Sleep-Wake Disturbances in Parkinson’s Disease: Current Evidence regarding Diagnostic and Therapeutic Decisions

Abstract

Sleep disorders have been frequently reported in patients with Parkinson’s disease (PD). However, there is insufficient evidence to guide precise recommendations on some diagnostic and treatment strategies. Here, we review clinical studies dealing with sleep abnormalities in PD and present clinical recommendations. Previous studies describing insomnia, excessive daytime sleepiness, narcolepsy-like episodes, circadian changes, sleep-disordered breathing, rapid eye movement sleep behavior disorder, vivid dreams and restless legs syndrome are evaluated. Longitudinal studies associating sleep disorders with PD onset or clinical deterioration are rare: only one longitudinal study associated daytime sleepiness with PD onset. Evidence suggests that clinical investigations must include direct questioning about depressive symptoms, nocturnal cramps, pain, nocturia and nighttime off periods. A patient interview must be conducted regarding sleep symptoms, including nightmares, abnormal behavior during sleep, snoring, restless legs syndrome and daytime sleepiness. Initial evidence indicates that light therapy improves motor function and depression. Advice on sleep hygiene, the treatment of concomitant depression and the careful use of dopaminergic drugs and hypnosedative agents should be considered. To date, very few controlled studies are available to make a recommendation for the management of sleep-wake disturbances in PD.

Effects of various factors on sleep disorders and quality of life in Parkinson’s disease

“…They may be present in all stages of PD but are mostly found in the more advanced stages [6,8]. The types of SD that were present in the group we studied (insomnia, EDS, nightmares, fragmented sleep, frequent night-time urination, PLM and RLS) were in accordance with previous studies [7][8][9].…”

“…These changes affect most patients with PD [6,7,8]. SD are also caused by other factors, such as depression, pain and other co-morbidities.…”

Comparative study of clinical profile between familial and sporadic Parkinson's disease

“…Parkinson's disease (PD) is a progressive nervous system disease occurring most often after the age of 50 years and effecting all ethnic groups 13 . Genetic susceptibility plays a stronger role in early onset familial cases, whereas environmental factors play a stronger role for late onset sporadic cases 14 .…”

“…This shows that in present study; both the groups disease is in early stage because the peak age of onset of PD is in the early 60s (range 35-85 years), and the course of illness ranges from 10 to 25 years 19 . At the beginning of the illness or as the disease progresses, postural instability and falls manifest, which adds to the disability and severity of the illness 13,20 . L-dopa dose for both the PD was found effective and there was no difference in their doses.…”

Insomnia in Parkinson’s Disease

“…While low doses of dopaminergic stimulation may result in sleepiness, higher doses may induce wakefulness [ 21 ]. As a result, lower doses given during the day may induce sleepiness but the additive effect at the end of the day may result in an alerting effect [ 50 ]. Additionally, PD-related urinary symptoms often disrupt sleep.…”