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Sleep disturbances in untreated Parkinson’s disease

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Abstract

Sleep abnormalities are frequently found in Parkinson’s disease (PD). However, it is unclear if they are present from the initial stages of PD. We thus aimed to assess sleep disturbances in newly diagnosed PD patients. We investigated 20 untreated PD patients using the Epworth Sleepiness Scale (ESS), the Pittsburgh Sleep Quality Index (PSQI) and the PD Sleep Scale (PDSS). Video-polysomnography and multiple sleep latency test (MSLT) were performed in 15 patients and 15 healthy controls. The ESS score was abnormally high in one patient, while short MSLT times were found in three other patients. The PSQI was higher (p < 0.05) and the PDSS lower (p < 0.001) in patients compared with controls. Video-polysomnography demonstrated a higher percentage of rapid eye movement sleep without atonia (RWA) in patients compared with controls (mean 28 vs. 2.9%, p < 0.001), whereas only one patient had clinically manifested rapid eye movement sleep behavior disorder (RBD). Interestingly, the occurrence of RWA correlated with the motor score (ρ = 0.65, p < 0.05). This study demonstrates that sleep disturbances emerge, in a proportion of patients, from the early stages of PD. RWA is a common finding while RBD is rarely present in early untreated PD.

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References

  1. Abbott RD, Ross GW, White LR et al (2005) Excessive daytime sleepiness and subsequent development of Parkinson’s disease. Neurology 65:1442–1446

    Article  PubMed  CAS  Google Scholar 

  2. Adler CH, Thorpy MJ (2005) Sleep issues in Parkinson’s disease. Neurology 64(Suppl 3):S12–S20

    PubMed  Google Scholar 

  3. Allen RP, Picchietti D, Hening WA, Trenkwalder C, Walters AS, Montplaisir J (2003) Restless legs syndrome: diagnostic criteria, special considerations, and epidemiology. A report from the restless legs syndrome diagnosis and epidemiology workshop at the National institutes of health. Sleep Med 4:101–119

    Article  PubMed  Google Scholar 

  4. American Academy of Sleep Medicine (2005) The international classification of sleep disorders–revised. American Academy of Sleep Medicine, Chicago

    Google Scholar 

  5. American Academy Task Force of Sleep Medicine (1999) Sleep-disordered breathing disorders in adults: recommendations for syndrome definition and measurement techniques in clinical research. Sleep 22:667–688

    Google Scholar 

  6. American Psychiatric Association (2000) Diagnostic and statistical manual of mental disorder, Fourth edn. Text revision (DSM-IV-TR). American Psychiatric Publishing, Washington

    Book  Google Scholar 

  7. Arnulf I, Konofal E, Merino-Andreu M, Houeto JL, Mesnage V, Welter ML, Lacomblez L, Golmard JL, Derenne JP, Agid Y et al (2002) Parkinson’s disease and sleepiness. An integral part of PD. Neurology 58:1019–1024

    PubMed  CAS  Google Scholar 

  8. Boeve BF, Silber MH, Saper CB, Ferman TJ, Dickson DW, Parisi JE, Benarroch EE, Ahlskog JE, Smith GE, Caselli RC, Tippman-Peikert M, Olson EJ, Lin SC, Young T, Wszolek Z, Schenck CH, Mahowald MW, Castillo PR, Del Tredici K, Braak H (2007) Pathophysiology of REM sleep behaviour disorder and relevance to neurodegenerative disease. Brain 130:2770–2788

    Article  PubMed  CAS  Google Scholar 

  9. Borek LL, Kohn R, Friedman JH (2007) Phenomenology of dreams in Parkinson’s disease. Mov Disord 22:198–202

    Article  PubMed  Google Scholar 

  10. Burke RE, Dauer WT, Vonsattel JP (2008) A critical evaluation of the Braak staging scheme for Parkinson’s disease. Ann Neurol 64:485–491

    Article  PubMed  Google Scholar 

  11. Buysse DJ, Reynolds CF, Monk TH, Berman SR, Kupfer DJ (1989) The Pittsburgh sleep quality index: a new instrument for psychiatry practice and research. Psychiatry Res 28:193–213

    Article  PubMed  CAS  Google Scholar 

  12. Chaudhuri KR, Pal S, Marco Di, Whately-Smith C, Bridgman K, Mathew R, Pezzela FR, Forbes A, Högl B, Trenkwalder C (2002) The Parkinson’s Disease Sleep Scale: a new instrument for assessing sleep and nocturnal disability in Parkinson’s disease. J Neurol Neurosurg Psychiatry 73:629–635

    Article  PubMed  CAS  Google Scholar 

  13. Cochen De Cock V, Vidaihet M, Arnulf I (2008) Sleep disturbances in patients with parkinsonism. Nat Clin Pract Neurol 4:254–266

    Article  Google Scholar 

  14. Consens FB, Chervin RD, Koeppe RA, Little R, Liu S, Junck L, Angell K, Heumann M, Gilman S (2005) Validation of a polysomnographic score for REM sleep behavior disorder. Sleep 28:993–997

    PubMed  Google Scholar 

  15. Dhawan V, Dhoat S, Williams AJ, Dimarco A, Pal S, Forbes A, Tobías A, Martinez-Martin P, Chaudhuri KR (2006) 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 248:158–162

    Article  PubMed  CAS  Google Scholar 

  16. Fabbrini G, Barbanti P, Aurilia C, Vanacore N, Pauletti C, Meco G (2002) Excessive daytime sleepiness in de novo and treated Parkinson’s disease. Mov Disord 17:1026–1030

    Article  PubMed  Google Scholar 

  17. Fabbrini G, Barbanti P, Aurilia C, Pauletti C, Vanacore N, Meco G (2003) Excessive daytime somnolence in Parkinson’s disease. Follow-up after 1 year of treatment. Neurol Sci 24:178–179

    Article  PubMed  CAS  Google Scholar 

  18. Ferrini-Strambi L, Franceschi M, Pinto P, Zucconi M, Smirne S (1992) Respiration and heart rate variability during sleep in untreated Parkinson patients. Gerontology 38:92–98

    Article  Google Scholar 

  19. Gagnon JF, Bedard MA, Fantini ML, Petit D, Panisset M, Rompré S, Carrier J, Montplaisir J (2002) REM sleep behavior disorder and REM sleep without atonia in Parkinson’s disease. Neurology 59:585–589

    PubMed  CAS  Google Scholar 

  20. Gagnon JF, Postuma RB, Mazza S, Doyon J, Montplaisir J (2006) Rapid-eye-movement sleep behaviour disorder and neurodegenerative diseases. Lancet Neurol 5:424–432

    Article  PubMed  Google Scholar 

  21. Garcia-Borreguero D, Caminero AB, de la Llave Y, Larrosa O, Barrio S, Granizo JJ, Pareja JA (2002) Decreased phasic EMG activity during rapid eye movement sleep in treatment-naïve Parkinson’s disease: effects of treatment with levodopa and progression of illness. Mov Disord 17:934–941

    Article  PubMed  Google Scholar 

  22. Gómez-Esteban JC, Tijero B, Somme J, Ciordia R, Berganzo K, Rouco I, Bustos JL, Valle MA, Lezcano E, Zarranz JJ (2011) Impact of psychiatric symptoms and sleep disorders on the quality of life of patients with Parkinson’s disease. J Neurol 258(3):494–499

    Google Scholar 

  23. Grandas F, Iranzo A (2004) Nocturnal problems occurring in Parkinson’s disease. Neurology 63(Suppl 3):S8–S11

    PubMed  CAS  Google Scholar 

  24. Hobson D, Lang AE, Martin WR, Razmy A, Rivest J, Fleming J (2002) Excessive daytime sleepiness and sudden-onset sleep in Parkinson disease. JAMA 287:455–463

    Article  PubMed  Google Scholar 

  25. Hőgl B, Seppi K, Brandauer E, Glatzl S, Frauscher B, Niedermüller U, Wenning G, Poewe W (2003) Increased daytime sleepiness in Parkinson’s disease: a questionnaire survey. Mov Disord 18:319–323

    Article  PubMed  Google Scholar 

  26. Johns MW (1991) A new method for measuring daytime sleepiness: the Epworth Sleepiness Scale. Sleep 14:540–545

    PubMed  CAS  Google Scholar 

  27. Kaynak D, Kiziltan G, Kaynak H, Benbir G, Uysal O (2005) Sleep and sleepiness in patients with Parkinson’s disease before and after dopaminergic treatment. Eur J Neurol 12:199–207

    Article  PubMed  CAS  Google Scholar 

  28. Lapierre O, Montplaisir J (1992) Polysomnographic features of REM sleep behavior disorder: development of a scoring method. Neurology 43:1371–1374

    Google Scholar 

  29. Mitler MM, Carskadon MA, Hirshkowitz M (2005) Evaluating sleepiness. In: Kryger MH, Roth T, Dement WC (eds) Principles and practice of sleep medicine, 4th ed. Elsevier Saunders, Philadelphia, pp 1417–1419

    Chapter  Google Scholar 

  30. 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 57:1392–1396

    PubMed  CAS  Google Scholar 

  31. Postuma RB, Gagnon JF, Vendette M, Fantini ML, Massicotte-Marquez J, Montpalisir J (2009) Quantifying the risk of neurodegenerative disease in idiopathic REM sleep behavior disorder. Neurology 72:1296–1300

    PubMed  CAS  Google Scholar 

  32. Rechtschaffen A, Kales A (eds) (1968) A manual of standardized terminology, technique and scoring system for sleep stages of human subjects. Brain Information Service/Brain Research Institute, UCLA, Los Angeles

  33. Rye DB, Jankovic J (2002) Emerging views of dopamine in modulating sleep/wake state from an unlikely source: PD. Neurology 58:341–346

    PubMed  Google Scholar 

  34. Scaglione C, Vignatelli L, Plazzi G, Marchese R, Negrotti A, Rizzo G, Lopane G, Bassein L, Maestri M, Bernardini S, Martinelli P, Abbruzzese G, Calzetti S, Bonuccelli U, Provini F, Coccagna G (2005) REM sleep behavior disorder in Parkinson’s disease: a questionnaire-based study. Neurol Sci 25:316–321

    Article  PubMed  CAS  Google Scholar 

  35. Shpirer I, Miniovitz A, Klein C, Goldstein R, Prokhorov T, Theitler J, Pollak L, Rabey JM (2006) Excessive daytime sleepiness in patients with Parkinson’s disease: a polysomnography study. Mov Disord 21:1432–1438

    Article  PubMed  Google Scholar 

  36. Tandberg E, Larsen JP, Karlsen K (1998) A community-based study of sleep disorders in patients with Parkinson’s disease. Mov Disord 13:895–899

    Article  PubMed  CAS  Google Scholar 

  37. Thannickal TC, Lai YY, Siegel JM (2007) Hypocretin (orexin) cell loss in Parkinson’s disease. Brain 130:1586–1595

    Article  PubMed  Google Scholar 

  38. Wetter TC, Collado-Seidel V, Pollmächer T, Yassouridis A, Trenkwalder C (2000) Sleep and periodic leg movement patterns in drug-free patients with Parkinson’s disease and multiple system atrophy. Sleep 23:361–367

    PubMed  CAS  Google Scholar 

  39. Wetter TC, Brunner H, Högl B, Yassouridis A, Trenkwalder C, Friess E (2001) Increased alpha activity in REM sleep in de novo patients with Parkinson’s disease. Mov Disord 16:928–933

    Article  PubMed  CAS  Google Scholar 

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Acknowledgments

This work was supported by the Czech Ministry of Education, project MSM 0021620849 and the Czech Ministry of Health, NT 11331-6.

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Authors and Affiliations

  1. First Faculty of Medicine, Department of Neurology, Centre of Clinical Neuroscience, General University Hospital in Prague, Charles University in Prague, Kateřinská 30, 128 21, Prague 2, Czech Republic

    Jitka Bušková, Jiří Klempíř, Veronika Majerová, Jana Picmausová, Karel Šonka, Robert Jech, Jan Roth & Evžen Růžička

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  1. Jitka Bušková
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  2. Jiří Klempíř
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  3. Veronika Majerová
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Correspondence to Evžen Růžička.

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Bušková, J., Klempíř, J., Majerová, V. et al. Sleep disturbances in untreated Parkinson’s disease. J Neurol 258, 2254–2259 (2011). https://doi.org/10.1007/s00415-011-6109-7

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  • DOI: https://doi.org/10.1007/s00415-011-6109-7

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