Abstract
The aim of this study is to investigate sleep quality in Parkinson’s disease (PD) and to correlate subjective measures, through clinical scales and sleep diary, with objective measures obtained by means of actigraphy. In this prospective comparative study, the population consisted of PD patients with a moderate stage of the disease, who were evaluated by subjective scales such as the Pittsburgh Sleep Quality Index—PSQI, Epworth Sleepiness Scale—ESS, Parkinson’s Disease Sleep Scale—PDSS and by sleep diary, besides objective measures from actigraphy recording over seven consecutive days. Participants were categorized into two groups: “good sleep” = PDSS > 100 and “poor sleep” = PDSS ≤ 100. In total, 48 individuals were evaluated, and the overall median (inter-quartile range) was 68 (55–70) for years of age, 95.3 (73.1–111.8) for PDSS, 8 (5–11) for PSQI. Twenty-eight (58.3%) participants had poor sleep quality according to the PDSS. Poor sleep quality was associated with higher depression score (p = 0.01) and with living without partner (p = 0.04). A significant difference was observed in all items of PDSS, except in the item daytime dozing (p = 0,10). Actigraphy—and sleep diary-based parameters did not vary according to the sleep quality measured with the PDSS. In general, subjective and objective sleep parameters presented weak to moderate correlation, except for sleep latency and sleep efficiency. Sleep quality is impaired in PD when assessed by actigraphy, clinical sleep scales and sleep diary. Parameters measured objectively should not be replaced by subjective parameters and vice versa due to the complexity of individual’s perception about sleep.
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Reynolds GO, Otto MW, Ellis TD, Cronh-Golomb A. The therapeutic potential of exercise to improve mood, cognition, and sleep in Parkinson’s disease. Mov Disord. 2016;31(1):23–38.
Menza M, Dobkin RD, Marin H, Bienfait K. Sleep disturbances in Parkinson’s disease. Mov Disord. 2010;25:117–22.
Askenasy JJM. Sleep disturbances in Parkinsonism. J Neural Transm. 2003;110:125–50.
Chen H, et al. Research on the premotor symptoms of Parkinson’s disease: clinical and etiological implications. Environ Health Perspect. 2013;121:1245–52.
Fifel K. Alterations of the circadian system in Parkinson’s disease patients. Mov Disord. 2017;32(5):682–92.
Targa AD, et al. Unraveling a new circuitry for sleep regulation in Parkinson’s disease. Neuropharmacology. 2016;108:161–71.
Bhidayasiri R, Trenkwalder C. Getting a good night sleep? The importance of recognizing and treating nocturnal hypokinesia in Parkinson’s disease. Parkinsonism Relat Disord. 2018;50:10–8.
Arnulf I, Leu-Semenescu S. Sleepiness in Parkinson’s disease. Parkinsonism Relat Disord. 2009;15:101–4.
Marinus J, Zhu K, Marras C, Aarsland D, van Hilten JJ. Risk factors for non-motor symptoms in Parkinson’s disease. Lancet Neurol. 2018;17(6):559–658.
Pal PK, Thennarasu K, Fleming J, Schulzer M, Brown T, Calne SM. Nocturnal sleep disturbances and daytime dysfunction in patients with Parkinson’s disease and in their caregivers. Parkinsonism Relat Disord. 2004;10:157–68.
Maiga B, Diop MS, Sangare M, Dembele K, Cisse L, Kone O, Seck LB, Landoure G, Guinto CO, Ndiaye M, Ndiaye MM. Sleep quality assessment in 35 Parkinson’s disease patients in the Fann Teaching Hospital, Dakar, Senegal. Rev Neurol. 2016;172(3):242–7.
Louter M, Arends JB, Bloem BR, Overeem S. Actigraphy as a diagnostic aid for REM sleep behavior disorder in Parknson’s disease. BMC Neurol. 2014;14:76.
Stavitsky K, Cronin-Golomb A. Sleep quality in Parkinson’s disease: an examination of clinical variables. Cogn Behav Neurol. 2011;24(2):43–9.
Aitken D, Naismith SL, Terpening Z, Lewis SJG. Dysfunctional sleep beliefs in Parkinson’s disease: relationships with subjective and objective sleep. J Clin Neurosci. 2014;21:1359–63.
Perez-Lloret S, Rossi M, Nouzeilles MI, Trenkwalder C, Cardinali DP, Marello M. Parkinson’s disease sleep scale, sleep logs, and actigraphy in the evaluation of sleep in parkinsonian patients. J Neurol. 2009;256:1480–4.
Stavitsky K, Saurman JL, McNamara P, Cronin-Golomb A. Sleep in Parkinson’s disease: a comparison of actigraphy and subjective measures. Parkinsonism Relat Disord. 2010;16(4):280–3.
Souza CFM, et al. A doença de Parkinson e o processo de envelhecimento motor: uma revisão de literatura. Rev Neurosci. 2011;19(4):718–23.
Instituto Brasileiro de Geografia e Estatística [Internet]. Brazil: Análise da projeção da população do Brasil e das unidade da federação; c2016 [cited 2016 Apr 26]. Available from: http://www.ibge.gov.br.
Pocock SJ. Clinical trials: a practical approach. Wiley, New York. (2013).
Hughes AJ, Daniel SE, Kilford L, Lees AJ. Accuracy of clinical diagnosis of idiopathic Parkinson’s disease: a clinico-pathological study of 100 cases. J Neurol Neurosurg Psychiatry. 1992;55(3):181–4.
Lourenço RA, Veras RP, Ribeiro PCC. Confiabilidade teste-reteste do Mini-Exame do Estado Mental em uma população idosa assistida em uma unidade ambulatorial de saúde. Rev Bras Geriatr Gerontol. 2008;11(1):7–16.
Tomlisnon CL, Stowe R, Patel S, Rick C, Gray R, Clarke CE. Systematic review of levodopa dose equivalency reporting in Parkinson’s disease. Mov Disord. 2010;25(15):2649–85.
The Unified Parkinson’s Disease Rating. Scale (UPDRS): status and recommendations. Mov Disord. 2003;18(7):738–50.
Paradela EMP, Lourenço RA, Veras RP. Validação da escala de depressão geriátrica em um ambulatório geral. Rev Saúde Pública. 2005;39(6):918–23.
Bertolazi AN, et al. Validation of the Brazilian Portuguese version of the Pittsburgh sleep quality index. Sleep Med. 2011;12:70–5.
Chaudhuri KR, et al. Improvements in nocturnal symptoms with ropinirole prolonged release in patients with advanced Parkinson’s disease. Eur J Neurol. 2012;19(1):105–13.
Chaudhuri KR, et al. The Parkinson’s disease sleep scale: a new instrument for assessing sleep and nocturnal disability in Parkinson’s disease. J Neurol Neurosurg Psychiatry. 2002;73:629–35.
Johns MW. A new method for measuring daytime sleepiness: the Epworth sleepiness scale. Sleep. 1991;14:540–5.
Associação Brasileira do Sono [Internet]. Brazil: Sleep Science; c2016 [cited 2016 Aug 03]. Available from: http://www.absono.com.br.
Campanini MZ, Lopez-Garcia E, Rodríguez-Artalejo F, González AD, Andrade SM, Mesas AE. Agreement between sleep diary and actigraphy in a highly educated Brazilian population. Sleep Med. 2017;35:27–34.
Van Den Berg JF, Van Rooij FJA, Vos H, Tulen JHM, Hofman A, Miedema HME, et al. Disagreement between subjective and actigraphic measures of sleep duration in a population-based study of elderly persons. J Sleep Res. 2008;17:295–302.
Klingelhoefer L, et al. Night-time sleep in Parkinson’s disease—the potential use of Parkinson’s KinetiGraph: a prospective comparative study. Eur J Neurol. 2016;23:1275–88.
Mack JM, Schamne MG, Sampaio TB, Pértile RAN, Fernandes PACM, Markus RP, et al. Melatoninergic system in Parkinson’s disease: from neuroprotection to the management of motor and nonmotor symptoms. Oxid Med Cell Longev. 2016;2016:3472032.
Goordazi Z, Mrklas KJ, Roberts DJ, Jette N, Pringsheim T, Holrovd-Leduc J. Detecting depression in Parkinson disease: a systematic review and meta-analysis. Neurol. 2016;87(4):426–37.
Nakabayashi TIK, Chagas MHN, Corrêa ACL, Tumas V, Loureiro SR, Crippa JAS. Prevalência de depressão na doença de Parkinson. Rev Psiq Clin. 2008;35(6):219–27.
Selcuk E, Stanton SCE, Slatcher RB, et al. perceived partner responsiveness predicts better sleep quality through lower anxiety. Soc Psychol Personal Sci. 2017;8(1):83–92.
Troxel WM, Robles TF, Hall M, et al. Marital quality and the marital bed: examining the covariation between relationship quality and sleep. Sleep Med Rev. 2007;11(5):389–404.
Ataide M, Franco CMR, Lins OG. Daytime sleepiness in Parkinson’s disease: perception, influence of drugs, and mood disorder. Sleep Disor. 2014;2014:939713.
Pandey S, Bajaj BK, Wadhwa A, Anand KS. Impact of sleep quality on the quality of life of patients with Parkinson’s disease: a questionnaire-based study. Clin Neurol Neurosurg. 2016;148:29–34.
Yu R, Tan C, Wu R. The impact of nocturnal disturbances on daily quality of life in patients with Parkinson’s disease. Neuropsychiatr Dis Treat. 2015;11:2005–12.
Harvey AG. A cognitive model of insomnia. Behav Res Ther. 2002;40:869–93.
Gunn DG, Naismith SL, Bolitho SJ, Lewis SJG. Actigraphically-defined sleep disturbance in Parkinson’s disease is associated with differential aspects of cognitive functioning. J Clin Neurosci. 2014;21(7):1112–5.
Muller L, Piantoni G, Koller D, Cash SS, Halgren E, Sejnowski TJ. Rotating waves during human sleep spindles organize global patterns of activity that repeat precisely through the night. eLife. 2016;5:e17267.
Bridayasiri R, et al. Rotigotine for nocturnal hypokinesia in Parkinson’s disease: quantitative analysis of efficacy from a randomized, placebo-controlled trial using an axial inertial sensor. Parkinsonism Relat Disord. 2017;44:124–8.
Pieranzoti M, et al. Rotigotine may improve sleep architecture in Parkinson’s disease: a double-blind, randomized, placebo-controlled polysomnographic study. Sleep Med. 2016;21:140–4.
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This study was financed in part by the Coordenação de Aperfeiçoamento de Pessoal de Nível Superior - Brasil (CAPES) - Finance Code 001.
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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Ethical Committee Permission: Local Ethics Committee in Research with Human Beings, under the opinion of the CEP-UEL approval no. 1.356.676.
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de Almeida, I.A., Mesas, A.E., Terra, M.B. et al. Evaluation of sleep quality in individuals with Parkinson’s disease using objective and subjective measures. Sleep Biol. Rhythms 17, 103–112 (2019). https://doi.org/10.1007/s41105-018-0185-3
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DOI: https://doi.org/10.1007/s41105-018-0185-3