A Review of Scales to Evaluate Sleep Disturbances in Movement Disorders

Abstract

Patients with movement disorders have a high prevalence of sleep disturbances that can be classified as (1) nocturnal sleep symptoms, such as insomnia, nocturia, restless legs syndrome (RLS), periodic limb movements (PLM), obstructive sleep apnea (OSA), and REM sleep behavior disorder; and (2) diurnal problems that include excessive daytime sleepiness (EDS) and sleep attacks. The objective of this review is to provide a practical overview of the most relevant scales that assess these disturbances to guide the choice of the most useful instrument/s depending on the line of research or clinical focus. For each scale, the reader will find a brief description of practicalities and psychometric properties, use in movement disorder cohorts and analyzed strengths and limitations. To assess insomnia, the Pittsburgh Sleep Quality Index, a generic scale, and three disease-specific scales: the Parkinson Disease Sleep Scale (PDSS), the PDSS-2, and Scales for outcomes in Parkinson’s disease (PD)-Sleep-Nocturnal Sleep subscale are discussed. To evaluate nocturia, there are no specific tools, but some extensively validated generic urinary symptom scales (the Overall Bladder Questionnaire and the Overactive Bladder Symptom Score) and some PD-specific scales that include a nocturia item are available. To measure RLS severity, there are currently four domain-specific generic scales: The International Restless Legs Scale, the Johns Hopkins Restless Legs Severity Scale, the Restless Legs Syndrome-6 measure, a Pediatric RLS Severity Scale, and the Augmentation Severity Rating Scale (a scale to evaluate augmentation under treatment) and several instruments that assess impact on quality of sleep and health-related quality of life. To evaluate the presence of PLM, no clinical scales have been developed to date. As far as OSA, commonly used instruments such as the Sleep Apnea Scale of the Sleep Disorders Questionnaire, the STOP-Bang questionnaire, and the Berlin Questionnaire are reviewed. Three scales have been extensively used to assess EDS: the generic Epworth Sleepiness Scale, the Stanford Sleepiness Scale, and the PD-specific Scales for outcomes in PD-Sleep-Daytime sleepiness subscale. To date, only the Inappropriate Sleep Composite Score specifically evaluates propensity to sleep attacks.

Parkinson's Disease: A Comprehensive Analysis of Fungi and Bacteria in Brain Tissue

“…PD affects over 6 million people worldwide [2][3][4], with the vast majority of patients diagnosed in their sixth decade of life. In addition to movement disorders, many patients show other clinical symptoms, including psycho emotional and cognitive deficits, dementia, sleep disturbances and olfactory and bladder dysfunction, among others [5][6][7][8][9]. Some of these symptoms can present years before diagnosis, prior to when motor signs are apparent.…”

Subtypes of Sleep Disturbance in Parkinson's Disease Based on the Cross-Culturally Validated Korean Version of Parkinson's Disease Sleep Scale-2

“…33 Third, convergent validity was only tested against the corresponding K-NMSS domain (domain 2 of K-NMSS), and not against other generic sleep scales such as the Pittsburgh Sleep Quality Index or the Wisconsin Sleep Questionnaire. 6,34 Fourth, our study did not determine the optimal cutoff score for K-PDSS-2. No such information is provided for Korean patients with PD, and thus further studies are needed to address the cutoff value for the K-PDSS-2 instrument.…”

Shedding Light on Nocturnal Movements in Parkinson’s Disease: Evidence from Wearable Technologies

“…Rating scales are the only standardised clinical tools for the semiquantitative evaluation of nocturnal symptom severity and impact on quality of life. These scales investigate a wide range of sleep disturbances, including insomnia, nocturia, breathing disorders, and daytime sleepiness [ 59 ]. However, the most relevant scales commonly used in PD only partially address the issue of abnormal nocturnal movements ( Table 3 ) [ 59 ].…”