Abstract
Background:
Sleep-related disturbances and sleep disorders are common in Parkinson’s disease (PD) and have a great impact on daily life of PD patients. This study was done to find the sleep characteristics and sleep disturbing factors in PD patients according to disease severity through clinical interview and polysomnographic (PSG) study. Methods: Fifty patients with PD (22 males, age 60.6 ± 6.4, Hoehn and Yahr (HY) stage 2.7 ± 1.0) were recruited and thoroughly interviewed about their sleep. PSG was performed on the patients taking routine antiparkinsonian medications. Patients were grouped into mild and moderate/severe group according to HY stage, and the results were compared between each group. Results: Ninety-four percent of total patients had one or more sleep-related disturbances based on the interview or PSG. On interview, the moderate/severe group complained more insomnia and REM sleep behavior disorder (RBD) than mild group. In PSG findings, the moderate/severe group showed lower sleep efficiency, longer sleep latency, REM sleep latency, waking time after sleep onset, and higher prevalence of RBD. Conclusions: In this study, most patients with PD had sleep disturbances. Clinical interview and PSG findings revealed deterioration of sleep quality along the disease severity. Our results suggest that sleep disturbances in PD patients are prevalent and warrant clinical attention, especially to the patients with advanced disease. (Korean J Clin Neurophysiol 2015;17:17-23)
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Table 1.
Hoehn and Yahr stage (n) | 1-2 (29) | 3-5 (21) | Total (50) | p-value |
---|---|---|---|---|
Age (years) | 60.4 ± 5.8 | 60.8 ± 7.2 | 60.6 ± 6.4 | ns |
Sex (Male : Female) | 10 : 19 | 12 : 9 | 22 : 28 | ns |
K-MMSE* | 27.1 ± 2.5 | 25.2 ± 5.5 | 26.3 ± 4.1 | ns |
Duration of disease (years) | 4.6 ± 2.4 | 8.1 ± 3.4 | 6.0 ± 3.4 | < 0.001 |
Duration of treatment (years) | 2.7 ± 1.9 | 5.2 ± 3.5 | 3.7 ± 2.9 | 0.011 |
L-DOPA equivalent dose# (mg/day) | 464.9 ± 273.3 | 1025.5 ± 771.6 | 700.1 ± 603.1 | 0.002 |
Motor score† | 8.6 ± 4.3 | 13.7 ± 5.6 | 10.8 ± 5.4 | 0.001 |
Hoehn and Yahr stage | 2.1 ± 0.4 | 3.5 ± 0.5 | 2.7 ± 1.0 |
Table 2.
Hoehn and Yahr stage (n) | 1-2 (29) | 3-5 (21) | Total (50) | p-value |
---|---|---|---|---|
Total sleeping time (hours/night) | 6.59 ± 1.33 | 5.24 ± 1.32 | 6.01 ± 1.48 | 0.002 |
Sleep latency (hours) | 0.41 ± 0.30 | 0.73 ± 1.15 | 0.55 ± 0.79 | ns |
Number of waking at night | 1.93 ± 1.19 | 3.14 ± 1.62 | 2.45 ± 1.50 | 0.001 |
Waking time during sleep (hours/night) | 0.39 ± 0.58 | 1.27 ± 1.10 | 0.77 ± 0.94 | 0.001 |
Number of naps during past week | 2.61 ± 3.01 | 4.21 ± 5.03 | 3.30 ± 4.04 | ns |
Number of nights with non-restorative sleep | 1.61 ± 0.83 | 2.29 ± 0.78 | 1.90 ± 0.87 | 0.006 |
Insomnia (n) | 41.4% (12) | 81.0% (17) | 58.0% (29) | 0.005 |
REM-sleep behavior disorder (n) | 37.9% (11) | 71.4% (15) | 52.0% (26) | 0.019 |
Snoring (n) | 55.2% (16) | 47.6% (10) | 52.0% (26) | ns |
Restless legs syndrome (n) | 17.2% (5) | 28.6% (6) | 22.0% (11) | ns |
Daytime sleepiness (1-5)* | 2.64 ± 1.10 | 2.67 ± 1.35 | 2.65 ± 1.20 | ns |
Nocturia# | 3.6 ± 1.6 | 4.5 ± 1.2 | 4.0 ± 1.5 | 0.037 |
Turning difficulty# | 1.3 ± 0.9 | 2.6 ± 1.5 | 1.8 ± 1.4 | < 0.001 |
Vivid dreaming# | 1.3 ± 0.6 | 1.5 ± 0.7 | 1.4 ± 0.7 | ns |
Back pain# | 1.6 ± 1.4 | 1.4 ± 1.0 | 1.5 ± 1.2 | ns |
Cramping pain# | 1.4 ± 0.9 | 1.5 ± 1.0 | 1.4 ± 1.0 | ns |
Rigidity# | 1.0 ± 0.2 | 1.3 ± 0.6 | 1.1 ± 0.5 | ns |
Leg jerk# | 1.1 ± 0.3 | 1.6 ± 1.2 | 1.3 ± 0.9 | 0.033 |
Table 3.
Hoehn and Yahr stage (n) | 1-2 (29) | 3-5 (21) | Total (50) | p-value |
---|---|---|---|---|
Total sleep time (min.) | 471.9 ± 63.0 | 494.3 ± 89.7 | 481.3 ± 75.3 | ns |
N1 sleep (%) | 14.8 ± 14.4 | 17.1 ± 11.8 | 15.7 ± 13.3 | ns |
N2 sleep (%) | 57.7 ± 13.0 | 52.7 ± 13.6 | 55.6 ± 13.3 | ns |
N3 sleep (%) | 8.2 ± 8.8 | 12.4 ± 10.3 | 10.0 ± 9.6 | ns |
REM sleep (%) | 19.5 ± 8.6 | 17.9 ± 10.8 | 18.7 ± 9.5 | ns |
Sleep efficiency (%) | 81.7 ± 12.0 | 71.4 ± 13.2 | 77.4 ± 13.4 | 0.006 |
Sleep latency (min.) | 17.8 ± 28.6 | 27.3 ± 19.3 | 21.8 ± 25.3 | 0.005 |
REM sleep latency (min.) | 113.6 ± 65.8 | 152.7 ± 94.5 | 130.0 ± 80.6 | ns |
Wake time after sleep onset (min.) | 85.6 ± 50.7 | 142.4 ± 72.9 | 109.4 ± 66.6 | 0.009 |
Arousal index (/hour) | 8.1 ± 3.3 | 7.0 ± 4.0 | 7.6 ± 3.6 | ns |
Apnea-Hypopnea index (/hour) | 4.9 ± 8.6 | 5.4 ± 7.9 | 5.1 ± 8.3 | ns |
PLM index* (/hour) | 7.4 ± 11.2 | 11.4 ± 20.7 | 9.1 ± 15.8 | ns |
REM-sleep behavior disorder | 37.9% (11) | 71.4% (15) | 52.0% (26) | 0.025 |
Sleep-related disordered breathing | 17.2% (5) | 33.3% (7) | 24.0% (12) | ns |
Significantly increased PLMI | 20.7% (6) | 23.8% (5) | 22.0% (11) | ns |
Table 4.
Duration of symptom (years) | Duration of treatment (years) | Levodopa equivalent dose (mg/day) | Motor score# | |
---|---|---|---|---|
Total sleep time (min.) | r = -.227 p = .112 | r = -.183 p = .205 | r = -.049 p = .735 | r = .043 p = .767 |
N1 sleep (%) | r = .217 p = .129 | r = .254 p = .075 | r = .369 p = .008* | r = .151 p = .294 |
N2 sleep (%) | r = -.229 p = .110 | r = -.145 p = .316 | r = -.221 p = .122 | r = -.284 p = .046* |
N3 sleep (%) | r = .238 p = .096 | r = .051 p = .724 | r = -.192 p = .183 | r = .110 p = .448 |
REM sleep (%) | r = -.224 p = .119 | r = -.207 p = .149 | r = -.016 p = .912 | r = .062 p = .669 |
Sleep efficiency (%) | r = -.321 p = .023* | r = -.196 p = .173 | r = -.313 p = .027* | r = -.294 p = .038* |
Sleep latency (mins) | r = .297 p = .036* | r = .337 p = .017* | r = .204 p = .155 | r = .034 p = .817 |
REM sleep latency (mins) | r = .212 p = .139 | r = .350 p = .013* | r = .229 p = .109 | r = .105 p = .466 |
Wake time after sleep onset (mins) | r = .236 p = .099 | r = .122 p = .397 | r = .275 p = .053 | r = .292 p = .040* |
Table 5.
Total (50) | RBD (26) | NRBD (24) | p-value |
---|---|---|---|
Age (years) | 61.5 ± 6.3 | 59.6 ± 6.4 | ns |
Duration of disease (years) | 7.1 ± 3.5 | 4.9 ± 2.9 | 0.029 |
Duration of treatment (years) | 4.3 ± 3.1 | 3.1 ± 2.6 | ns |
L-DOPA equivalent dose (mg/day) | 850.9 ± 717.0 | 537.2 ± 403.5 | ns |
Motor score* | 11.3 ± 4.6 | 10.1 ± 6.2 | ns |
Hoehn and Yahr stage | 2.9 ± 0.8 | 2.4 ± 0.9 | 0.018 |
K-MMSE | 25.8 ± 4.8 | 26.8 ± 3.3 | ns |
MMSEC# (n) | 26.9% (7) | 4.2% (1) | 0.030 |
Total sleep time (mins) | 483.5 ± 67.6 | 479.0 ± 84.3 | ns |
Sleep efficiency (%) | 74.7 ± 15.6 | 80.3 ± 9.9 | ns |
Sleep latency | 29.2 ± 30.9 | 13.8 ± 14.1 | 0.012 |
REM sleep latency (mins) | 145.4 ± 92.2 | 113.4 ± 63.6 | ns |