Original articleProgressive sleep ‘destructuring’ in Parkinson's disease. A polysomnographic study in 46 patients☆
Introduction
Sleep abnormalities in Parkinson's disease (PD) are frequent and partially due to nocturnal recurrence of PD motor symptoms and side effects of pharmacotherapy. There is also increasing evidence that the disease underlying degenerative process accounts by itself for impairment in the expression of wakefulness and REM sleep, which could be due to the primary degeneration of sleep-regulating centers such as the locus coeruleus [1], [2] and the involvement of non-dopaminergic transmitters [3]. It should also be noted that dopamine neurons show state-dependent fluctuations in their activity [4]. So far there have been no polysomnographic (PSG) studies that have examined whether or not the loss of the physiological sleep architecture is progressive with longer disease duration, and if such is the case, whether it could similarly be linked to the progression of motor impairment and the increase of dopaminergic medication. Thus the objective of the present study has been to search for potential links between PSG-proven sleep abnormalities in non-demented PD patients and these major disease parameters.
Section snippets
Methods
We retrospectively reviewed the medical records and PSG data of 56 consecutive patients with parkinsonian syndrome (PS) and various sleep complaints. The PS was classified using established consensus criteria [5], [6]. Fifty-four patients were suffering from levodopa-responsive PS, defined as idiopathic PD in 49 patients, Lewy body dementia (LBD) in 2 patients and multiple system atrophy (MSA) in 3 patients. Two patients were suffering from levodopa-resistant PS, classified as progressive
Demographics
The patient sample was composed of 36 men and 10 women. The mean age was 64.26 (9.40) [range: 44–78] years, the Hoehn and Yahr stage 2.34 (0.86) [range:1–4], the disease duration 7.01 (4.60) [range: 0.5–20] years, and the Epworth sleepiness score (data from 36 patients) 8.53 (4.78) [range: 0–18]. Eighty-five percent (39 patients) expressed one or more sleep complaints. M-RBD were reported by 12 (26%) patients, M-H by 9 (20%), M-EDS by 19 (41%) and M-I by 16 (35%).
Descriptive polysomnographic data
For the whole sample, sleep
Discussion
From our retrospective PSG study evolves the novel finding that in PD there is progressive nocturnal sleep ‘destructuring’ (SD). With this neologism we want to express that over time there is gradual loss of the physiological nocturnal sleep architecture, but not yet overt disintegration or dissolution of the major sleep components. Thus, with longer disease duration Parkinsonian patients of our cohort had lower sleep efficiency and reduced percentages of total sleep, deep sleep and REM sleep.
Acknowledgements
We are grateful to Dr Cynthia L. Comella, MD, Department of Neurological Sciences, Rush University, Chicago for fruitful discussions on the design of this study.
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This work has been partly presented at the 128th Annual Meeting of the American Neurological Association, San Francisco, October 20-24, 2003.