Sleep Disturbances and Sleep Disordered Breathing Impair Cognitive Performance in Parkinson’s Disease

Abstract

Background Sleep disturbances and impairment of cognitive function are among the most frequent non-motor symptoms in Parkinson’s disease (PD) with negative implications on quality of life of patients and caregivers. Despite the fact that sleep disturbances are a major issue in PD patients, only limited data are available regarding interactions of sleep disturbances and cognitive performance. Objective This post hoc analysis of the RaSPar trial was therefore designed to further elucidate sleep disturbances and their impact on cognition in PD. Methods Twenty-six PD patients with sleep disturbances were evaluated thoroughly including assessments of patients’ subjective and objective sleep quality by interview, questionnaires, and polysomnography (PSG). Cognitive performance was assessed by Parkinson Neuropsychometric Dementia Assessment (PANDA) and Test of Attentional Performance (TAP), and associations of sleep and cognitive function were evaluated. Results We did not detect differences in cognitive performance between patients with and without rapid eye movement (REM) sleep behavior disorder (RBD). Instead, cognitive impairment, particularly affecting cognitive domains attention, executive function/working memory, and semantic memory, was associated with impaired PSG-measured sleep quality (e.g., sleep efficiency) and sleep disordered breathing (SDB) (Apnea-Hypopnea Index > 5/h). Global cognitive performance was decreased in patients with SDB (PANDA score 23.2 ± 3.5 vs. 26.9 ± 2.2, P = 0.020, unpaired two-sided t -test). Conclusion Sleep apnea and other sleep disturbances impair cognitive performance in PD and should be evaluated in routine care, and treatment options such as continuous airway pressure therapy should be considered.

Progressive Prefrontal Cortex Dysfunction in Parkinson's Disease With Probable REM Sleep Behavior Disorder: A 3-Year Longitudinal Study

“…Of note, recent studies have demonstrated the RBD increased risk of cognitive impairment (Boot et al, 2012 ; Postuma et al, 2019 ). A recent study has reported no significant differences in cognitive performance between patients with PD-pRBD + and PD-pRBD − , whereas cognitive decline is associated with sleep efficiency (Hermann et al, 2020 ). In this work, we found that patients with PD-pRBD + exhibited a more rapid decline in cognition.…”

Pharmacological and Non-pharmacological Treatments of Sleep Disorders in Parkinson's Disease

“…It has been proposed that pulmonary dysfunction, rigidity of muscles of the chest wall, and changes in posture/kyphoscoliosis may be potential risks for SDB in PD patients [ 32 ]. Neurodegeneration was also proposed as a cause of SDB in PD, but studies showed no correlation between SDB and caudal brainstem serotonergic innervation or striatal dopaminergic innervation [ 140 ]. There is also an association between SDB and other types of sleep disorders.…”

“…For example, OSA can aggravate excessive daytime somnolence in PD patients [ 141 ]. In some studies, SDB increases the frequency and severity of RBD events and RBD may render PD patients prone to SDB, although RBD influences sleep-related breathing parameters modestly [ 142 , 143 ] but in other studies, PD patients with RBD seem to experience lower rate of OSA, which is possibly due to a protective effect of enhanced muscle tone during REM sleep [ 140 ].…”

“…Studies have found severe OSA is associated with an obvious reduction in the number of position changes and an increased supine sleep position while sleeping [ 146 ]. While in some studies, OSA is related to both the central dysfunction of the brainstem respiratory centers and a peripheral airways involvement [ 140 ]. Higher body mass index (BMI) is one of the most important risk factors for OSA in general population.…”

Current Update on Clinically Relevant Sleep Issues in Parkinson’s Disease: A Narrative Review

“…Supine sleep was related to longer disease duration, daytime sleepiness and a higher AHI but not to total sleep time, sleep efficiency or sleep stage. Additionally, an AHI > 5/h and decreased sleep efficiency have been reported to contribute to impaired cognition, particularly attention, executive function/working memory, and semantic memory in patients with PD [169], implying that the Over 11 years of follow-up in community-dwelling older men, reduced circadian rhythmicity was associated with an increased risk of incident PD [177].…”