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Sleep Disturbances in the Prodromal Stage of Parkinson Disease

  • Sleep Disorders (A Iranzo, Section Editor)
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Opinion statement

Decades of research on neurodegenerative diseases such as Parkinson’s disease (PD) have shifted our focus from clinical symptomatic stages to one step earlier, the prodromal stage. There is convincing evidence showing that sleep disorders such as excessive daytime somnolence, insomnia, obstructive sleep apnea, and particularly REM sleep behavior disorder (RBD) are potential prodromal features starting years and decades before conversion to PD. This review aims to provide an overview on various sleep disorders as prodromal features of PD. We start with a discussion of how neuroanatomy of sleep might link to PD pathology. Afterwards, specific sleep disorders that are either known or suspected to be a prodromal symptom for PD, namely insomnia, sleep apnea, somnolence, and RBD, are discussed. Disturbances in serotonergic, cholinergic, dopaminergic, and glutamatergic neurotransmitter systems have made sleep disorders potential candidates for prodromal PD. Nevertheless, the strength of such linkage varies considerably for different entities. While RBD is by far the strongest prodromal manifestation for PD with a high likelihood of phenoconversion and there is reasonable evidence that somnolence can predict PD, data on the prodromal role of sleep apnea and insomnia is limited. Treatment options are available for symptomatic relief of prodromal sleep disorders; however, there is a dearth of knowledge on neuroprotective agents to be used on people with prodromal sleep disorders to either prevent or postpone conversion to PD.

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Author notes

  1. Ahmed Al-Qassabi and Seyed-Mohammad Fereshtehnejad have contributed equally.

Authors and Affiliations

  1. Department of Neurology and Neurosurgery, McGill University, Montreal, QC, Canada

    Ahmed Al-Qassabi MD, Seyed-Mohammad Fereshtehnejad MD, MPH, PhD & Ronald B. Postuma MD MSc

  2. College of Medicine, Sultan Qaboos University, Muscat, Oman

    Ahmed Al-Qassabi MD

  3. Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society (NVS), Karolinska Institutet, Stockholm, Sweden

    Seyed-Mohammad Fereshtehnejad MD, MPH, PhD

  4. Centre for Advanced Research in Sleep Medicine, Hôpital du Sacré-Coeur de Montréal, Montreal, QC, Canada

    Ronald B. Postuma MD MSc

  5. Department of Neurology, L7-305 Montreal General Hospital, 1650 Cedar Avenue, Montreal, QC, H3G 1A4, Canada

    Ronald B. Postuma MD MSc

Authors
  1. Ahmed Al-Qassabi MD
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  2. Seyed-Mohammad Fereshtehnejad MD, MPH, PhD
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  3. Ronald B. Postuma MD MSc
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Corresponding author

Correspondence to Ronald B. Postuma MD MSc.

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Conflict of Interest

Ahmed Al-Qassabi declares that he has no conflict of interest.

Seyed-Mohammad Fereshtehnejad has received Richard and Edith Strauss Postdoctoral Fellowship (McGill University, Canada) and Preston Robb Fellowship (Montreal Neurological Institute, Canada).

Ronald B. Postuma has received personal compensation for travel, speaker fees, and consultation from Biotie, Biogen, Boehringer-Ingelheim, Roche, and Teva Neurosciences and is funded by grants from the Fonds de Recherche du Québec–Santé, the Michael J. Fox Foundation, the W. Garfield Weston Foundation, and the Canadian Institutes of Health Research.

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This article does not contain any studies with human or animal subjects performed by any of the authors.

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This article is part of the Topical Collection on Sleep Disorders

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Al-Qassabi, A., Fereshtehnejad, SM. & Postuma, R.B. Sleep Disturbances in the Prodromal Stage of Parkinson Disease. Curr Treat Options Neurol 19, 22 (2017). https://doi.org/10.1007/s11940-017-0458-1

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  • DOI: https://doi.org/10.1007/s11940-017-0458-1

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