Associations Between Fluctuations in Daytime Sleepiness and Motor and Non‐Motor Symptoms in Parkinson's Disease

Abstract

Background Background: Non-motor fluctuations are a major concern in Parkinson's disease (PD), and they have been categorized into neuropsychiatric, autonomic and sensory fluctuations. However, this categorization does not include sleep and sleep-related features, and the association between daytime sleepiness and other motor and/or non-motor fluctuations in PD remains to be elucidated. Objective Objective: To investigate the relationship between daytime sleepiness and other non-motor and motor fluctuations in people with PD. Methods Methods: A three-day home diary recording daytime sleepiness, mood, anxiety, and motor symptoms was used along with the Karolinska Sleepiness Scale (KSS) and 6 days of accelerometer (Parkinson's KinetiGraph™; PKG™) registration to detect motor fluctuations among people with a DaTSCAN verified clinical PD diagnosis (32 men; mean PD duration, 8.2 years). Participants were categorized as motor fluctuators or non-fluctuators according to the UPDRS part IV and/or the presence of motor and non-motor fluctuations. Results Results: Fifty-two people with PD participated. Daytime sleepiness correlated significantly with motor symptoms, mood and anxiety among those classified as motor fluctuators (n = 28). Motor fluctuators showed stronger correlations between the individual mean level of all diary variables (daytime sleepiness, anxiety, mood and motor symptoms) when compared to the non-fluctuators (n = 24). Stronger positive within-individual correlations were found among fluctuators in comparison to non-fluctuators. In general, PKG data did not correlate with diary data. Conclusion Conclusion: Episodes of daytime sleepiness, as reported by home diaries, were associated with other selfreported non-motor and motor fluctuations, but were not supported by PKG data.

Like a Wave in Its Variable Shape, Breadth, and Depth: A Qualitative Interview Study of Experiences of Daytime Sleepiness in People with Parkinson’s Disease

“…None of the participants expressed the idea that their motor or nonmotor symptoms were directly linked to sleepiness. This finding was unexpected, as several studies [ 14 , 20 , 32 , 33 ] have found a correlation between EDS, motor symptoms, and nonmotor symptoms (e.g., depression and anxiety) in people with PD. However, such associations are not necessarily causal and have in general not been particularly strong [ 6 , 14 , 32 ].…”

“…This study is a part of a larger prospective study that aimed to investigate the relationship between daytime sleepiness and nonmotor and motor fluctuations in people with PD [ 20 ]. Participants in the prospective study were recruited from a hospital outpatient clinic in Stockholm, Sweden, that specializes in PD and other neurological movement disorders.…”

“…All participants provided their written informed consent before inclusion in the original prospective study [ 20 ]. The informed consent form included the information that they might be asked to take part in a qualitative interview study about experiences of daytime sleepiness.…”

Association between Excessive Daytime Sleepiness and the Cholinergic Ascending Reticular System in Parkinson’s Disease

“…The frequency of EDS in PD is reported to be 11-60% [2][3][4][5][6][7][8]. EDS is associated with aging, disease duration, male sex, depression, fatigue, anxiety, cognitive impairment, sleep disorders at night, disorders of the sleep-wake mechanism, and dosage of dopamine agonists [2][3][4][5][6][7][8][9]. However, the pathophysiology of EDS in PD has not been completely clarified.…”

Accurate Monitoring of Parkinson’s Disease Symptoms With a Wearable Device During COVID-19 Pandemic

“…Sensors that are currently in use, can help in the evaluation of motor symptoms in patients' home environment and have shown promising results in the care of patients with PD (9, 10). Nonetheless, disadvantages of these technologies still exist, like the fact that each device has shown satisfactory results only in the detection of specific symptoms and not sufficient correlation with patients' diaries (11,12), thus further enhancements and clinical validation will guarantee the applicability of wearable technologies in everyday clinical practice (13,14). Especially, in the era of the COVID-19 pandemic that disrupted the patients' access to healthcare, poor follow-up of the patients aggravates the difficulties on the clinical evaluation and threatens to deteriorate their quality of life (15,16).…”