Sleep disturbances in untreated Parkinson’s disease

Abstract

Sleep abnormalities are frequently found in Parkinson's disease (PD). However, it is unclear if they are present from the initial stages of PD. We thus aimed to assess sleep disturbances in newly diagnosed PD patients. We investigated 20 untreated PD patients using the Epworth Sleepiness Scale (ESS), the Pittsburgh Sleep Quality Index (PSQI) and the PD Sleep Scale (PDSS). Video-polysomnography and multiple sleep latency test (MSLT) were performed in 15 patients and 15 healthy controls. The ESS score was abnormally high in one patient, while short MSLT times were found in three other patients. The PSQI was higher (p < 0.05) and the PDSS lower (p < 0.001) in patients compared with controls. Video-polysomnography demonstrated a higher percentage of rapid eye movement sleep without atonia (RWA) in patients compared with controls (mean 28 vs. 2.9%, p< 0.001), whereas only one patient had clinically manifested rapid eye movement sleep behavior disorder (RBD). Interestingly, the occurrence of RWA correlated with the motor score (ρ = 0.65, p < 0.05). This study demonstrates that sleep disturbances emerge, in a proportion of patients, from the early stages of PD. RWA is a common finding while RBD is rarely present in early untreated PD.

Sleep Disturbances in Patients with Parkinson’s Disease

“…patients compared with controls was observed, whereas only one patient clinically manifested RBD [22]. Because RBD precedes the onset of PD and can manifest during the early phase of PD, abnormalities in REM sleep in the early phase of PD are supported by PSG findings.…”

“…No differences in mean SL between the levodopa-alone group and the levodopa and dopamine agonist group were reported [20]. In untreated PD patients, the mean SL on MSLT was not different compared with controls (11.7±4 vs. 12.5±2 min) [22]. The mean SL was in the pathological range (<8 min) in three PD patients and in none of the controls, and one patient with PD had a single sleep onset REM on MSLT.…”

“…Although a higher levodopa equivalent dose is correlated with increased daytime sleepiness in PD [62,64,71], the association between the specific type of dopamine agonist and EDS is unclear [61,62,72,73] (Figure 9). Untreated PD patients do not seem to have EDS compared with controls [22,74]. However, the study consisting of 3078 men aged 71 to 93 years showed that there was more than a threefold excess (odds ratio 3.3) in the risk of PD in men with EDS versus men without EDS [75].…”

Sleep-wake disturbances in the premotor and early stage of Parkinson's disease

“…With disease progression, EDS becomes very frequent and prominent [67], and the addition of dopaminergic medication appears to worsen its severity [66]. In early studies, subjective sleepiness and short sleep latencies in the multiple sleep latency test indicative of objective EDS were present in some drug-naïve patients with Parkinson's disease but not more often than in controls [68][69][70]. However, men with EDS had a three-fold higher risk of developing Parkinson's disease than controls without EDS [71].…”

Sleep problems and hypothalamic dopamine D3 receptor availability in Parkinson disease

“…18,19,21 With regard to the influence of dopaminergic medication, several studies have now shown that increased daytime sleepiness or a condition mimicking narcolepsy 22 develops after the introduction of dopaminergic treatment, particularly D3 agonists, in patients with PD, while there is no difference in prevalence of EDS in untreated patients with PD compared with healthy controls. [23][24][25] These studies indicate that dopaminergic therapy plays a strong role in the emergence of EDS in PD. EDS in patients with PD who have never used dopamine agonists was found to be associated with H&Y stage 23 and mood and autonomic dysfunction, 25 suggesting that disease-related changes in sleep-wake regulation also contribute to EDS.…”