Sleep and Periodic Leg Movement Patterns in Drug-Free Patients with Parkinson's Disease and Multiple System Atrophy

Wetter, Thomas C.; Collado-Seidel, V.; Pollmächer, Thomas; Yassouridis, Alexander; Trenkwalder, Claudia

doi:10.1093/sleep/23.3.1c

Cited by 316 publications

(178 citation statements)

References 27 publications

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“…Periodic leg kicks are thought to be more frequent in diseases with impaired dopaminergic transmission, like PD 81 and multisystem atrophy. 18 A previous study in our laboratory concurred with these reports and showed high prevalence in periodic kicks during the night in PD and an association with lower quality of life. 39 However, these studies assessed periodic leg kicks which were independent of arousals.…”

supporting

confidence: 87%

“…11 Sleep disorders such as obstructive sleep apnea (OSA), restless legs syndrome (RLS), periodic limb movements syndrome (PLMS), and REM sleep behavior disorder (RBD) are commonly reported in patients with PD in rates similar or higher than in the general older adult population. [12][13][14][15][16][17][18][19][20][21][22][23][24][25] Sleep disorders result in complaints about disturbed sleep, excessive daytime sleepiness, cognitive decline, and depression, all of which are also recognized as NMS of PD. [26][27][28][29] Additionally, sleep disorders have been shown to substantially impact healthrelated quality of life in patients with PD.…”

mentioning

confidence: 99%

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Effects of Sleep Disorders on the Non-Motor Symptoms of Parkinson Disease

Neikrug

Maglione

Liu³

et al. 2013

Journal of Clinical Sleep Medicine

106

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Study Objectives: To evaluate the impact of sleep disorders on non-motor symptoms in patients with Parkinson disease (PD). Design: This was a cross-sectional study. Patients with PD were evaluated for obstructive sleep apnea (OSA), restless legs syndrome (RLS), periodic limb movement syndrome (PLMS), and REM sleep behavior disorder (RBD). Cognition was assessed with the Montreal Cognitive Assessment and patients completed self-reported questionnaires assessing non-motor symptoms including depressive symptoms, fatigue, sleep complaints, daytime sleepiness, and quality of life. Setting: Sleep laboratory. Participants: 86 patients with PD (mean age = 67.4 ± 8.8 years; range: 47-89; 29 women). Interventions: N/A. Measurements and Results: Having sleep disorders was a predictor of overall non-motor symptoms in PD (R 2 = 0.33, p < 0.001) while controlling for age, PD severity, and dopaminergic therapy. These analyses revealed that RBD (p = 0.006) and RLS (p = 0.014) were signifi cant predictors of increased non-motor symptoms, but OSA was not. More specifi cally, having a sleep disorder signifi cantly predicted sleep complaints (ΔR 2 = 0.13, p = 0.006), depressive symptoms (ΔR 2 = 0.01, p = 0.03), fatigue (ΔR 2 = 0.12, p = 0.007), poor quality of life (ΔR 2 = 0.13, p = 0.002), and cognitive decline (ΔR 2 = 0.09, p = 0.036). Additionally, increasing number of sleep disorders (0, 1, or ≥ 2 sleep disorders) was a signifi cant contributor to non-motor symptom impairment (R 2 = 0.28, p < 0.001). Conclusion: In this study of PD patients, presence of comorbid sleep disorders predicted more non-motor symptoms including increased sleep complaints, more depressive symptoms, lower quality of life, poorer cognition, and more fatigue. RBD and RLS were factors of overall increased non-motor symptoms, but OSA was not. S C I E N T I F I C I N V E S T I G A T I O N SP arkinson disease (PD) is a progressive neurodegenerative disorder primarily characterized by motor symptoms and increasing motor-related disability, including bradykinesia, rigidity, and tremor.1 Non-motor symptoms (NMS) such as sleep dysfunction, sleepiness, fatigue, pain, and depressive symptoms, are common in PD. In a large multicenter study, NMS were reported by 99% of 1072 PD patients.2 The presentation of NMS in PD is highly variable, and the understanding of such heterogeneity in PD is limited and incomplete.3,4 Chaudhuri et al. 4 suggested that NMS dominate the clinical picture in patients with PD and contribute to the severe disability these patients experience, impair quality of life, and even shorten life expectancy. Studies have suggested that NMS, more than motor symptoms, may impact caregiver distress, quality of life, institutionalization rates, and overall costs related to PD .4-6 A 15-year follow-up study of patients with PD reported that the NMS that did not respond to dopamine therapy (e.g., dementia, sleep disruption) were "more disabling than endof-dose failure or dyskinesia" and were the major cause of morbidity and mortality. Sixty to 98% of pati...

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supporting

confidence: 87%

mentioning

confidence: 99%

Effects of Sleep Disorders on the Non-Motor Symptoms of Parkinson Disease

Neikrug

Maglione

Liu³

et al. 2013

Journal of Clinical Sleep Medicine

106

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“…7 Although PLMS has been studied mostly in the setting of PD and is frequently associated with dopamine deficiency, 6,19 the association observed in the current study remained after adjusting for dopaminergic use and after exclusion of participants with a history of PD. Elevated PLMS could be an early marker of cognitive impairment even in older men free of PD or other apparent dopamine-related disorders.…”

Section: Discussionmentioning

confidence: 63%

“…2,3 The exact mechanism of PLMS is unclear, but impaired dopaminergic transmission is frequently suggested. [4][5][6] Notably, a high prevalence of PLMS has been reported among patients with Parkinson disease (PD) and Lewy body dementia, 5,6 further supporting a potentially close link between PLMS and dopaminergic hypoactivity. In addition, higher PLMS has been correlated with impaired executive function in the setting of PD.…”

Section: Introductionmentioning

confidence: 98%

Periodic Limb Movements in Sleep are Associated with Greater Cognitive Decline in Older Men without Dementia

Leng

Blackwell

Stone

et al. 2016

Sleep

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Study Objectives: To examine the association between periodic limb movements in sleep (PLMS) and change in selected aspects of cognition in community-dwelling older men. Methods: We studied 2,636 older men without dementia who underwent in-home polysomnography with measurement of the periodic limb movement index (PLMI) and periodic limb movement arousal index (PLMAI) using piezoelectric sensors. Random-effects models and logistic regression were used to examine the association between PLMI, PLMAI, and 3-to 4-y change in cognition. Results: After multivariable adjustment, men with a high PLMI had greater decline on the Trail Making Test -Part B (P trend = 0.02); those with a PLMI ≥ 30 were 48% more likely (odds ratio = 1.48, 95% confidence interval = 1.05-2.07) to experience the development of significant cognitive impairment (≥ 1 SD above mean change). Further adjustment for sleep efficiency, nocturnal hypoxemia, or dopaminergic medication use and analysis among men without Parkinson disease (n = 2,607) showed similar findings. No significant association was found for PLMAI or for Modified Mini-Mental State Examination scores. Conclusions: Among older men without dementia, higher PLMS frequency was associated with greater decline in cognition, particularly in executive function.

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“…PLMS occur frequently in PD patients (Wetter et al, 2000) and are also associated with sleep disorders involving a dopaminergic impairment (Montplaisir et al, 2000).…”

Section: Introductionmentioning

confidence: 99%

The Effect of Cabergoline on Sleep, Periodic Leg Movements in Sleep, and Early Morning Motor Function in Patients with Parkinson's Disease

Högl

Rothdach

Wetter

et al. 2003

Neuropsychopharmacol

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To investigate the effect of the dopamine D2 and D1 receptor agonist cabergoline on sleep, periodic leg movements (PLMs) in sleep, and early morning motor performance in patients with Parkinson's disease (PD). It was hypothesized that cabergoline had long-lasting beneficial effects on sleep and PLMs in sleep in patients with PD, after a single evening intake. A total of 15 patients with idiopathic PD underwent two nights of polysomnography and motor tests (UPDRS, tapping test) before and after 6-8 weeks of treatment with cabergoline (dosage: 3-6 mg/day). Additionally, patients completed a subjective sleep visual analog scale (VAS) before and during cabergoline treatment. Compared to baseline values, treatment with cabergoline did not change sleep efficiency or the amount of stage 1 and stage 2 sleep. The number of awakenings (22.4 7 10.1 vs 32.5 7 13.3, po0.05) and stage shifts (119 7 42 vs 148 7 46, po0.05) were increased during treatment with cabergoline, and PLMs in sleep were reduced (PLM index 34.9 7 44.9 vs 6.7 7 4.2 per hour, po0.05). Cabergoline significantly improved early morning motor function, and in spite of increased phase shifts and awakenings, patients felt significantly more refreshed in the morning during cabergoline therapy. Cabergoline slightly fragmented sleep, without altering its total amount. The functional significance of this finding is uncertain. The subjective quality of sleep improved, and periodic limb movements in sleep decreased.

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Sleep and Periodic Leg Movement Patterns in Drug-Free Patients with Parkinson's Disease and Multiple System Atrophy

Cited by 316 publications

References 27 publications

Effects of Sleep Disorders on the Non-Motor Symptoms of Parkinson Disease

Effects of Sleep Disorders on the Non-Motor Symptoms of Parkinson Disease

Periodic Limb Movements in Sleep are Associated with Greater Cognitive Decline in Older Men without Dementia

The Effect of Cabergoline on Sleep, Periodic Leg Movements in Sleep, and Early Morning Motor Function in Patients with Parkinson's Disease

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