disease during REM sleep. Brain 130:450–456PubMedCrossRefGoogle Scholar
  9. 9.
    Scaglione C, Vignatelli L, Plazzi G et al (2005) REM sleep behavior disorder in Parkinson’s disease: a questionnaire-based study. Neurol Sci 25:316–321PubMedCrossRefGoogle Scholar
  10. 10.
    Poryazova R, Waldvogel D, Bassetti CL (2007) Sleepwalking in patients with Parkinson disease. Arch Neurol 64:1524–1527PubMedCrossRefGoogle Scholar
  11. 11.
    Olson EJ, Boeve BF, Silber MH (2000) Rapid eye movement sleep behaviour disorder: demographic, clinical and laboratory findings in 93 cases. Brain 123:331–339PubMedCrossRefGoogle Scholar
  12. 12.
    Lin FC, Lai CL, Huang P, Liu CK, Hsu CY (2009) The rapid-eye-movement sleep behavior disorder in Chinese–Taiwanese patients. Psychiatry Clin Neurosci 63:557–562PubMedCrossRefGoogle Scholar
  13. 13.
    Tan EK, Lum SY, Fook-Chong SMC et al (2002) Evaluation of somnolence in Parkinson’s disease: comparison with age- and sex-matched controls. Neurology 58:465–468PubMedGoogle Scholar
  14. 14.
    Comella CL, Nardine TM, Diederich NJ, Stebbins GT (1998) Sleep-related violence, injury, and REM sleep behavior disorder in Parkinson’s disease. Neurology 51:526–529PubMedGoogle Scholar
  15. 15.
    Ondo WG, Dat Vuong K, Khan H, Atassi F, Kwak C, Jankovic J (2001) Daytime sleepiness and other sleep disorders in Parkinson’s disease. Neurology 57:1392–1396PubMedGoogle Scholar
  16. 16.
    Ferri R, Lanuzza B, Cosentino FI et al (2007) A single question for the rapid screening of restless legs syndrome in the neurological clinical practice. Eur J Neurol 14:1016–1021PubMedCrossRefGoogle Scholar
  17. 17.
    Stiasny-Kolster K, Mayer G, Schäfer S, Möller JC, Heinzel-Gutenbrunner M, Oertel WH (2007) The REM sleep behavior disorder screening questionnaire—a new diagnostic instrument. Mov Disord 22:2386–2393PubMedCrossRefGoogle Scholar
  18. 18.
    Fenelon G, Mahieux F, Huon R, Ziegler M (2000) Hallucinations in Parkinson’s disease. Prevalence, phenomenology and risk factors. Brain 123:733–745PubMedCrossRefGoogle Scholar
  19. 19.
    De Maindreville AD, Fénelon G, Mahieux F (2005) Hallucinations in Parkinson’s disease: a follow-up study. Mov Disord 20:212–217PubMedCrossRefGoogle Scholar
  20. 20.
    Harding AJ, Stimson E, Henderson JM, Halliday GM (2002) Clinical correlates of selective pathology in the amygdala of patients with Parkinson’s disease. Brain 125:2431–2445PubMedCrossRefGoogle Scholar
  21. 21.
    Kalaitzakis ME, Christian LM, Moran LB, Graeber MB, Pearce RKB, Gentleman SM (2009) Dementia and visual hallucinations associated with limbic pathology in Parkinson’s disease. Parkinsonism Relat Disord 15:196–204PubMedCrossRefGoogle Scholar
  22. 22.
    Dubois B, Pillon B (1997) Cognitive deficits in Parkinson’s disease. J Neurol 244:2–8PubMedCrossRefGoogle Scholar
  23. 23.
    Uc E, Rizzo M, Anderson S, Qian S, Rodnitzky R, Dawson J (2005) Visual dysfunction in Parkinson disease without dementia. Neurology 65:1907–1913PubMedCrossRefGoogle Scholar
  24. 24.
    Fernandez HH, Lapane KL, Ott BR, Friedman JH (2000) Gender differences in the frequency and treatment of behavior problems in Parkinson’s disease. SAGE Study Group. Mov Disord 15:490–496Google Scholar
  25. 25.
    Klein DA, Steinberg M, Galik E et al (1999) Wandering behaviour in community-residing persons with dementia. Int J Geriat Psychiatry 14:272–279CrossRefGoogle Scholar
  26. 26.
    Bliwise DL, Watts RL, Watts N, Rye DB, Irbe D, Hughes M (1995) Disruptive nocturnal behavior in Parkinson’s disease and Alzheimer’s disease. J Geriatr Psychiatry Neurol 8:107–110PubMedGoogle Scholar
  27. 27.
    Bachman D, Rabins P (2006) “Sundowning” and other temporally associated agitation states in dementia patients. Annu Rev Med 57:499–511PubMedCrossRefGoogle Scholar
  28. 28.
    Gagnon JF, Bédard MA, Fantin ML et al (2002) REM sleep behavior disorder and REM sleep without atonia in Parkinson’s disease. Neurology 59:585–589PubMedGoogle Scholar
  29. 29.
    Eisensehr I, v Lindeiner H, Jäger M, Noachtar S (2001) REM sleep behavior disorder in sleep-disordered patients with versus without Parkinson’s disease: is there a need for polysomnography? J Neurol Sci 186:7–11PubMedCrossRefGoogle Scholar
  30. 30.
    Yoritaka A, Ohizumi H, Tanaka S, Hattori N (2009) Parkinson’s disease with and without REM sleep behaviour disorder: are there any clinical differences? Eur Neurol 61:164–170PubMedCrossRefGoogle Scholar
  31. 31.
    Oudiette D, De Cock VC, Lavault S, Leu S, Vidailhet M, Arnulf I (2009) Nonviolent elaborate behaviors may also occur in REM sleep behavior disorder. Neurology 72:551–557PubMedCrossRefGoogle Scholar
  32. 32.
    Schenck CH, Boyd JL, Mahowald MW (1997) A parasomnia overlap disorder involving sleepwalking, sleep terrors, and REM sleep behavior disorder in 33 polysomnographically confirmed cases. Sleep 20:972–981PubMedGoogle Scholar
  33. 33.
    Plazzi G, Vetrugno R, Provini F, Montagna P (2005) Sleepwalking and other ambulatory behaviours during sleep. Neurol Sci 26(Suppl 3):193–198CrossRefGoogle Scholar
  34. 34.
    Kumar S, Bhatia M, Behari M (2003) Excessive daytime sleepiness in Parkinson’s disease as assessed by Epworth Sleepiness Scale (ESS). Sleep Med 4:339–342PubMedCrossRefGoogle Scholar
  35. 35.
    Landry P, Montplaisir J (1998) Lithium-induced somnambulism. Can J Psychiatry 43:957–958PubMedGoogle Scholar
  36. 36.
    Dolder CR, Nelson MH (2008) Hypnosedative-induced complex behaviours: incidence, mechanisms and management. CNS Drugs 22:1021–1036PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2011

Authors and Affiliations

  • Michael Oberholzer
    • 1
    • 2
  • Rositsa Poryazova
    • 1
  • Claudio L. Bassetti
    • 1
    • 3
  1. 1.Department of NeurologyUniversity Hospital ZurichZurichSwitzerland
  2. 2.Department of Clinical Neurosciences, Division of NeurorehabilitationUniversity of GenevaGeneva 14Switzerland
  3. 3.Department of Neurology, Neurocenter (EOC) of Southern SwitzerlandOspedale CivicoLuganoSwitzerland

Personalised recommendations