Sleep disturbance in movement disorders: insights, treatments and challenges

Abstract

Sleep and circadian rhythm disturbances are central features of many movement disorders, exacerbating motor and non-motor symptoms and impairing quality of life. Understanding these disturbances to sleep is clinically important and may further our understanding of the underlying movement disorder. This review evaluates the current anatomical and neurochemical understanding of normal sleep and the recognised primary sleep disorders. In addition, we undertook a systematic review of the evidence for disruption to sleep across multiple movement disorders. Rapid eye movement sleep behaviour disorder has emerged as the most reliable prodromal biomarker for the alpha synucleinopathies, including Parkinson’s disease and multiple system atrophy, often preceding motor symptom onset by several years. Abnormal sleep has also been described for many other movement disorders, but further evidence is needed to determine whether this is a primary or secondary phenotypic component of the underlying condition. Medication used in the treatment of motor symptoms also affects sleep and can aggravate or cause certain sleep disorders. Within the context of movement disorders, there is also some suggestion of a shared underlying mechanism for motor and sleep pathophysiology, with evidence implicating thalamic and brainstem structures and monoaminergic neurotransmission. This review highlights the need for an understanding of normal and abnormal sleep within the movement disorder clinic, an ability to screen for specific causes of poor sleep and to treat sleep disturbance to improve quality of life. Key sleep disorders also act as important biomarkers and have implications in diagnosis, prognosis and the development of future therapies.

Factors contributing to sleep disturbances and excessive daytime sleepiness in patients with Parkinson's disease

“…Although PD is characterized by motor symptoms, such as bradykinesia, resting tremor, and rigidity, numerous non-motor symptoms appear, which often precede motor symptoms. Sleep disturbance is one of the major non-motor symptoms observed in 74–98% of individuals diagnosed with PD ( 2 ) and affects their overall quality of life ( 3 ). Sleep disturbances are typically multifactorial and may be influenced by the disease-related degeneration of wake-active monoaminergic and cholinergic neurons in the hypothalamus and brainstem, nocturnal motor and non-motor PD symptoms, coexisting sleep disorders such as rapid eye movement sleep behavior disorder (RBD), restless legs syndrome (RLS), obstructive sleep apnea (OSA) and circadian rhythm disorders, medications for PD and complications, and aging ( 4 ).…”

Sleep alterations in a mouse model of Spinocerebellar ataxia type 3

“…Many movement disorders including the synucleinopathies display altered oscillatory states during sleep relative to healthy subjects, even preceding clinical disease onset 39, 40 . To quantify differences in brain EEG oscillations between SCA3 mice and controls, we used spectrographic analysis to quantify the power of all EEG oscillations across sleep (REM and NREM) and wake states (Figure 3, 4, and 5).…”

Circulating CircRNAs Panel Acts as a Biomarker for the Early Diagnosis and Severity of Parkinson’s Disease

“…PD, also known as palsy tremor, is one of the most common neurodegenerative diseases in middle-aged and elderly people ( Bailey et al, 2021 ; Lin et al, 2021 ). The prevalence increases significantly with age.…”