Skip to main content
SpringerLink
Log in

Nocturnal journey of body and mind in Parkinson’s disease: the manifestations, risk factors and their relationship to daytime symptoms. Evidence from the NIGHT-PD study

  • Neurology and Preclinical Neurological Studies - Original Article
  • Published:
Journal of Neural Transmission Aims and scope Submit manuscript

Abstract

Nocturnal manifestations of Parkinson’s disease (PD) are myriad, have diverse etiologies and include motor, sleep, urinary, and neuropsychiatric symptoms which are often associated with daytime somnolence. While most patients perceive these symptoms as troublesome, the recognition of nocturnal problems related to PD is still low in clinical practice. We conducted a survey using semi-structured interviews and self-rated questionnaires of 215 consecutive patients with PD enrolled in three centers in Thailand to determine the prevalence and risk factors of nocturnal disabilities and their relationship to daytime symptoms. We found that 96.6 % of patients reported the presence of nocturnal symptoms as determined by the modified version of Parkinson’s Disease Sleep Scale (MPDSS). Our survey indicated that the most frequent and distressing symptom was the interruption of sleep to pass urine (56.7 %, 4.4 ± 3.9). The severity of symptoms revealed in the MPDSS increased along with the disease duration (p < 0.05) and Hoehn and Yahr stages (p = 0.01). There were similar to findings of the Nocturnal Akinesia Dystonia and Cramp Score (NADCS) where patients with advanced disease had significantly higher NADCS scores than early/moderate disease (p < 0.001). There was a significant correlation of total MPDSS scores with the total scores of the 9-item Wearing-Off Questionnaire (WOQ-9); (r = −0.43, p < 0.05) [motor (r = −0.35, p < 0.05) and nonmotor subscores (r = −0.43, p < 0.05)]; total nonmotor symptoms (NMS) scores (r = −0.55, p < 0.05); Parkinson’s Disease Questionnaire-8 Summary Index (PDQ-8 SI) (r = −0.52, p < 0.05); and the total NADCS (r = −0.35, p < 0.05). Multiple regression analysis identified PDQ-8 SI (β = −0.27, p = 0.005) as the most significant predictor of nocturnal manifestations of PD, followed by the nonmotor subscore of WOQ (β = −0.24, p = 0.006), and the NMS item 20 (feeling light-headed, dizzy, or weak when standing from sitting or lying) (β = −0.22, p = 0.003). Our study found that nocturnal symptoms of PD are very common and we suggest that good clinical practice should include a comprehensive review of nighttime manifestations, particularly for those patients who already experience “wearing-off” symptoms.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  • Abe K, Hikita T, Sakoda S (2005) Sleep disturbances in Japanese patients with Parkinson’s disease–comparing with patients in the UK. J Neurol Sci 234(1–2):73–78. doi:10.1016/j.jns.2005.03.036

    Article  PubMed  Google Scholar 

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

    Article  CAS  PubMed  Google Scholar 

  • Barone P, Amboni M, Vitale C, Bonavita V (2004) Treatment of nocturnal disturbances and excessive daytime sleepiness in Parkinson’s disease. Neurology 63(8 Suppl 3):S35–S38

    Article  PubMed  Google Scholar 

  • Bhidayasiri R, Truong DD (2012) Therapeutic strategies for nonmotor symptoms in early Parkinson’s disease: the case for a higher priority and stronger evidence. Parkinsonism Relat Disord 18(Suppl 1):S110–S113. doi:10.1016/S1353-8020(11)70035-9

    Article  PubMed  Google Scholar 

  • Bhidayasiri R, Saksornchai K, Kaewwilai L, Phanthumchinda K (2011) A census of movement disorders at a Thai university hospital. J Neurol Sci 301(1–2):31–34. doi:10.1016/j.jns.2010.11.010

    Article  PubMed  Google Scholar 

  • Buysse DJ, Reynolds CF 3rd, Monk TH, Berman SR, Kupfer DJ (1989) The Pittsburgh Sleep Quality Index: a new instrument for psychiatric practice and research. Psychiatry Res 28(2):193–213

    Article  CAS  PubMed  Google Scholar 

  • Canesi M, Mariani CB, Isaias IU, Pezzoli G (2010) Night-time use of rotigotine in advanced Parkinson’s disease. Funct Neurol 25(4):201–204

    PubMed  Google Scholar 

  • Chahine LM, Daley J, Horn S, Duda JE, Colcher A, Hurtig H, Cantor C, Dahodwala N (2013) Association between dopaminergic medications and nocturnal sleep in early-stage Parkinson’s disease. Parkinsonism Relat Disord 19(10):859–863. doi:10.1016/j.parkreldis.2013.05.009

    Article  PubMed  Google Scholar 

  • Chaudhuri KR, Martinez-Martin P (2004) Clinical assessment of nocturnal disability in Parkinson’s disease: the Parkinson’s Disease Sleep Scale. Neurology 63(8 Suppl 3):S17–S20

    Article  PubMed  Google Scholar 

  • Chaudhuri KR, Pal S, Bridgman K, Trenkwalder C (2001) Achieving 24-hour control of Parkinson’s disease symptoms: use of objective measures to improve nocturnal disability. Eur Neurol 46(Suppl 1):3–10

    Article  PubMed  Google Scholar 

  • Chaudhuri KR, Pal S, DiMarco A, Whately-Smith C, Bridgman K, Mathew R, Pezzela FR, Forbes A, Hogl 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(6):629–635

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  • Chaudhuri KR, Martinez-Martin P, Schapira AH, Stocchi F, Sethi K, Odin P, Brown RG, Koller W, Barone P, MacPhee G, Kelly L, Rabey M, MacMahon D, Thomas S, Ondo W, Rye D, Forbes A, Tluk S, Dhawan V, Bowron A, Williams AJ, Olanow CW (2006) International multicenter pilot study of the first comprehensive self-completed nonmotor symptoms questionnaire for Parkinson’s disease: the NMSQuest study. Mov Disord 21(7):916–923. doi:10.1002/mds.20844

    Article  PubMed  Google Scholar 

  • Comella CL (2007) Sleep disorders in Parkinson’s disease: an overview. Mov Disord 22(Suppl 17):S367–S373. doi:10.1002/mds.21682

    Article  PubMed  Google Scholar 

  • Dhawan V, Dhoat S, Williams AJ, Dimarco A, Pal S, Forbes A, Tobias 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(1–2):158–162. doi:10.1016/j.jns.2006.05.004

    Article  CAS  PubMed  Google Scholar 

  • Evans JR, Mason SL, Williams-Gray CH, Foltynie T, Brayne C, Robbins TW, Barker RA (2011) The natural history of treated Parkinson’s disease in an incident, community based cohort. J Neurol Neurosurg Psychiatry 82(10):1112–1118. doi:10.1136/jnnp.2011.240366

    Article  PubMed  Google Scholar 

  • Factor SA, McAlarney T, Sanchez-Ramos JR, Weiner WJ (1990) Sleep disorders and sleep effect in Parkinson’s disease. Mov Disord 5(4):280–285

    Article  CAS  PubMed  Google Scholar 

  • Gallagher DA, Lees AJ, Schrag A (2010) What are the most important nonmotor symptoms in patients with Parkinson’s disease and are we missing them? Mov Disord 25(15):2493–2500. doi:10.1002/mds.23394

    Article  PubMed  Google Scholar 

  • Gibb WR, Lees AJ (1988) The relevance of the Lewy body to the pathogenesis of idiopathic Parkinson’s disease. J Neurol Neurosurg Psychiatry 51(6):745–752

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  • Hoehn MM, Yahr MD (1967) Parkinsonism: onset, progression and mortality. Neurology 17(5):427–442

    Article  CAS  PubMed  Google Scholar 

  • Hogl B, Arnulf I, Comella C, Ferreira J, Iranzo A, Tilley B, Trenkwalder C, Poewe W, Rascol O, Sampaio C, Stebbins GT, Schrag A, Goetz CG (2010) Scales to assess sleep impairment in Parkinson’s disease: critique and recommendations. Mov Disord 25(16):2704–2716. doi:10.1002/mds.23190

    Article  PubMed  Google Scholar 

  • Jagota P, Asawavichienjinda T, Bhidayasiri R (2012) The low prevalence of primary restless legs syndrome in Thai Parkinson’s disease patients at Chulalongkorn University Hospital. J Med Assoc Thai 95(2):175–180

    PubMed  Google Scholar 

  • Jenkinson C, Fitpatrick R, Peto V, Dummett S, Morley D, Saunders P (2012) The Parkinson’s Disease Questionnaire. Health Services Research Unit, University of Oxford, Oxford

    Google Scholar 

  • Lang AE (2011) A critical appraisal of the premotor symptoms of Parkinson’s disease: potential usefulness in early diagnosis and design of neuroprotective trials. Mov Disord 26(5):775–783. doi:10.1002/mds.23609

    Article  PubMed  Google Scholar 

  • Lees AJ, Blackburn NA, Campbell VL (1988) The nighttime problems of Parkinson’s disease. Clin Neuropharmacol 11(6):512–519

    Article  CAS  PubMed  Google Scholar 

  • Louter M, Munneke M, Bloem BR, Overeem S (2012) Nocturnal hypokinesia and sleep quality in Parkinson’s disease. J Am Geriatr Soc 60(6):1104–1108. doi:10.1111/j.1532-5415.2012.03966.x

    Article  PubMed  Google Scholar 

  • Marinus J, Visser M, van Hilten JJ, Lammers GJ, Stiggelbout AM (2003) Assessment of sleep and sleepiness in Parkinson disease. Sleep 26(8):1049–1054

    PubMed  Google Scholar 

  • Martinez-Martin P, Rodriguez-Blazquez C, Kurtis MM, Group NV (2011) The impact of non-motor symptoms on health-related quality of life of patients with Parkinson’s disease. Mov Disord 26(3):399–406. doi:10.1002/mds.23462

    Article  PubMed  Google Scholar 

  • Medcalf P (2005) Good practice in the assessment and management of nocturnal Parkinson’s disease symptoms. Age Ageing 34(5):435–438. doi:10.1093/ageing/afi157

    Article  PubMed  Google Scholar 

  • O’brien RM (2007) A caution regarding rules of thumb for variance inflation factors. Qual Quant 41(5):673–690

    Article  Google Scholar 

  • Pal PK, Thennarasu K, Fleming J, Schulzer M, Brown T, Calne SM (2004) Nocturnal sleep disturbances and daytime dysfunction in patients with Parkinson’s disease and in their caregivers. Parkinsonism Relat Disord 10(3):157–168. doi:10.1016/j.parkreldis.2003.11.002

    Article  CAS  PubMed  Google Scholar 

  • Politis M, Wu K, Molloy S, G Bain P, Chaudhuri KR, Piccini P (2010) Parkinson’s disease symptoms: the patient’s perspective. Mov Disord 25(11):1646–1651. doi:10.1002/mds.23135

    Article  PubMed  Google Scholar 

  • Ray Chaudhuri K, Martinez-Martin P, Rolfe KA, Cooper J, Rockett CB, Giorgi L, Ondo WG (2012) Improvements in nocturnal symptoms with ropinirole prolonged release in patients with advanced Parkinson’s disease. Eur J Neurol 19(1):105–113. doi:10.1111/j.1468-1331.2011.03442.x

    Article  CAS  PubMed  Google Scholar 

  • Reichmann H, Cooper J, Rolfe K, Martinez-Martin P (2011) Sleep duration and “on” time during different periods of the day and night in patients with advanced Parkinson’s disease receiving adjunctive ropinirole prolonged release. Parkinsons Dis 2011:354760. doi:10.4061/2011/354760

    PubMed Central  PubMed  Google Scholar 

  • Rye DB, Jankovic J (2002) Emerging views of dopamine in modulating sleep/wake state from an unlikely source: PD. Neurology 58(3):341–346

    Article  PubMed  Google Scholar 

  • Shulman LM, Taback RL, Rabinstein AA, Weiner WJ (2002) Non-recognition of depression and other non-motor symptoms in Parkinson’s disease. Parkinsonism Relat Disord 8(3):193–197

    Article  CAS  PubMed  Google Scholar 

  • Sowers JR, Vlachakis N (1984) Circadian variation in plasma dopamine levels in man. J Endocrinol Invest 7(4):341–345

    Article  CAS  PubMed  Google Scholar 

  • Stacy M (2010) The wearing-off phenomenon and the use of questionnaires to facilitate its recognition in Parkinson’s disease. J Neural Transm 117(7):837–846. doi:10.1007/s00702-010-0424-5

    Article  PubMed  Google Scholar 

  • Stacy M, Bowron A, Guttman M, Hauser R, Hughes K, Larsen JP, LeWitt P, Oertel W, Quinn N, Sethi K, Stocchi F (2005) Identification of motor and nonmotor wearing-off in Parkinson’s disease: comparison of a patient questionnaire versus a clinician assessment. Mov Disord 20(6):726–733. doi:10.1002/mds.20383

    Article  PubMed  Google Scholar 

  • Stacy M, Hauser R, Oertel W, Schapira A, Sethi K, Stocchi F, Tolosa E (2006) End-of-dose wearing off in Parkinson disease: a 9-question survey assessment. Clin Neuropharmacol 29(6):312–321. doi:10.1097/01.WNF.0000232277.68501.08

    Article  PubMed  Google Scholar 

  • Stacy MA, Murphy JM, Greeley DR, Stewart RM, Murck H, Meng X, Investigators C-IS (2008) The sensitivity and specificity of the 9-item Wearing-off Questionnaire. Parkinsonism Relat Disord 14(3):205–212. doi:10.1016/j.parkreldis.2007.07.013

    Article  CAS  PubMed  Google Scholar 

  • Stocchi F (2006) The levodopa wearing-off phenomenon in Parkinson’s disease: pharmacokinetic considerations. Expert Opin Pharmacother 7(10):1399–1407. doi:10.1517/14656566.7.10.1399

    Article  CAS  PubMed  Google Scholar 

  • Stocchi F, Barbato L, Nordera G, Berardelli A, Ruggieri S (1998) Sleep disorders in Parkinson’s disease. J Neurol 245(Suppl 1):S15–S18

    Article  PubMed  Google Scholar 

  • Tan EK, Seah A, See SJ, Lim E, Wong MC, Koh KK (2001) Restless legs syndrome in an Asian population: a study in Singapore. Mov Disord 16(3):577–579

    Article  CAS  PubMed  Google Scholar 

  • Tanasanvimon S, Ayuthaya NI, Phanthumchinda K (2007) Modified Parkinson’s Disease Sleep Scale (MPDSS) in Thai Parkinson’s disease patients. J Med Assoc Thai 90(11):2277–2283

    PubMed  Google Scholar 

  • Tandberg E, Larsen JP, Karlsen K (1998) A community-based study of sleep disorders in patients with Parkinson’s disease. Mov Disord 13(6):895–899

    Article  CAS  PubMed  Google Scholar 

  • Train the Brain Forum Committee (1993) Thai mental state examination. Siriraj Hosp Gaz 45(6):359–374

    Google Scholar 

  • Trenkwalder C, Kies B, Rudzinska M, Fine J, Nikl J, Honczarenko K, Dioszeghy P, Hill D, Anderson T, Myllyla V, Kassubek J, Steiger M, Zucconi M, Tolosa E, Poewe W, Surmann E, Whitesides J, Boroojerdi B, Chaudhuri KR, Recover Study G (2011) Rotigotine effects on early morning motor function and sleep in Parkinson’s disease: a double-blind, randomized, placebo-controlled study (RECOVER). Mov Disord 26(1):90–99. doi:10.1002/mds.23441

    Article  PubMed Central  PubMed  Google Scholar 

  • Wienecke M, Werth E, Poryazova R, Baumann-Vogel H, Bassetti CL, Weller M, Waldvogel D, Storch A, Baumann CR (2012) Progressive dopamine and hypocretin deficiencies in Parkinson’s disease: is there an impact on sleep and wakefulness? J Sleep Res 21(6):710–717. doi:10.1111/j.1365-2869.2012.01027.x

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

The study was supported by the Rachadaphiseksomphot Endowment Fund of the “Strengthen CU’s Researcher’s Project” and research unit (RU) Grant Number GRU 56-012-30-002 of Chulalongkorn Center of Excellence on Parkinson’s Disease and Related Disorders, Chulalongkorn University, Bangkok, Thailand. We would like to thank Ratanaruedee Devahastin, Onnalin Jandaew, Montira Vittayakittipong, Paveena Nanphan, Jutarat Taensiri, and Pensri Chongphattararot for their assistance in patient recruitment and data assortment.

Author information

Authors and Affiliations

  1. Chulalongkorn Center of Excellence on Parkinson’s Disease and Related Disorders, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, 10330, Thailand

    Roongroj Bhidayasiri, Onanong Jitkritsadakul, Pattamon Panyakaew, Lalita Kaewwilai, Nonglak Boonrod, Sitthi Petchrutchatachart, Priya Jagota, Kamolwan Boonpeng & Surat Singmaneesakulchai

  2. Department of Neurology, David Geffen School of Medicine at UCLA, Los Angeles, 90095, USA

    Roongroj Bhidayasiri

  3. Maharat Nakhon Ratchasima Hospital, Nakhon Ratchasima, Thailand

    Pawut Mekawichai

  4. Faculty of Medicine, Songklanagarind Hospital, Prince of Songkla University, Songkhla, Thailand

    Suwanna Setthawatcharawanich

Authors
  1. Roongroj Bhidayasiri
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Pawut Mekawichai
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Onanong Jitkritsadakul
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Pattamon Panyakaew
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Lalita Kaewwilai
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Nonglak Boonrod
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Sitthi Petchrutchatachart
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Priya Jagota
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Kamolwan Boonpeng
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Surat Singmaneesakulchai
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Suwanna Setthawatcharawanich
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Roongroj Bhidayasiri.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Bhidayasiri, R., Mekawichai, P., Jitkritsadakul, O. et al. Nocturnal journey of body and mind in Parkinson’s disease: the manifestations, risk factors and their relationship to daytime symptoms. Evidence from the NIGHT-PD study. J Neural Transm 121 (Suppl 1), 59–68 (2014). https://doi.org/10.1007/s00702-014-1199-x

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00702-014-1199-x

Keywords

Search

Navigation