Sleep disturbances in Taiwanese patients with Parkinson's disease

Abstract

IntroductionSleep disturbance is a common nonmotor symptom of Parkinson's disease (PD) and strongly affects patients’ quality of life. The relationship between excessive daytime sleepiness (EDS) and nighttime problems remains uncertain. Arguments persist regarding the risk factors for sleep disturbance among patients with PD. Furthermore, the prevalence of EDS appears to be lower in Asian countries. Herein, we conducted the study to describe the characteristics of sleep problems in a sample of Taiwanese PD patients and delineate the difference with reported sleep disturbances in Caucasian PD patients from the literature.MethodsPatients with PD were recruited from the outpatient clinic of a tertiary medical center and were evaluated using standardized assessment protocols, including the Parkinson's Disease Sleep Scale (PDSS), the Pittsburgh Sleep Quality Index (PSQI), Epworth Sleepiness Scale (ESS), and 39‐Item Parkinson's Disease Questionnaire (PDQ‐39).ResultsA total of 225 patients with PD were recruited. The mean age of patients with PD was 65.7 years old and the mean disease duration was 8.18 years. Among the patients, 53.8% were defined as poor sleepers (PSQI > 5) and 26.3% had EDS. Seventy‐one percent of the poor sleepers used hypnotic medications. The poor sleepers were worse in the scores of Unified Parkinson's Disease Rating Scale (UPDRS), PDSS, and the PDQ‐39, and received higher levodopa daily dosage. A PDSS score of <126 indicate that a patient with PD was a poor sleeper. EDS was positively correlated with advanced Hoehn and Yahr stages and use of dopamine agonists but not with levodopa daily dosage and levodopa equivalent daily dosage.ConclusionsTaiwanese patients with PD had a lower prevalence of EDS compared with the literatures reported in Caucasian patients. We identify and suggest that PDSS total score, rather than subcategory items, should be used to predict poor sleep among patients with PD.

Clinical Features and Correlates of Poor Nighttime Sleepiness in Patients with Parkinson’s Disease

“…The prevalence of PNS was 55.45% in patients with PD in the present study, which is higher than that reported in other studies [ 22 ]. This difference may be attributed to differences in the methodology and questionnaire interpretation.…”

Efficacy of cognitive behavioral therapy for insomnia comorbid to Parkinson's disease: A focus on psychological and daytime functioning with a single‐case design with multiple baselines

“…Despite the fact that International, Europeans and National guidelines all recommend CBT‐i as the first‐line treatment for insomnia regardless of the presence or absence of comorbidity, few patients affected by PD have access to CBT‐i (Haute Autorité de Santé, ; Qaseem et al, ; Riemann et al, ). In addition, benzodiazepine prescription remains very common in the disease in response to a sleep complaint (Lin et al, ). In this context, qualitative studies could be very interesting to identify both patients and health professionals' beliefs surrounding insomnia diagnosis and its management in PD.…”

“…In this context, nonbenzodiazepine hypnotic, sedative atypical antipsychotic, anti‐depressive, dopaminergic agents, and melatonin have been tested (Calandra‐Buonaura et al, ; Dowling et al, ; Juri, Chaná, Tapia, Kunstmann, & Parrao, ; Kashihara et al, ; Medeiros et al, ; Melone et al, ; Menza et al, ; Pierantozzi et al, ; Poewe et al, ; Ray Chaudhuri et al, ; Rios Romenets et al, ). Despite this insufficient therapeutic evidence, sedative agents are still and frequently prescribed to manage sleep complaint in patients with PD (Lin et al, ). However, the risks associated with this pharmacological approach are well known in PD.…”

“…Despite this insufficient therapeutic evidence, sedative agents are still and frequently prescribed to manage sleep complaint in patients with PD (Lin et al, 2017). However, the risks associated with this pharmacological approach are well known in PD.…”

Ethnic Variation in the Manifestation of Parkinson’s Disease: A Narrative Review

“…Studies in Asian countries suggest a prevalence in the range of 15-32% of patients. [86][87][88][89] Whereas studies in North America and Europe suggest a prevalence of EDS between 41-57% [90][91][92][93][94][95].…”