Sleep and Parkinson's disease: A review of case‐control polysomnography studies

Abstract

The link between Parkinson's disease (PD) and certain primary sleep disorders has yet to be clarified. We performed a systematic review of case-control polysomnography studies to evaluate the relationship between PD and sleep disorders. A PubMed literature search and bibliography review yielded 15 case-control polysomnography studies in patients with PD. Studies differed by recruitment methods, duration of polysomnography monitoring, and sleep parameters measured. Subjective sleepiness was greater in patients than controls (50%-66% vs 2.9%-12%) despite lack of objective increase in daytime sleepiness by mean sleep latency testing. The 4 case-control polysomnography studies investigating rapid eye movement behavior disorder support a higher prevalence in PD (0%-47% vs 0%-1.8% in controls), although differences in diagnostic criteria hamper interpretation. The preponderance of evidence did not support an increased incidence of obstructive sleep apnea (27%-60% vs 13%-65%) or periodic leg movements of sleep in patients compared to controls. Adequately powered, prospective studies with uniform methodology and healthy controls are needed to further address the association and pathophysiological significance between PD and sleep problems.

Sleep Disturbances in Essential Tremor and Parkinson Disease: A Polysomnographic Study

“…On the contrary three of five studies suggested that the control group had increased OSAS compared with the PD group. 26 We also found five previous studies analyzing RBD in patients with PD. The RBD diagnostic criteria were modified in 2005, requiring RWA to be demonstrated by EMG in submental and limb muscles and the existence of a clear history of dream-enacting behaviors, suggesting that PSG is essential for establishing an accurate diagnosis of RBD.…”

“…Overnight polysomnography is an objective method of measuring the parameters of sleep architecture and pathophysiological events during sleep. 25 To our knowledge, although several studies have been conducted with PD patients using PSG, 26 sleep disorders in ET patients have not previously been investigated using this technology. In our study, we found no differences among PD, ET, and control groups in terms of TST, WBS, SEI, SCI, CA, AHI, RDI, arousal indices, or PLMI.…”

“…These results might be interpreted as surprising since sleep problems in PD patients are common in clinical practice. However when the polysomnographic studies in PD patients are analyzed, the results are conflicting, as discussed in a review written by Peeraully et al 26 This review concluded that the majority of studies using polysomnography have shown no increase in arousals in PD patients; but some have shown that awakenings may be increased in PD patients but are influenced by dopaminergic treatment. Additionally, no differences between patients and controls in terms of sleep stages were reported.…”

“…In the Perully review, there were conflicting data regarding TST, sleep efficiency, and REM sleep in PD patients. 26 The reason for these conflicting results might be related to dopaminergic medication, disease stage, age, genetics, and psychosocial situation of the patients. We also observed significantly elevated mean SpO 2 in patients with PD compared with those with ET.…”

Sleep Disturbances in Patients with Parkinson’s Disease

“…However, in PD patients, lower levels of decline in the minimal or mean nocturnal oxygen saturation levels than in AHImatched controls were observed [17,21]. In contrast, recent studies suggest that the comorbidity of SAS is not more frequent in PD patients than in the general population, and thus, it may not a relevant issue in PD [10,11,134]. Moreover, it has been argued that SAS may not play a major role in EDS in PD.…”