Characteristics of sleep structure in Parkinson's disease patients with hallucinations based on polysomnography

Abstract

Hallucination is a common non-motor symptom in patients with Parkinson's disease (PD). Additionally, sleep disorders are associated with an increased risk of hallucinations in PD patients. This study aimed to examine the association between hallucination and objective sleep parameters in PD patients. We retrospectively recruited 278 PD patients who underwent polysomnography and clinical assessments and classified them into non-hallucination and hallucination groups. Hallucinations were observed in 77 older PD patients who had more severe motor symptoms and higher scores on the Non-Motor Symptoms Questionnaire (NMSQ), Hamilton Depression Scale (HAMD) and Hamilton Anxiety Scale (HAMA) but lower scores on the Montreal Cognitive Assessment (MOCA) and PD Sleep Scale (PDSS) than PD patients without hallucinations. Analysis of the polysomnographic variables in patients with hallucinations showed that they exhibited a decrease in total sleep time, sleep efficiency (SE), rapid eye movement (REM) sleep time and slow wave sleep (SWS, N3) time and percentage but a significant increase in wake time after sleep onset (WASO), periodic limb movement index (PLMI) scores, and stage 2 NREM (N2)percentage. Logistic regression analysis revealed that higher NMSQ scores, lower MOCA scores, lower SE, and a lower percentage of N3 sleep were associated with hallucinations in PD patients. Our results suggested that PD patients with hallucinations had worse sleep quality and differences in sleep architecture (measured by polysomnography).

Phantosmia in Parkinson’s Disease: A Systematic Review of the Phenomenology of Olfactory Hallucinations

“…This rigorous screening ensured that only the most relevant articles were considered for further examination in our review. After assessing 261 full papers for eligibility, only 29 studies fulfilled the necessary criteria and underwent data extraction ( Figure 1 ) [ 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 ]. Among the 232 full-text articles excluded, none met the inclusion criteria.…”

“…Considering the absence of a specific tool for assessing OHs in PD patients, most authors opted to interview patients using semi-structured questionnaires or non-specific questions related to the presence of phantosmia [ 16 , 18 , 19 , 25 , 27 , 28 , 29 , 32 , 33 , 35 , 42 , 43 ]. Other authors assessed phantosmia in PD patients using structured questionnaires or interviews, including the Neuropsychiatric Inventory (NPI), the Schedule for Assessment of Positive Symptoms (SAPS), the Enhanced Scale for Assessment of Positive Symptoms in Parkinson’s Disease (eSAPS-PD), the MDS-UPDRS hallucinations and psychosis item, the Psycho-Sensory hAllucinations Scale (PSAS), the Psychosis and Hallucinations Questionnaire (PsycH-Q), and the University of Miami Parkinson’s disease Hallucinations Questionnaire (UM-PDHQ) [ 17 , 20 , 21 , 22 , 23 , 24 , 26 , 30 , 31 , 34 , 36 , 37 , 38 , 39 , 40 , 41 , 44 ]. However, the available data in the literature did not identify the most appropriate tool to assess the presence of phantosmia in PD patients.…”

“…While these data have not been exhaustively detailed, several studies have indicated the concurrent presence of other types of hallucinations alongside phantosmia [ 18 , 19 , 20 , 21 , 22 , 23 , 24 , 26 , 28 , 29 , 30 , 33 , 35 , 36 , 37 , 39 , 40 , 41 , 42 , 43 , 44 ]. Importantly, in the study by Solla and colleagues, nine patients with OHs (56.3%) also reported visual hallucinations and auditory hallucinations, and four (25%) had gustatory hallucinations.…”

“…One crucial point that emerged from this systematic search of the literature is the lack of a specific and validated tool for the assessment of phantosmia in PD patients. Most of the studies included in this review used semi-structured interviews or other structured questionnaires designed primarily for an initial evaluation of psychosis in PD [ 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 ]. As already mentioned, the heterogeneity in assessment methods may contribute to the variation in reported prevalence.…”

Sleep structure and related clinical characteristics in drug-naïve Parkinson's disease with subjectively different sleep quality

“…Therefore, the increase in nocturnal arousal events may be of great value in predicting the progression of motor dysfunction in PD. Our recent study found that N3 sleep (slow-wave sleep, SWS) is one of the important risk factors in PD patients with hallucinations ( 49 ). The deconstruction of the sleep structure is a process affected by many complex factors.…”