Sleep in Parkinson’s disease

Abstract

Sleep disturbances are common in Parkinson's disease and comprise the entire spectrum of sleep disorders. On the one hand regulation of sleep and wakefulness is affected in Parkinson's disease, leading to the development of disorders, such as insomnia and daytime sleepiness. While on the other hand control of motor activity during sleep is impaired, with subsequent manifestation of parasomnias (mainly REM sleep behavior disorders, but also, albeit more rarely, sleepwalking, and overlap parasomnia). Restless legs syndrome has been reported to be frequent in patients with Parkinson's disease, although there is no consensus on whether it is more frequent in Parkinson's disease than in the general population. The same is true for sleep-related breathing disorders. Regarding the diagnosis of sleep disorders in patients with Parkinson's disease, one of the main challenges is correctly identifying excessive daytime sleepiness as there are many potential confounding factors, for example it is necessary to distinguish sleeprelated breathing disorders from medication effects, and to distinguish restless legs syndrome from the concomitant presence of potential mimics specific to Parkinson's disease, such as akathisia, nocturnal leg cramps, nocturnal hypokinesia, early morning dystonia, etc. The correct diagnosis of REM sleep behavior disorder is also not always easy, and video-polysomnography should be performed in order to exclude mimic-like movements at the end of sleep apneas or violent periodic leg movements of sleep. These aspects and specific considerations about diagnosis and treatment of sleep disorders in patients with Parkinson's disease will be reviewed.

Deep learning for automated sleep staging using instantaneous heart rate

“…As symptoms appear during sleep, they are not easily apparent to patients and most sleep disorders remain undiagnosed 1 . Moreover, sleep deficiency and anomalies in sleep architecture are linked to many chronic health problems, including sleep apnea, diabetes, stroke, brain injury, Parkinson's disease, depression, and Alzheimer's disease [2][3][4][5][6][7][8] . Therefore measuring sleep behavior can diagnose sleep disorders and also lead to early detection of other health conditions.…”

“…Many important symptoms of sleep disorders such as insomnia, sleep fragmentation, rapid eye movement (REM) instability and inadequate deep sleep only have one or few measurements per night which may be insufficient to make conclusive diagnosis about individuals 2 . As a result, despite a growing body of evidence linking sleep stages with a large number of comorbidities [2][3][4][5][6][7][8] , most clinical analysis of sleep stages are cross-sectional studies on populations rather than on individual patients 2,12 . This limits the clinical utility of sleep stages.…”

Systematic Review Looking at the Use of Technology to Measure Free-Living Symptom and Activity Outcomes in Parkinson’s Disease in the Home or a Home-like Environment

“…Considering non-motor symptoms, sleep is evaluated in 11 studies, predominantly using wearable devices. This patient-relevant [108] 'outcome' in PD is very complicated with various sleep diagnoses being more common in the PD population (e.g., REM sleep behaviour disorder, restless legs syndrome, insomnia) [109]. Other non-motor outcomes remain largely unmeasured in the home environment.…”

Shedding Light on Nocturnal Movements in Parkinson’s Disease: Evidence from Wearable Technologies

“…In addition to age-related sleep changes, pathophysiologic findings of abnormal nocturnal movements in PD patients include abnormal sleep macrostructure (e.g., sleep fragmentation and sleep-cycle dysregulation with a relative increase in superficial sleep), and impaired sleep microstructure (e.g., disturbed sleep spindles and K-complexes) [ 48 ]. Accordingly, sleep architecture changes may partially contribute to abnormal nocturnal movements in PD.…”