Journal List > Korean J Clin Neurophysiol > v.17(1) > 1084152

Lee, Cheon, and Kim: Sleep Disturbances in Patients with Parkinson’s Disease according to Disease Severity

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.
Clinical characteristics according to disease severity
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

* Korean version of Mini-Mental State Examination

# Levodopa-equivalent dose

Sum of UPDRS items 20 (“tremor at rest”), 22 (“rigidity”), 23 (“finger taps”), 26 (“leg agility”) ns, not significant

Table 2.
Sleep schedule, sleep disorders and disturbing factors based on interview
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

* Scored by severity.

# Scored by frequency of event. ns, not significant.

Table 3.
Polysomnographic findings
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

* Periodic limb movement index. ns, not significant.

Table 4.
Correlations between PSG parameters and clinical characteristics
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*

# Sum of UPDRS items 20 (“tremor at rest”), 22 (“rigidity”), 23 (“finger taps”), 26 (“leg agility”).

* p < 0.05.

Table 5.
Comparison between patients with and without REM sleep behavior disorder (RBD)
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

* Sum of UPDRS items 20 (“tremor at rest”), 22 (“rigidity”), 23 (“finger taps”), 26 (“leg agility”).

# Number of patients with abnormal K-MMSE score corrected for age and educational level. ns, not significant.

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