A Review of Sleep and Its Disorders in Patients with Parkinson's Disease in Relation to Various Brain Structures

Abstract

Sleep is an indispensable normal physiology of the human body fundamental for healthy functioning. It has been observed that Parkinson's disease (PD) not only exhibits motor symptoms, but also non-motor symptoms such as metabolic irregularities, altered olfaction, cardiovascular dysfunction, gastrointestinal complications and especially sleep disorders which is the focus of this review. A good understanding and knowledge of the different brain structures involved and how they function in the development of sleep disorders should be well comprehended in order to treat and alleviate these symptoms and enhance quality of life for PD patients. Therefore it is vital that the normal functioning of the body in relation to sleep is well understood before proceeding on to the pathophysiology of PD correlating to its symptoms. Suitable treatment can then be administered toward enhancing the quality of life of these patients, perhaps even discovering the cause for this disease.

Poor nighttime sleep is positively associated with dyskinesia in Parkinson's disease patients

“…Potential contributing factors include degeneration of central sleep regulatory areas, adverse effects of anti-parkinsonian medications, age-related sleep changes, and the impact of motor symptoms (nighttime akinesia, dyskinesia, tremor, and rigidity) [9]. Degeneration of multiple areas of the central nervous system involving various neurotransmitters is associated with sleep disorders in PD, including the dopaminergic ventral tegmental area, serotonergic dorsal raphe nuclei, noradrenergic locus coeruleus and dorsal nucleus of the vagal nerve, and cholinergic laterodorsal tegmental nucleus and pedunculopontine nucleus [11]. …”

Practical Evaluation and Management of Insomnia in Parkinson's Disease: A Review

“…Dysfunction in any of these pathways results in daytime sleepiness with inadvertent episodes of napping, decreasing homeostatic sleep drive at night. Other key structures are also compromised in PD (ventral tegmental area, dorsal raphe nucleus, locus ceruleus, pedunculus pontine nucleus, and lateral hypothalamus), resulting in the loss of coordination of sleep stage transitions and greater sleep instability in PD …”

“…A comprehensive review of neuroanatomical structures underlying sleep and wakefulness is beyond the scope of this review; however, we focus here on known degenerative changes in PD impacting wakefulness and sleep consolidation. 25 Widespread neuronal loss with neurotransmitter deficits across dopaminergic and nondopaminergic systems occur in PD. First, there is the loss of the dopaminergic neurons of the substantia nigra pars compacta, a component of the ascending reticular activating system.…”

“…Other key structures are also compromised in PD (ventral tegmental area, dorsal raphe nucleus, locus ceruleus, pedunculus pontine nucleus, and lateral hypothalamus), resulting in the loss of coordination of sleep stage transitions and greater sleep instability in PD. 25,26 Dysfunction of the circadian system in PD, as a consequence of both neurodegeneration and medications, may also contribute to insomnia complaints. 26 In studies of individuals with early PD, the function of the suprachiasmatic nucleus (SCN) is unchanged, with untreated individuals having similar circadian melatonin profiles to age-matched healthy controls.…”

Changes in characteristics of sleep-wake cycle and motor activity at the preclinical stage of Parkinson's disease in old rats

“…Нейродегенеративный процесс при БП охваты-вает несколько структур головного мозга и затрагивает периферическую нервную систему [3], приводя к появлению немоторных симптомов болезни [4,5]. До 80-90% пациентов с БП имеют расстройства сна и поведения [6][7][8][9][10], которые могут быть представлены бессонницей, фрагментацией сна, повышенной дневной сонливостью, парасомнией в виде парадоксального сна без мышечной атонии (rapid eye movement sleep behavioral disorder -RBD), а также кошмарными сновидениями, сноговорением, ночными галлюцинациями. Тем не менее вопрос о том, какие нарушения сна могут рассматриваться в качестве ранних маркеров БП, к настоящему моменту остается дискуссионным [8].…”