Fatigue correlates with sleep disturbances in Parkinson disease

Abstract

Background: Many Parkinson disease (PD) patients complain about chronic fatigue and sleep disturbances during the night. The objective of this study is to determine the relationship between fatigue and sleep disturbances by using polysomnography (PSG) in PD patients. Methods: Two hundred and thirty-two PD patients (152 with mild fatigue and 80 with severe fatigue) were recruited in this study. Demographic information and clinical symptoms were collected. Fatigue severity scale (FSS) was applied to evaluate the severity of fatigue, and PSG was conducted in all PD patients. FSS ≥4 was defined as severe fatigue, and FSS <4 was defined as mild fatigue. Multivariate logistic regression and linear regression models were used to investigate the associations between fatigue and sleep disturbances. Results: Patients with severe fatigue tended to have a longer duration of disease, higher Unified Parkinson Disease Rating Scale score, more advanced Hoehn and Yahr stage, higher daily levodopa equivalent dose, worse depression, anxiety, and higher daytime sleepiness score. In addition, they had lower percentage of rapid eye movement (REM) sleep ( P = 0.009) and were more likely to have REM sleep behavior disorder (RBD) ( P = 0.018). Multivariate logistic regression analyses found that the presence of RBD and proportion of REM sleep were the independent predictors for fatigue. After the adjustment of age, sex, duration, body mass index, severity of disease, scores of Hamilton Rating Scale for Depression, Hamilton Anxiety Rating Scale, and other sleep disorders, proportion of REM sleep and degree of REM sleep without atonia in patients with PD were still associated with FSS score. Conclusion: Considering the association between fatigue, RBD, and the altered sleep architecture, fatigue is a special subtype in PD and more studies should be focused on this debilitating symptom.

The Impact of Fatigue on Sleep and Other Non-Motor Symptoms in Parkinson’s Disease

“…Fatigue can have several correlations with sleep disturbances in PD as well. One polysomnographic study demonstrated lower percentages of rapid eye movement (REM) sleep in PD patients with severe fatigue compared to those with mild fatigue; in addition, REM sleep behaviour disorder (RBD) was a significant predictor of fatigue in this study [9]. According to a questionnaire-based study which was part of the International Nonmotor Scale validation project, fatigue correlated significantly with depression, anxiety, and sleep dysfunction [10].…”

“…Levodopa may have a beneficial effect on fatigue in PD patients [19]. Higher levodopa equivalent daily dose (LEDD) was noticed in PD patients with fatigue in some studies [9,20], while similarly, LEDD is known to be associated with EDS [21] and RBD [22]. According to one study, patients who received a combination of levodopa/dopamine agonists presented more EDS compared to those under levodopa monotherapy, but no differences were noted regarding fatigue between these two groups [23].…”

Recent Trends and Practices Toward Assessment and Rehabilitation of Neurodegenerative Disorders: Insights From Human Gait

“…The muscle activity was measured at six locations of the dominant side (GM, BF, VM, AR, ES, RF, SO, and TA) at a frequency of 1,000 Hz. Muscle fatigue estimation for neurological disorders such as hemiplegia (Boudarham et al, 2013(Boudarham et al, , 2014Wang et al, 2017;Mazzoli et al, 2018;Fujita et al, 2020Fujita et al, , 2021, PD (Huang et al, 2017;Palinkas et al, 2019;Cao et al, 2021), MS (Octavia et al, 2015;Porcaro et al, 2019;Stańczyk et al, 2019) has been reported. The approach for EMG-to-muscle force has also been analyzed in Bogey et al (2005).…”

Efficacy of non-pharmacological interventions for sleep quality in Parkinson’s disease: a systematic review and network meta-analysis

“…Sleep disorder is the most common non-motor symptom in PD, with an incidence of about 47.66% to 89.10% ( Liu et al, 2018 ) and increasing year by year with the course of disease. More and more evidence shows that PD sleep disorders can lead to decreased quality of life ( Zuzuárregui and During, 2020 ), impaired psychosocial and cognitive function ( Riemann, 2019 ), fatigue ( Cao et al, 2020 ), depression ( Demet et al, 1999 ) or substance abuse ( Hasler et al, 2012 ) and may increase the risk of cardiovascular and metabolic diseases ( He et al, 2017 ). In addition to health risks, sleep disorders can also bring significant socio-economic burdens ( Frandsen et al, 2020 ).…”