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Milane T, Hansen C, Correno MB, Chardon M, Barbieri FA, Bianchini E, Vuillerme N. Comparison of sleep characteristics between Parkinson's disease with and without freezing of gait: A systematic review. Sleep Med 2024; 114:24-41. [PMID: 38150950 DOI: 10.1016/j.sleep.2023.11.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Revised: 08/03/2023] [Accepted: 11/15/2023] [Indexed: 12/29/2023]
Abstract
Parkinson's disease (PD) is a neurodegenerative disorder characterized by a range of motor and non-motor symptoms. Among the motor complaints, freezing of gait (FOG) is a common and disabling phenomenon that episodically hinders patients' ability to produce efficient steps. Concurrently, sleep disorders are prevalent in PD and significantly impact the quality of life of affected individuals. Numerous studies have suggested a bidirectional relationship between FOG and sleep disorders. Therefore, our objective was to systematically review the literature and compare sleep outcomes in PD patients with FOG (PD + FOG) and those without FOG (PD-FOG). By conducting a comprehensive search of the PubMed and Web of Science databases, we identified 20 eligible studies for inclusion in our analysis. Our review revealed that compared to PD-FOG, PD + FOG patients exhibited more severe symptoms of rapid eye movement sleep behavior disorder in nine studies, increased daytime sleepiness in eight studies, decreased sleep quality in four studies, and more frequent and severe sleep disturbances in four studies. These findings indicate that PD + FOG patients generally experience worse sleep quality, higher levels of daytime sleepiness, and more disruptive sleep disturbances compared to those without FOG (PD-FOG). The association between sleep disturbances and FOG highlights the importance of evaluating and monitoring these symptoms in PD patients and open the possibility for future studies to assess the impact of managing sleep disturbances on the severity and occurrence of FOG, and vice versa.
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Affiliation(s)
- Tracy Milane
- AGEIS, Université Grenoble Alpes, 38000, Grenoble, France; Department of Neurology, UKSH Campus Kiel, Kiel University, Arnold-Heller-Str. 3, Haus D, 24105, Kiel, Germany
| | - Clint Hansen
- AGEIS, Université Grenoble Alpes, 38000, Grenoble, France; Department of Neurology, UKSH Campus Kiel, Kiel University, Arnold-Heller-Str. 3, Haus D, 24105, Kiel, Germany.
| | - Mathias Baptiste Correno
- AGEIS, Université Grenoble Alpes, 38000, Grenoble, France; Department of Neurology, UKSH Campus Kiel, Kiel University, Arnold-Heller-Str. 3, Haus D, 24105, Kiel, Germany
| | - Matthias Chardon
- AGEIS, Université Grenoble Alpes, 38000, Grenoble, France; São Paulo State University (Unesp), School of Sciences, Department of Physical Education, Human Movement Research Laboratory (MOVI-LAB), Bauru, Brazil
| | - Fabio A Barbieri
- São Paulo State University (Unesp), School of Sciences, Department of Physical Education, Human Movement Research Laboratory (MOVI-LAB), Bauru, Brazil
| | - Edoardo Bianchini
- AGEIS, Université Grenoble Alpes, 38000, Grenoble, France; Department of Neuroscience, Mental Health and Sensory Organs (NESMOS), Sapienza University of Rome, 00189, Rome, Italy
| | - Nicolas Vuillerme
- AGEIS, Université Grenoble Alpes, 38000, Grenoble, France; LabCom Telecom4Health, Orange Labs & Université Grenoble Alpes, CNRS, Inria, Grenoble INP-UGA, 38000, Grenoble, France; Institut Universitaire de France, 75005, Paris, France.
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Cristini J, Potvin-Desrochers A, Seo F, Dagher A, Postuma RB, Rosa-Neto P, Carrier J, Amara AW, Steib S, Paquette C, Roig M. The Effect of Different Types of Exercise on Sleep Quality and Architecture in Parkinson Disease: A Single-Blinded Randomized Clinical Trial Protocol. Phys Ther 2024; 104:pzad073. [PMID: 37354450 PMCID: PMC10776310 DOI: 10.1093/ptj/pzad073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Revised: 04/17/2023] [Accepted: 05/18/2023] [Indexed: 06/26/2023]
Abstract
OBJECTIVES The purpose of this trial is to (1) determine the best exercise modality to improve sleep quality and sleep architecture in people with Parkinson disease (PD); (2) investigate whether exercise-induced improvements in sleep mediate enhancements in motor and cognitive function as well as other non-motor symptoms of PD; and (3) explore if changes in systemic inflammation after exercise mediate improvements in sleep. METHODS This is a multi-site, superiority, single-blinded randomized controlled trial. One hundred fifty persons with PD and sleep problems will be recruited and randomly allocated into 4 intervention arms. Participants will be allocated into 12 weeks of either cardiovascular training, resistance training, multimodal training, or a waiting list control intervention. Assessments will be conducted at baseline, immediately after each intervention, and 8 weeks after each intervention by blinded assessors. Objective sleep quality and sleep architecture will be measured with polysomnography and electroencephalography. Motor and cognitive function will be assessed with the Unified PD Rating Scale and the Scale for Outcomes in PD-Cognition, respectively. Subjective sleep quality, fatigue, psychosocial functioning, and quality of life will be assessed with questionnaires. The concentration of inflammatory biomarkers in blood serum will be assessed with enzyme-linked immunosorbent assays. IMPACT This study will investigate the effect of different types of exercise on sleep quality and architecture in PD, exploring interactions between changes in sleep quality and architecture with motor and cognitive function and other non-motor symptoms of the disease as well as mechanistic interactions between systemic inflammation and sleep. The results will provide important practical information to guide physical therapists and other rehabilitation professionals in the selection of exercise and the design of more personalized exercise-based treatments aimed at optimizing sleep, motor, and cognitive function in people with PD.
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Affiliation(s)
- Jacopo Cristini
- Memory and Motor Rehabilitation Laboratory (MEMORY-LAB), Jewish Rehabilitation Hospital, Laval, Québec, Canada
- School of Physical and Occupational Therapy, McGill University, Montreal, Québec, Canada
- Feil and Oberfeld Research Centre, Jewish Rehabilitation Hospital, Center for Interdisciplinary Research in Rehabilitation (CRIR), Laval, Québec, Canada
| | - Alexandra Potvin-Desrochers
- Feil and Oberfeld Research Centre, Jewish Rehabilitation Hospital, Center for Interdisciplinary Research in Rehabilitation (CRIR), Laval, Québec, Canada
- Department of Kinesiology & Physical Education, McGill University, Montreal, Québec, Canada
- Human Brain Control of Locomotion Laboratory, McGill University, Montreal, Québec, Canada
| | - Freddie Seo
- Memory and Motor Rehabilitation Laboratory (MEMORY-LAB), Jewish Rehabilitation Hospital, Laval, Québec, Canada
- Feil and Oberfeld Research Centre, Jewish Rehabilitation Hospital, Center for Interdisciplinary Research in Rehabilitation (CRIR), Laval, Québec, Canada
| | - Alain Dagher
- The Neuro (Montreal Neurological Institute-Hospital), McGill University, Montreal, Québec, Canada
| | - Ronald B Postuma
- The Neuro (Montreal Neurological Institute-Hospital), McGill University, Montreal, Québec, Canada
| | - Pedro Rosa-Neto
- The Neuro (Montreal Neurological Institute-Hospital), McGill University, Montreal, Québec, Canada
- Translational Neuroimaging Laboratory, The McGill University Research Centre for Studies in Aging, Montreal, Québec, Canada
| | - Julie Carrier
- Département de Psychologie, Université de Montréal, Montreal, Québec, Canada
- Centre d'Études Avancées en Médecine du Sommeil (CÉAMS), Hôpital du Sacré-Cœur de Montréal, Montreal, Québec, Canada
| | - Amy W Amara
- Department of Neurology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Simon Steib
- Department of Exercise, Training and Active Aging, Institute of Sport and Sport Science, University of Heidelberg, Heidelberg, Baden-Württemberg, Germany
| | - Caroline Paquette
- Feil and Oberfeld Research Centre, Jewish Rehabilitation Hospital, Center for Interdisciplinary Research in Rehabilitation (CRIR), Laval, Québec, Canada
- Department of Kinesiology & Physical Education, McGill University, Montreal, Québec, Canada
- Human Brain Control of Locomotion Laboratory, McGill University, Montreal, Québec, Canada
| | - Marc Roig
- Memory and Motor Rehabilitation Laboratory (MEMORY-LAB), Jewish Rehabilitation Hospital, Laval, Québec, Canada
- School of Physical and Occupational Therapy, McGill University, Montreal, Québec, Canada
- Feil and Oberfeld Research Centre, Jewish Rehabilitation Hospital, Center for Interdisciplinary Research in Rehabilitation (CRIR), Laval, Québec, Canada
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Shen Y, Shi H, Zhong J, Pan P, Wang S, Chen M, Chen Z, Liu C. Factors correlated with excessive daytime sleepiness in patients with Parkinson's disease: A polysomnography study. Brain Behav 2023; 13:e3202. [PMID: 37533356 PMCID: PMC10570485 DOI: 10.1002/brb3.3202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2023] [Revised: 07/19/2023] [Accepted: 07/21/2023] [Indexed: 08/04/2023] Open
Abstract
OBJECTIVE To explore the factors correlated with excessive daytime sleepiness (EDS) in patients with Parkinson's disease (PD). METHODS A total of 239 PD patients were divided into two groups based on the presence of EDS (Epworth Sleepiness Scale score≥10) (PD-EDS vs. PD-non-EDS). Participants underwent an extensive assessment to determine demographic features, disease severity, polysomnography characteristics, and nonmotor symptoms. RESULTS Of the 239 patients, 56 patients (23.4%) were classified as having PD combined with EDS. Binary logistic regression analysis showed that fatigue (Fatigue Severity Scale [FSS] score ≥4) (odds ratio [OR] [95% CI] = 4.897 [2.376-10.095], p < .001) and the respiratory-related microarousal index (OR [95% CI] = 2.063 [1.085-3.923], p = .027) were independent risk factors for EDS in PD patients. A priori-determined stratified analysis showed that after adjustment for confounding factors, the association of the respiratory-related microarousal index with EDS was significant (OR = 4.404, 95% CI 1.673-11.592, p trend = .036) in patients with respiratory arousal index scores in the highest quintile compared with those with scores in the lowest quintile. CONCLUSION Our data revealed a close association among the respiratory-related microarousal index, FSS scores, and EDS. It can be speculated that fragmented sleep and pathological abnormalities of the central nervous system resulting in changes in arousal are major influencing factors of EDS in PD.
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Affiliation(s)
- Yuan Shen
- Department of NeurologyThe Yancheng School of Clinical Medicine of Nanjing Medical University, The Sixth Affiliated Hospital of Nantong University, Yancheng Third People's HospitalYanchengChina
| | - Haicun Shi
- Department of NeurologyThe Yancheng School of Clinical Medicine of Nanjing Medical University, The Sixth Affiliated Hospital of Nantong University, Yancheng Third People's HospitalYanchengChina
| | - JianGuo Zhong
- Department of NeurologyThe Yancheng School of Clinical Medicine of Nanjing Medical University, The Sixth Affiliated Hospital of Nantong University, Yancheng Third People's HospitalYanchengChina
| | - PingLei Pan
- Department of NeurologyThe Yancheng School of Clinical Medicine of Nanjing Medical University, The Sixth Affiliated Hospital of Nantong University, Yancheng Third People's HospitalYanchengChina
| | - ShuFang Wang
- Department of NeurologyThe Yancheng School of Clinical Medicine of Nanjing Medical University, The Sixth Affiliated Hospital of Nantong University, Yancheng Third People's HospitalYanchengChina
| | - MingZhu Chen
- Department of NeurologyThe Yancheng School of Clinical Medicine of Nanjing Medical University, The Sixth Affiliated Hospital of Nantong University, Yancheng Third People's HospitalYanchengChina
| | - ZhiPeng Chen
- Department of NeurologyThe Yancheng School of Clinical Medicine of Nanjing Medical University, The Sixth Affiliated Hospital of Nantong University, Yancheng Third People's HospitalYanchengChina
| | - ChunFeng Liu
- Department of NeurologyThe Second Affiliated Hospital of Soochow UniversitySuzhouChina
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Li P, van Wezel R, He F, Zhao Y, Wang Y. The role of wrist-worn technology in the management of Parkinson's disease in daily life: A narrative review. Front Neuroinform 2023; 17:1135300. [PMID: 37124068 PMCID: PMC10130445 DOI: 10.3389/fninf.2023.1135300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Accepted: 03/28/2023] [Indexed: 05/02/2023] Open
Abstract
Parkinson's disease (PD) is a neurodegenerative disorder that affects millions of people worldwide. Its slow and heterogeneous progression over time makes timely diagnosis challenging. Wrist-worn digital devices, particularly smartwatches, are currently the most popular tools in the PD research field due to their convenience for long-term daily life monitoring. While wrist-worn sensing devices have garnered significant interest, their value for daily practice is still unclear. In this narrative review, we survey demographic, clinical and technological information from 39 articles across four public databases. Wrist-worn technology mainly monitors motor symptoms and sleep disorders of patients in daily life. We find that accelerometers are the most commonly used sensors to measure the movement of people living with PD. There are few studies on monitoring the disease progression compared to symptom classification. We conclude that wrist-worn sensing technology might be useful to assist in the management of PD through an automatic assessment based on patient-provided daily living information.
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Affiliation(s)
- Peng Li
- Biomedical Signals and Systems (BSS) Group, Faculty of Electrical Engineering, Mathematics and Computer Science (EEMCS), University of Twente, Enschede, Netherlands
- Department of Biophysics, Donders Institute for Brain, Cognition and Behaviour, Radboud University, Nijmegen, Netherlands
- *Correspondence: Peng Li,
| | - Richard van Wezel
- Biomedical Signals and Systems (BSS) Group, Faculty of Electrical Engineering, Mathematics and Computer Science (EEMCS), University of Twente, Enschede, Netherlands
- Department of Biophysics, Donders Institute for Brain, Cognition and Behaviour, Radboud University, Nijmegen, Netherlands
| | - Fei He
- Centre for Computational Science and Mathematical Modelling, Coventry University, Coventry, United Kingdom
| | - Yifan Zhao
- School of Aerospace, Transport and Manufacturing, Cranfield University, Cranfield, United Kingdom
| | - Ying Wang
- Biomedical Signals and Systems (BSS) Group, Faculty of Electrical Engineering, Mathematics and Computer Science (EEMCS), University of Twente, Enschede, Netherlands
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van Wamelen DJ, Rukavina K, Podlewska AM, Chaudhuri KR. Advances in the Pharmacological and Non-pharmacological Management of Non-motor Symptoms in Parkinson's Disease: An Update Since 2017. Curr Neuropharmacol 2023; 21:1786-1805. [PMID: 35293295 PMCID: PMC10514535 DOI: 10.2174/1570159x20666220315163856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 01/19/2022] [Accepted: 03/10/2022] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Non-motor symptoms (NMS) are an important and ubiquitous determinant of quality of life in Parkinson's disease (PD). However, robust evidence for their treatment is still a major unmet need. OBJECTIVE This study aimed to provide an updated review on advances in pharmacological, nonpharmacological, and exercise-based interventions for NMS in PD, covering the period since the publication of the MDS Task Force Recommendations. METHODS We performed a literature search to identify pharmacological, non-pharmacological, and exercise-based interventions for NMS in PD. As there are recent reviews on the subject, we have only included studies from the 1st of January 2017 to the 1st of December 2021 and limited our search to randomised and non-randomised (including open-label) clinical trials. RESULTS We discuss new strategies to manage NMS based on data that have become available since 2017, for instance, on the treatment of orthostatic hypotension with droxidopa, several dopaminergic treatment options for insomnia, and a range of non-pharmacological and exercise-based interventions for cognitive and neuropsychiatric symptoms, pain, and insomnia and excessive sleepiness. CONCLUSION Recent evidence suggests that targeted non-pharmacological treatments, as well as some other NMS management options, may have a significant beneficial effect on the quality of life and need to be considered in the pathways of treatment of PD.
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Affiliation(s)
- Daniel J. van Wamelen
- Department of Basic & Clinical Neuroscience, Institute of Psychiatry, Psychology & Neuroscience, Division of Neuroscience, King’s College London, London, United Kingdom
- Parkinson Foundation Centre of Excellence at King’s College Hospital NHS Foundation Trust, London, United Kingdom
- Department of Neurology, Radboud University Medical Center, Donders Institute for Brain, Cognition, and Behaviour, Centre of Expertise for Parkinson & Movement Disorders, Nijmegen, the Netherlands
| | - Katarina Rukavina
- Department of Basic & Clinical Neuroscience, Institute of Psychiatry, Psychology & Neuroscience, Division of Neuroscience, King’s College London, London, United Kingdom
- Parkinson Foundation Centre of Excellence at King’s College Hospital NHS Foundation Trust, London, United Kingdom
| | - Aleksandra M. Podlewska
- Department of Basic & Clinical Neuroscience, Institute of Psychiatry, Psychology & Neuroscience, Division of Neuroscience, King’s College London, London, United Kingdom
- Parkinson Foundation Centre of Excellence at King’s College Hospital NHS Foundation Trust, London, United Kingdom
| | - K. Ray Chaudhuri
- Department of Basic & Clinical Neuroscience, Institute of Psychiatry, Psychology & Neuroscience, Division of Neuroscience, King’s College London, London, United Kingdom
- Parkinson Foundation Centre of Excellence at King’s College Hospital NHS Foundation Trust, London, United Kingdom
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Confortin SC, Santos IDS, Batista RFL, Eckeli AL, Tovo-Rodrigues L, Del-Ponte B, Menezes AMB, Wehrmeister FC, Gonçalves H, Cardoso VC, Barbieri MA, Bettiol H, Silva AAMD. Sleep characteristics and excessive daytime sleepiness in adolescents and adults: results from the birth cohorts of three Brazilian cities - RPS Consortium. REVISTA BRASILEIRA DE EPIDEMIOLOGIA 2023; 26:e230027. [PMID: 37162069 PMCID: PMC10168628 DOI: 10.1590/1980-549720230027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Accepted: 03/03/2023] [Indexed: 05/11/2023] Open
Abstract
OBJECTIVE To describe the prevalence of insufficient sleep duration, long sleep latency, terminal or maintenance insomnia, subjective sleep quality, and excessive daytime sleepiness among participants of birth cohorts conducted in three Brazilian cities, and to evaluate differences in prevalence rates within cohorts according to sociodemographic characteristics. METHODS Cross-sectional analyses involving adolescents and adults participating in four birth cohorts conducted in Ribeirão Preto (RP78 and RP94), Pelotas (PEL93) and São Luís (SL97/98). Sleep duration, latency, terminal or maintenance insomnia, and subjective sleep quality were obtained through the Pittsburgh Sleep Quality Index; and excessive daytime sleepiness was assessed using the Epworth Sleepiness Scale. Differences in the prevalence of the outcomes were analyzed in each cohort according to sociodemographic characteristics (skin color, marital status, socioeconomic status, study and working at the time of the interview) stratified by sex. RESULTS Insufficient sleep duration was the most common outcome at the four cohorts, with higher frequency among men. Long latency was more frequently reported by young adult women in RP94 and PEL93 cohorts, and insomnia by women of the four cohorts, when compared to men of the same age. Women generally suffered more from excessive daytime sleepiness and evaluated the quality of their sleep more negatively than men. In addition to sex, being a student and working were associated with the largest number of outcomes in both sexes. CONCLUSION Sleep disorders are more prevalent in women, reinforcing the need for greater investment in sleep health in Brazil, without disregarding gender and socioeconomic determinants.
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Affiliation(s)
- Susana Cararo Confortin
- Universidade Federal do Maranhão, Graduate Program in Collective Health - São Luís (MA), Brazil
| | - Iná da Silva Santos
- Universidade Federal de Pelotas, Graduate Program in Epidemiology - Pelotas (RS), Brazil
| | | | - Alan Luiz Eckeli
- Universidade de São Paulo, Faculty of Medicine of Ribeirão Preto - Ribeirão Preto (SP), Brazil
| | - Luciana Tovo-Rodrigues
- Universidade Federal de Pelotas, Graduate Program in Epidemiology - Pelotas (RS), Brazil
| | - Bianca Del-Ponte
- Universidade Federal de Pelotas, Graduate Program in Epidemiology - Pelotas (RS), Brazil
| | | | | | - Helen Gonçalves
- Universidade Federal de Pelotas, Graduate Program in Epidemiology - Pelotas (RS), Brazil
| | - Viviane Cunha Cardoso
- Universidade de São Paulo, Faculty of Medicine of Ribeirão Preto - Ribeirão Preto (SP), Brazil
| | - Marco Antonio Barbieri
- Universidade de São Paulo, Faculty of Medicine of Ribeirão Preto - Ribeirão Preto (SP), Brazil
| | - Heloisa Bettiol
- Universidade de São Paulo, Faculty of Medicine of Ribeirão Preto - Ribeirão Preto (SP), Brazil
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Bailey GA, Matthews C, Szewczyk-krolikowski K, Moore P, Komarzynski S, Davies EH, Peall KJ. Use of remote monitoring and integrated platform for the evaluation of sleep quality in adult-onset idiopathic cervical dystonia. J Neurol 2023; 270:1759-1769. [PMID: 36414751 PMCID: PMC9971061 DOI: 10.1007/s00415-022-11490-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Revised: 11/08/2022] [Accepted: 11/11/2022] [Indexed: 11/23/2022]
Abstract
BACKGROUND Up to 70% of individuals diagnosed with adult-onset idiopathic focal cervical dystonia (AOIFCD) report difficulties with sleep. Larger cohort studies using wrist-worn accelerometer devices have emerged as an alternative to smaller polysomnography studies, in order to evaluate sleep architecture. METHODS To measure activity during the sleep/wake cycle, individuals wore a consumer-grade wrist device (Garmin vivosmart 4) continuously over 7 days on their non-dominant wrist, while completing a daily sleep diary and standardised sleep and non-motor questionnaires via a dedicated app. Sleep measures were derived from the captured raw triaxial acceleration and heart rate values using previously published validated algorithms. RESULTS Data were collected from 50 individuals diagnosed with AOIFCD and 47 age- and sex-matched controls. Those with AOIFCD self-reported significantly higher levels of excessive daytime sleepiness (p = 0.04) and impaired sleep quality (p = 0.03), while accelerometer measurements found the AOIFCD cohort to have significantly longer total sleep times (p = 0.004) and time spent in NREM sleep (p = 0.009), compared to controls. Overall, there was limited agreement between wearable-derived sleep parameters, and self-reported sleep diary and visual analogue scale records. DISCUSSION This study shows the potential feasibility of using consumer-grade wearable devices in estimating sleep measures at scale in dystonia cohorts. Those diagnosed with AOIFCD were observed to have altered sleep architecture, notably longer total sleep time and NREM sleep, compared to controls. These findings suggest that previously reported disruptions to brainstem circuitry and serotonin neurotransmission may contribute to both motor and sleep pathophysiology.
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Affiliation(s)
- Grace A. Bailey
- grid.5600.30000 0001 0807 5670Neuroscience and Mental Health Research Institute, Cardiff University School of Medicine, Hadyn Ellis Building, Maindy Road, Cardiff, CF24 4HQ UK
| | | | | | - Peter Moore
- grid.416928.00000 0004 0496 3293The Walton Centre NHS Foundation Trust, Liverpool, UK
| | | | | | - Kathryn J. Peall
- grid.5600.30000 0001 0807 5670Neuroscience and Mental Health Research Institute, Cardiff University School of Medicine, Hadyn Ellis Building, Maindy Road, Cardiff, CF24 4HQ UK
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da Silva EC, Carneiro JR, de Almeida Fonseca Viola PC, Confortin SC, da Silva AAM. Association of Food Intake with Sleep Durations in Adolescents from a Capital City in Northeastern Brazil. Nutrients 2022; 14:nu14235180. [PMID: 36501210 PMCID: PMC9735429 DOI: 10.3390/nu14235180] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Revised: 11/26/2022] [Accepted: 11/27/2022] [Indexed: 12/12/2022] Open
Abstract
(1) Background: During adolescence, there are significant changes in food consumption, such as reducing the consumption of in natura or minimally processed foods and increasing the consumption of ultra-processed foods. Thus, eating habits can influence sleep duration and, consequently, affect the quality of life of young people. This study thus aims to estimate the association of consumption of in natura or minimally processed, processed, and ultra-processed foods with sleep durations in adolescents. (2) Methods: This is a cross-sectional study including 964 adolescents (18 to 19 years old) from the 1997 to 1998 birth cohort in São Luís, Maranhão. Food consumption was assessed using the food frequency questionnaire (FFQ) and stratified based on the NOVA classification. Sleep duration was verified using accelerometry in hours. The analysis of the association between the consumption of in natura or minimally processed, processedand ultra-processed foods with sleep durations in adolescents used crude and adjusted linear regression (by gender, age, skin color, education, economic class, work, consumption of alcohol, smoking, screen time, physical activity, use of illicit drugs, anxiety, depressive symptoms, and lean and fat mass). A directed acyclic graph (DAG) was used to determine the minimum set of adjustment factors. (3) Results: Of the 964 individuals evaluated, 52.0% were female. The mean sleep duration was 6 h (± 0.95). In the crude and adjusted analyses, no association was observed between food consumption according to the degree of processing and adolescent sleep durations. (4) Conclusion: There was no association between the consumption of in natura or minimally processed, processed, and ultra-processed foods with sleep durations.
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Affiliation(s)
- Emanuellen Coelho da Silva
- Department of Public Health, School of Nutrition, Federal University of Maranhão, São Luís 65020-905, MA, Brazil
- Correspondence: ; Tel.: +55-983-272-9670
| | - Juliana Ramos Carneiro
- Department of Public Health, School of Medicine, Federal University of Maranhão, São Luís 65020-905, MA, Brazil
| | - Poliana Cristina de Almeida Fonseca Viola
- Nutrition Department, Nutrition Teacher at the Health Sciences Center, Federal University of Piauí, Teresina 64049-550, MA, Brazil
- Postgraduation Program in Collective Health, Department of Public Health, Federal University of Maranhão, São Luís 65020-905, MA, Brazil
| | - Susana Cararo Confortin
- Postgraduation Program in Collective Health, Department of Public Health, Federal University of Maranhão, São Luís 65020-905, MA, Brazil
| | - Antônio Augusto Moura da Silva
- Postgraduation Program in Collective Health, Department of Public Health, Federal University of Maranhão, São Luís 65020-905, MA, Brazil
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Prusynski RA, Kelly VE, Fogelberg DJ, Pradhan S. The association between sleep deficits and sedentary behavior in people with mild Parkinson disease. Disabil Rehabil 2022; 44:5585-5591. [PMID: 34218729 PMCID: PMC10659136 DOI: 10.1080/09638288.2021.1940320] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Revised: 05/06/2021] [Accepted: 06/04/2021] [Indexed: 10/20/2022]
Abstract
Purpose: Sleep deficits are a common nonmotor symptom of Parkinson disease (PD). People with mild PD also achieve less physical activity (PA) than healthy older adults (HOA), but the relationship between sleep and PA in PD is unclear. This study examined associations between sleep and PA in participants with PD and HOA.Materials and Methods: Secondary analysis of a prospective observational study. Participants wore a commercially available activity monitor for two weeks. Wilcoxon Rank-Sum tests compared nighttime sleep, wakenings after sleep onset, number of wakenings, naps, step count, and PA intensity between PD and HOA groups. Age-adjusted regression models calculated associations between nighttime sleep and PA.Results: Per day, participants with PD slept 75 fewer minutes (p < 0.01), took 5,792 fewer steps (p < 0.001), achieved less PA at all intensities, and had 32% more sedentary time (p < 0.001) compared to HOA. Thirty minutes more sleep was associated with 26 fewer sedentary minutes for HOA (p = 0.01) and 25 fewer sedentary minutes for the PD group (p < 0.001).Conclusions: Sleep and PA are reduced in mild PD compared to HOA. Both groups demonstrated similar associations between reduced sleep and increased sedentary behavior. Results may encourage providers to screen for sleep deficits when promoting PA.IMPLICATIONS FOR REHABILITATIONThe use of a wrist-worn commercial activity and sleep monitor was well tolerated by both healthy older adults and people with mild Parkinson Disease in this study.People with mild Parkinson Disease slept less and were less active than a group of healthy older adults.Less sleep was associated with more sedentary behavior in both groups.The relationship between poor sleep and sedentary behavior in mild Parkinson Disease suggests that rehabilitation interventions may be optimized by targeting both physical activity and sleep deficits.
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Affiliation(s)
- Rachel A Prusynski
- Department of Rehabilitation Medicine, University of Washington, Washington, Seattle, WA, USA
| | - Valerie E Kelly
- Department of Rehabilitation Medicine, University of Washington, Washington, Seattle, WA, USA
| | - Donald J Fogelberg
- Department of Rehabilitation Medicine, University of Washington, Washington, Seattle, WA, USA
| | - Sujata Pradhan
- Department of Rehabilitation Medicine, University of Washington, Washington, Seattle, WA, USA
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Wang W, Peng H, Bouak F. Measuring sleep parameters of naval sailors: A comparison between subjective self-report and wrist actigraphy. APPLIED ERGONOMICS 2022; 102:103744. [PMID: 35287086 DOI: 10.1016/j.apergo.2022.103744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Revised: 02/18/2022] [Accepted: 03/08/2022] [Indexed: 06/14/2023]
Abstract
Wrist actigraph and self-report activity logs were used in a Royal Canadian Navy's at-sea exercise to track sleep patterns of naval personnel. In this study, we compared sleep parameters obtained from two measurement methods and investigated their intrinsic biases. The results revealed a strong agreement between two methods for recording sleep offset times, but a relatively poor agreement for parameters that include substantial periods of transition between sleep and wake states. Overall, self-reported sleep durations were substantially longer than actigraphic estimates (mean bias of -30.6 min; limits of agreement -95.9 to 34.8 min), and the discrepancy was mainly caused by differences in two methods to track sleep onset latency and Wake-up After Sleep Onset (WASO). Based on a customised activity log, a strong positive correlation (rho = 0.75, p < .001) between self-report and actigraphy was observed for sleep duration estimates, which confirmed the effectiveness of the activity log in field studies. Between two participant groups with different work schedules, the agreement between self-report and actigraphy was consistently better for day workers than watch keepers. The findings inform future sleep research planning that involves naval personnel in field settings.
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Affiliation(s)
- Wenbi Wang
- Defence Research and Development Canada, 1133 Sheppard Ave. W, Toronto, ON, M3K 2C9, Canada.
| | - Henry Peng
- Defence Research and Development Canada, 1133 Sheppard Ave. W, Toronto, ON, M3K 2C9, Canada.
| | - Fethi Bouak
- Defence Research and Development Canada, 1133 Sheppard Ave. W, Toronto, ON, M3K 2C9, Canada.
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11
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Personalized Assessment of Insomnia and Sleep Quality in Patients with Parkinson's Disease. J Pers Med 2022; 12:jpm12020322. [PMID: 35207811 PMCID: PMC8875986 DOI: 10.3390/jpm12020322] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 02/15/2022] [Accepted: 02/17/2022] [Indexed: 02/01/2023] Open
Abstract
Sleep disturbances are more common in patients with Parkinson’s disease (PD) than in the general population and are considered one of the most troublesome symptoms by these patients. Insomnia represents one of the most common sleep disturbances in PD, and it correlates significantly with poor quality of life. There are several known causes of insomnia in the general population, but the complex manifestations that might be associated with PD may also induce insomnia and impact the quality of sleep. The treatment of insomnia and the strategies needed to improve sleep quality may therefore represent a challenge for the neurologist. A personalized approach to the PD patient with insomnia may help the clinician to identify the factors and comorbidities that should also be considered in order to establish a better individualized therapeutic plan. This review will focus on the main characteristics and correlations of insomnia, the most common risk factors, and the main subjective and objective methods indicated for the assessment of insomnia and sleep quality in order to offer a concise guide containing the main steps needed to approach the PD patient with chronic insomnia in a personalized manner.
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12
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Del Pino R, Murueta-Goyena A, Ayala U, Acera M, Fernández M, Tijero B, Carmona M, Fernández T, Gabilondo I, Gómez-Esteban JC. Clinical long-term nocturnal sleeping disturbances and excessive daytime sleepiness in Parkinson's disease. PLoS One 2021; 16:e0259935. [PMID: 34851977 PMCID: PMC8635374 DOI: 10.1371/journal.pone.0259935] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Accepted: 11/01/2021] [Indexed: 11/17/2022] Open
Abstract
Objective To prospectively evaluate nocturnal sleep problems and excessive daytime sleepiness (EDS) in Parkinson’s disease (PD) patients, and analyze the influence of motor symptoms, treatment, and sex differences on sleep problems in PD. Methods Sleep disturbances of 103 PD patients were assessed with Parkinson’s Disease Sleep Scale (PDSS) and the Epworth Sleepiness Scale (ESS). Student’s t-test for related samples, one-way ANOVA with Tukey’s HSD post hoc test were used to assess group differences. Bivariate correlations and mixed-effects linear regression models were used to analyze the association between clinical aspects and sleep disturbances over time. Results At baseline, 48.5% of PD patients presented nocturnal problems and 40% of patients presented EDS. The PDSS and ESS total score slightly improve over time. Nocturnal problems were associated with age and motor impartment, explaining the 51% of the variance of the PDSS model. Males presented less nocturnal disturbances and more EDS than females. Higher motor impairment and combined treatment (L-dopa and agonist) were related to more EDS, while disease duration and L-dopa in monotherapy were related to lower scores, explaining the 59% of the model. Conclusions Sleep disturbances changed over time and age, diseases duration, motor impairment, treatment and sex were associated with nocturnal sleep problems and EDS. Agonist treatment alone or in combination with L-dopa might predict worse daytime sleepiness, while L-dopa in monotherapy is related to lower EDS, which significantly affects the quality of life of PD patients.
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Affiliation(s)
- Rocio Del Pino
- Neurodegenerative Diseases Group, Biocruces Bizkaia Health Research Institute, Barakaldo, Bizkaia, Spain
| | - Ane Murueta-Goyena
- Neurodegenerative Diseases Group, Biocruces Bizkaia Health Research Institute, Barakaldo, Bizkaia, Spain.,Department of Neurosciences, University of the Basque Country (UPV/EHU), Leioa, Bizkaia, Spain
| | - Unai Ayala
- Biomedical Engineering Department, Faculty of Engineering, Mondragon Unibertsitatea, Mondragon, Gipuzkoa, Spain
| | - Marian Acera
- Neurodegenerative Diseases Group, Biocruces Bizkaia Health Research Institute, Barakaldo, Bizkaia, Spain
| | - Mónica Fernández
- Faculty of Medicine Neurology, University of the Basque Country (UPV/EHU), Leioa, Spain
| | - Beatriz Tijero
- Neurodegenerative Diseases Group, Biocruces Bizkaia Health Research Institute, Barakaldo, Bizkaia, Spain.,Cruces University Hospital, Barakaldo, Bizkaia, Spain
| | - Mar Carmona
- Neurodegenerative Diseases Group, Biocruces Bizkaia Health Research Institute, Barakaldo, Bizkaia, Spain
| | - Tamara Fernández
- Neurodegenerative Diseases Group, Biocruces Bizkaia Health Research Institute, Barakaldo, Bizkaia, Spain.,Cruces University Hospital, Barakaldo, Bizkaia, Spain
| | - Iñigo Gabilondo
- Neurodegenerative Diseases Group, Biocruces Bizkaia Health Research Institute, Barakaldo, Bizkaia, Spain.,Cruces University Hospital, Barakaldo, Bizkaia, Spain.,Ikerbasque: The Basque Foundation for Science, Bilbao, Spain
| | - Juan Carlos Gómez-Esteban
- Neurodegenerative Diseases Group, Biocruces Bizkaia Health Research Institute, Barakaldo, Bizkaia, Spain.,Department of Neurosciences, University of the Basque Country (UPV/EHU), Leioa, Bizkaia, Spain.,Cruces University Hospital, Barakaldo, Bizkaia, Spain
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13
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van Wamelen DJ, Sringean J, Trivedi D, Carroll CB, Schrag AE, Odin P, Antonini A, Bloem BR, Bhidayasiri R, Chaudhuri KR. Digital health technology for non-motor symptoms in people with Parkinson's disease: Futile or future? Parkinsonism Relat Disord 2021; 89:186-194. [PMID: 34362670 DOI: 10.1016/j.parkreldis.2021.07.032] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Revised: 07/26/2021] [Accepted: 07/28/2021] [Indexed: 10/20/2022]
Abstract
INTRODUCTION There is an ongoing digital revolution in the field of Parkinson's disease (PD) for the objective measurement of motor aspects, to be used in clinical trials and possibly support therapeutic choices. The focus of remote technologies is now also slowly shifting towards the broad but more "hidden" spectrum of non-motor symptoms (NMS). METHODS A narrative review of digital health technologies for measuring NMS in people with PD was conducted. These digital technologies were defined as assessment tools for NMS offered remotely in the form of a wearable, downloadable as a mobile app, or any other objective measurement of NMS in PD that did not require a hospital visit and could be performed remotely. Searches were performed using peer-reviewed literature indexed databases (MEDLINE, Embase, PsycINFO, Cochrane Database of Systematic Reviews, Cochrane CENTRAL Register of Controlled Trials), as well as Google and Google Scholar. RESULTS Eighteen studies deploying digital health technology in PD were identified, for example for the measurement of sleep disorders, cognitive dysfunction and orthostatic hypotension. In addition, we describe promising developments in other conditions that could be translated for use in PD. CONCLUSION Unlike motor symptoms, non-motor features of PD are difficult to measure directly using remote digital technologies. Nonetheless, it is currently possible to reliably measure several NMS and further digital technology developments are underway to offer further capture of often under-reported and under-recognised NMS.
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Affiliation(s)
- Daniel J van Wamelen
- King's College London, Department of Neurosciences, Institute of Psychiatry, Psychology & Neuroscience, London, United Kingdom; Parkinson's Foundation Centre of Excellence at King's College Hospital, Denmark Hill, London, United Kingdom; Radboud University Medical Centre; Donders Institute for Brain, Cognition and Behaviour; Department of Neurology, Nijmegen, the Netherlands.
| | - Jirada Sringean
- Chulalongkorn Centre of Excellence for Parkinson's Disease & Related Disorders, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand
| | - Dhaval Trivedi
- King's College London, Department of Neurosciences, Institute of Psychiatry, Psychology & Neuroscience, London, United Kingdom; Parkinson's Foundation Centre of Excellence at King's College Hospital, Denmark Hill, London, United Kingdom
| | - Camille B Carroll
- Faculty of Health, University of Plymouth, Plymouth, Devon, United Kingdom
| | - Anette E Schrag
- Department of Clinical and Movement Neurosciences, University College London, London, United Kingdom
| | - Per Odin
- Division of Neurology, Department of Clinical Sciences, Lund University, Lund, Sweden
| | - Angelo Antonini
- Movement Disorders Unit, Department of Neuroscience, University of Padua, Padua, Italy
| | - Bastiaan R Bloem
- Radboud University Medical Centre; Donders Institute for Brain, Cognition and Behaviour; Department of Neurology, Nijmegen, the Netherlands
| | - Roongroj Bhidayasiri
- Chulalongkorn Centre of Excellence for Parkinson's Disease & Related Disorders, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand; The Academy of Science, The Royal Society of Thailand, Bangkok, Thailand
| | - K Ray Chaudhuri
- King's College London, Department of Neurosciences, Institute of Psychiatry, Psychology & Neuroscience, London, United Kingdom; Parkinson's Foundation Centre of Excellence at King's College Hospital, Denmark Hill, London, United Kingdom
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14
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Williamson JR, Telfer B, Mullany R, Friedl KE. Detecting Parkinson's Disease from Wrist-Worn Accelerometry in the U.K. Biobank. SENSORS (BASEL, SWITZERLAND) 2021; 21:2047. [PMID: 33799420 PMCID: PMC7999802 DOI: 10.3390/s21062047] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 03/09/2021] [Accepted: 03/10/2021] [Indexed: 02/06/2023]
Abstract
Parkinson's disease (PD) is a chronic movement disorder that produces a variety of characteristic movement abnormalities. The ubiquity of wrist-worn accelerometry suggests a possible sensor modality for early detection of PD symptoms and subsequent tracking of PD symptom severity. As an initial proof of concept for this technological approach, we analyzed the U.K. Biobank data set, consisting of one week of wrist-worn accelerometry from a population with a PD primary diagnosis and an age-matched healthy control population. Measures of movement dispersion were extracted from automatically segmented gait data, and measures of movement dimensionality were extracted from automatically segmented low-movement data. Using machine learning classifiers applied to one week of data, PD was detected with an area under the curve (AUC) of 0.69 on gait data, AUC = 0.84 on low-movement data, and AUC = 0.85 on a fusion of both activities. It was also found that classification accuracy steadily improved across the one-week data collection, suggesting that higher accuracy could be achievable from a longer data collection. These results suggest the viability of using a low-cost and easy-to-use activity sensor for detecting movement abnormalities due to PD and motivate further research on early PD detection and tracking of PD symptom severity.
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Affiliation(s)
- James R. Williamson
- Lincoln Laboratory, Massachusetts Institute of Technology, Lexington, MA 02421, USA; (B.T.); (R.M.)
| | - Brian Telfer
- Lincoln Laboratory, Massachusetts Institute of Technology, Lexington, MA 02421, USA; (B.T.); (R.M.)
| | - Riley Mullany
- Lincoln Laboratory, Massachusetts Institute of Technology, Lexington, MA 02421, USA; (B.T.); (R.M.)
| | - Karl E. Friedl
- U.S. Army Research Institute of Environmental Medicine, Natick, MA 01760, USA;
- Department of Neurology, University of California, San Francisco, CA 94143, USA
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15
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Al-Sharman A, Ismaiel IA, Khalil H, El-Salem K. Exploring the Relationship Between Sleep Quality, Sleep-Related Biomarkers, and Motor Skill Acquisition Using Virtual Reality in People With Parkinson's Disease: A Pilot Study. Front Neurol 2021; 12:582611. [PMID: 33737900 PMCID: PMC7960758 DOI: 10.3389/fneur.2021.582611] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2020] [Accepted: 01/20/2021] [Indexed: 11/13/2022] Open
Abstract
Background and Objectives: Despite the fact that sleep disturbances are among the most common and disabling manifestations of Parkinson's disease (PD), no study has investigated the effect of sleep quality and sleep-related biomarkers on motor skill acquisition in people with Parkinson's disease (PwPD). Objective: To examine the relationship between skill acquisition, sleep quality, and sleep-related biomarkers in PwPD using virtual reality (VR) system. Methods: This is a cross sectional study conducted on 31 PwPD and 31 healthy controls. To assess skill acquisition, each participant practiced a VR game 6 times (blocks). The main outcomes from the VR game were the required time to complete the VR game and the recorded errors. Motor skill acquisition was calculated as the difference of scores between block 6 and block 2 for both outcomes. Sleep was assessed subjectively using Pittsburgh Sleep Quality Index (PSQI) and objectively using the Actisleep. To assess sleep related biomarker, plasma serotonin level was examined. Results: PwPD and healthy controls demonstrated a practice-related improvement in performance as shown by the main effect of block for each of the VR outcome measures (p < 0.000, time required to complete VR game; p < 0.000, recorded errors). There was no interaction effect between Block X Group for both outcome measures. There were significant correlations in both groups (p < 0.05) between motor skill acquisition (as indicated by the difference of time required to complete the VR game between block 6 and block 2) and PSQI total score, wake after sleep onset, and sleep efficiency. Additionally, a significant correlation was observed in both groups between motor skill acquisition (as indicated by the difference of time required to complete the VR game between block 6 and block 2) and the plasma serotonin level (p < 0.05). These correlations in PwPD remained significant, even after adjusting for disease motor severity, cognitive status, depression, and daily dose of L-dopa. Discussion and Conclusions: Sleep quality may influence motor skill acquisition in PwPD. Healthcare professionals are encouraged to be aware about sleep quality and sleep assessment tools. Therapies may target improving sleep quality which could result in improving motor skill acquisition.
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Affiliation(s)
- Alham Al-Sharman
- Department of Rehabilitation Sciences, Faculty of Applied Medical Sciences, Jordan University of Science and Technology, Irbid, Jordan
| | - Ismail Alhaj Ismaiel
- Department of Rehabilitation Sciences, Faculty of Applied Medical Sciences, Jordan University of Science and Technology, Irbid, Jordan
| | - Hanan Khalil
- Department of Rehabilitation Sciences, Faculty of Applied Medical Sciences, Jordan University of Science and Technology, Irbid, Jordan
| | - Khalid El-Salem
- Department of Neurosciences, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
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16
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Iakovakis D, Mastoras RE, Hadjidimitriou S, Charisis V, Bostanjopoulou S, Katsarou Z, Klingelhoefer L, Reichmann H, Trivedi D, Chaudhuri RK, Hadjileontiadis LJ, D S, D J. Smartwatch-based Activity Analysis During Sleep for Early Parkinson's Disease Detection. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2020; 2020:4326-4329. [PMID: 33018953 DOI: 10.1109/embc44109.2020.9176412] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Parkinson's Disease (PD) is the second most common neurodegenerative disorder with the non-motor symptoms preceding the motor impairment that is needed for clinical diagnosis. In the current study, an angle-based analysis that processes activity data during sleep from a smartwatch for quantification of sleep quality, when applied on controls and PD patients, is proposed. Initially, changes in their arm angle due to activity are captured from the smartwatch triaxial accelerometry data and used for the estimation of the corresponding binary state (awake/sleep). Then, sleep metrics (i.e., sleep efficiency index, total sleep time, sleep fragmentation index, sleep onset latency, and wake after sleep onset) are computed and used for the discrimination between controls and PD patients. A process of validation of the proposed approach when compared with the PSG-based ground truth in an in-the-clinic setting, resulted in comparable state estimation. Moreover, data from 15 early PD patients and 11 healthy controls were used as a test set, including 1,376 valid sleep recordings in-the-wild setting. The univariate analysis of the extracted sleep metrics achieved up to 0.77 AUC in early PD patients vs. healthy controls classification and exhibited a statistically significant correlation (up to 0.46) with the clinical PD Sleep Scale 2 counterpart Items. The findings of the proposed method show the potentiality to capture non-motor behavior from users' nocturnal activity to detect PD in the early stage.
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17
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Shedding Light on Nocturnal Movements in Parkinson's Disease: Evidence from Wearable Technologies. SENSORS 2020; 20:s20185171. [PMID: 32927816 PMCID: PMC7571235 DOI: 10.3390/s20185171] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Revised: 09/04/2020] [Accepted: 09/09/2020] [Indexed: 12/13/2022]
Abstract
In Parkinson’s disease (PD), abnormal movements consisting of hypokinetic and hyperkinetic manifestations commonly lead to nocturnal distress and sleep impairment, which significantly impact quality of life. In PD patients, these nocturnal disturbances can reflect disease-related complications (e.g., nocturnal akinesia), primary sleep disorders (e.g., rapid eye movement behaviour disorder), or both, thus requiring different therapeutic approaches. Wearable technologies based on actigraphy and innovative sensors have been proposed as feasible solutions to identify and monitor the various types of abnormal nocturnal movements in PD. This narrative review addresses the topic of abnormal nocturnal movements in PD and discusses how wearable technologies could help identify and assess these disturbances. We first examine the pathophysiology of abnormal nocturnal movements and the main clinical and instrumental tools for the evaluation of these disturbances in PD. We then report and discuss findings from previous studies assessing nocturnal movements in PD using actigraphy and innovative wearable sensors. Finally, we discuss clinical and technical prospects supporting the use of wearable technologies for the evaluation of nocturnal movements.
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18
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Cristini J, Weiss M, De Las Heras B, Medina-Rincón A, Dagher A, Postuma RB, Huber R, Doyon J, Rosa-Neto P, Carrier J, Amara AW, Roig M. The effects of exercise on sleep quality in persons with Parkinson's disease: A systematic review with meta-analysis. Sleep Med Rev 2020; 55:101384. [PMID: 32987321 DOI: 10.1016/j.smrv.2020.101384] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2020] [Revised: 06/28/2020] [Accepted: 06/30/2020] [Indexed: 12/20/2022]
Abstract
We conducted a systematic review with meta-analysis to determine the evidence in support of exercise to improve sleep quality assessed subjectively and objectively in Parkinson's Disease (PD). Standardized mean differences (SMD) comparing the effects of exercise and control interventions on sleep quality with 95% confidence intervals (CI) were calculated. Data from 10 randomized and 2 non-randomized controlled trials, including a total of 690 persons with PD were included. Exercise had a significant positive effect on sleep quality assessed subjectively (SMD = 0.53; 95% CI = 0.16-0.90; p = 0.005). However, the methodological quality of the studies showing positive effects on sleep quality was significantly poorer than the studies showing no effects. Only one study assessed the impact of exercise on objective sleep quality, showing improvements in sleep efficiency assessed with polysomnography (SMD = 0.94; 95% CI = 0.38-1.50; p = 0.001). Exercise performed at moderate to maximal intensities (SMD = 0.46; 95% CI = 0.05-0.87; p = 0.03) had significant effects on subjective sleep quality. In contrast, exercise performed at mild to moderate intensities showed non-significant effects (SMD = 0.76; 95% CI = -0.24-1.76; p = 0.14). These results support the use of exercise to improve sleep quality in persons with PD and reinforce the importance of achieving vigorous exercise intensities. Biases, limitations, practice points and directions for future research are discussed.
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Affiliation(s)
- Jacopo Cristini
- Memory and Motor Rehabilitation Laboratory (MEMORY-LAB), Feil and Oberfeld Research Centre, Jewish Rehabilitation Hospital, Montreal Center for Interdisciplinary Research in Rehabilitation (CRIR), Laval, Quebec, Canada; School of Physical and Occupational Therapy, Faculty of Medicine, McGill University, Montreal, Quebec, Canada
| | - Maxana Weiss
- Memory and Motor Rehabilitation Laboratory (MEMORY-LAB), Feil and Oberfeld Research Centre, Jewish Rehabilitation Hospital, Montreal Center for Interdisciplinary Research in Rehabilitation (CRIR), Laval, Quebec, Canada; School of Physical and Occupational Therapy, Faculty of Medicine, McGill University, Montreal, Quebec, Canada
| | - Bernat De Las Heras
- Memory and Motor Rehabilitation Laboratory (MEMORY-LAB), Feil and Oberfeld Research Centre, Jewish Rehabilitation Hospital, Montreal Center for Interdisciplinary Research in Rehabilitation (CRIR), Laval, Quebec, Canada; School of Physical and Occupational Therapy, Faculty of Medicine, McGill University, Montreal, Quebec, Canada
| | - Almudena Medina-Rincón
- Memory and Motor Rehabilitation Laboratory (MEMORY-LAB), Feil and Oberfeld Research Centre, Jewish Rehabilitation Hospital, Montreal Center for Interdisciplinary Research in Rehabilitation (CRIR), Laval, Quebec, Canada; Universitat Internacional de Catalunya, Barcelona, Catalonia, Spain
| | - Alain Dagher
- Montreal Neurological Institute, McGill University, Montreal, Quebec, Canada
| | - Ronald B Postuma
- Montreal Neurological Institute, McGill University, Montreal, Quebec, Canada
| | - Reto Huber
- Child Development Center, University Children's Hospital and Department of Child and Adolescent Psychiatry and Psychotherapy, Psychiatric Hospital, University of Zurich, Switzerland
| | - Julien Doyon
- Montreal Neurological Institute, McGill University, Montreal, Quebec, Canada
| | - Pedro Rosa-Neto
- Translational Neuroimaging Laboratory, McGill University Research Centre for Studies in Aging, Douglas Research Institute, Le Centre Intégré Universitaire de Santé et de Services Sociaux (CIUSSS) de l'Ouest-de-l'Île-de-Montréal; Department of Neurology and Neurosurgery, Psychiatry and Pharmacology and Therapeutics, McGill University, Montreal, Canada
| | - Julie Carrier
- Department of Psychology, Université de Montréal, Montréal, Québec, Canada
| | - Amy W Amara
- University of Alabama at Birmingham, Alabama, USA
| | - Marc Roig
- Memory and Motor Rehabilitation Laboratory (MEMORY-LAB), Feil and Oberfeld Research Centre, Jewish Rehabilitation Hospital, Montreal Center for Interdisciplinary Research in Rehabilitation (CRIR), Laval, Quebec, Canada; School of Physical and Occupational Therapy, Faculty of Medicine, McGill University, Montreal, Quebec, Canada. https://memorylab.ca/
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19
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Wu JQ, Cronin-Golomb A. Temporal Associations between Sleep and Daytime Functioning in Parkinson's Disease: A Smartphone-Based Ecological Momentary Assessment. Behav Sleep Med 2020; 18:560-569. [PMID: 31199163 DOI: 10.1080/15402002.2019.1629445] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
OBJECTIVES/BACKGROUND Disruptions to mood, cognition, and other daytime functioning are common and debilitating symptoms of Parkinson's disease (PD), and there is evidence that sleep problems contribute to these symptoms. However, previous studies are limited by reliance on self-reported sleep and cross-sectional designs. With the aim of assessing sleep as a possible treatment target for improving daytime functioning in PD, we used smartphone-based ecological momentary assessment (EMA) and actigraphy to investigate temporal associations between sleep (objective and subjective) and daytime functioning. PARTICIPANTS/METHODS Twenty participants with mild-moderate PD wore actigraphs and completed sleep diaries for 14-15 days. They reported daytime functioning (anxiety, positive affect, cognitive function, fatigue, and social function) twice daily via smartphone-administered questionnaires. Multilevel modeling examined whether sleep quantity/quality predicted next-day functioning, and whether current mood (anxiety, positive affect) predicted later sleep. RESULTS Average completion rates for sleep diaries and daytime questionnaires were 94% and 91%, respectively. Subjective sleep quality predicted next-day anxiety (B = -.75, SE = .25, p= .003), but objective sleep did not predict any daytime functioning variables (p's>.112). Positive affect predicted later subjective sleep quality (B = 0.03, SE = .01, p = .003) but not objective sleep quantity/quality (p's>.107). CONCLUSIONS We demonstrated the feasibility of using EMA in PD. On a daily timescale, subjective sleep quality was bidirectionally associated with mood, whereas objective sleep was not associated with any daytime functioning. This discrepancy suggests that perception of sleep is important for mood in PD, which could provide targets for non-pharmacological interventions.
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Affiliation(s)
- Jade Q Wu
- Department of Psychological and Brain Sciences, Boston University , Boston, MA.,Psychiatry and Behavioral Sciences, Duke University Medical Center , Durham, NC
| | - Alice Cronin-Golomb
- Department of Psychological and Brain Sciences, Boston University , Boston, MA
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20
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Bohnen NI, Hu MTM. Sleep Disturbance as Potential Risk and Progression Factor for Parkinson's Disease. JOURNAL OF PARKINSONS DISEASE 2020; 9:603-614. [PMID: 31227656 PMCID: PMC6700634 DOI: 10.3233/jpd-191627] [Citation(s) in RCA: 62] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Sleep disturbances are common and a major source of disability in Parkinson's disease (PD). Primary and secondary insomnia, rapid eye movement sleep behavior disorder (RDB), central sleep apnea, restless legs, and nocturnal akinesia are common sleep disturbances in PD. Prodromal presence of RBD is associated with a more severe motor and non-motor PD subtype implying a significant disease-modifying effect of this parasomnia. Other disease-modifying mechanisms of sleep disturbances in PD include impaired glymphatic clearance, endoplasmic reticulum stress, nocturnal brain deoxygenation and inflammatory processes among others. Impairments of neural circuit switching and imbalance between inhibitory and excitatory neuronal populations are likely responsible for episodic sleep disturbances, in particular RBD. As neural circuits may predict patterns of α-synuclein propagation in the nervous system, impairments of such circuits are of high relevance for PD pathophysiology. Future research is needed to determine whether appropriate treatment for disturbed sleep might slow progression of PD.
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Affiliation(s)
- Nicolaas I Bohnen
- Radiology, University of Michigan, Ann Arbor, MI, USA.,Neurology, University of Michigan, Ann Arbor, MI, USA.,Neurology Service and GRECC, Veterans Administration Ann Arbor Healthcare System, Ann Arbor, MI, USA.,Morris K. Udall Center of Excellence for Parkinson's Disease Research, University of Michigan, Ann Arbor, MI, USA
| | - Michele T M Hu
- Division of Neurology, Nuffield Department of Clinical Neurosciences, Oxford University, Oxford, UK.,Department of Neurology, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
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21
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Moon S, Sarmento CVM, Steinbacher M, Smirnova IV, Colgrove Y, Lai SM, Lyons KE, Liu W. Can Qigong improve non-motor symptoms in people with Parkinson's disease - A pilot randomized controlled trial? Complement Ther Clin Pract 2020; 39:101169. [PMID: 32379638 PMCID: PMC7607921 DOI: 10.1016/j.ctcp.2020.101169] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2020] [Revised: 03/14/2020] [Accepted: 03/31/2020] [Indexed: 01/27/2023]
Abstract
Non-motor symptoms (NMS) including sleep disorders, anxiety, depression, fatigue, and cognitive decline can significantly impact quality of life in people with PD. Qigong exercise is a mind-body exercise that shows a wide range of benefits in various medical conditions. The purpose of this study was to investigate the effect of Qigong exercise on NMS with a focus on sleep quality. Seventeen participants completed a 12-week intervention of Qigong (n = 8) or sham Qigong (n = 9). Disease severity, anxiety and depression levels, fatigue, cognition, quality of life, and other NMS of the participants were evaluated prior to the intervention and at the end of the 12-week intervention. After the intervention, both Qigong and sham-Qigong group showed significant improvement in sleep quality (p < 0.05) and overall NMS (p < 0.05). No significant difference was found between groups. Qigong exercise has the potential as a rehabilitation method for people with PD, specifically alleviating NMS in PD. However, this finding needs to be carefully considered due to the small sample size and potentially low intervention fidelity of this study.
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Affiliation(s)
- Sanghee Moon
- Department of Physical Therapy and Rehabilitation Science, University of Kansas Medical Center, Kansas City, KS, USA.
| | - Caio V M Sarmento
- Department of Physical Therapy and Rehabilitation Science, University of Kansas Medical Center, Kansas City, KS, USA; Department of Physical Therapy, Department of Physical Therapy, California State University, Fresno, CA, USA.
| | - Michael Steinbacher
- Department of Physical Therapy and Rehabilitation Science, University of Kansas Medical Center, Kansas City, KS, USA.
| | - Irina V Smirnova
- Department of Physical Therapy and Rehabilitation Science, University of Kansas Medical Center, Kansas City, KS, USA.
| | - Yvonne Colgrove
- Department of Physical Therapy and Rehabilitation Science, University of Kansas Medical Center, Kansas City, KS, USA.
| | - Sue-Min Lai
- Department of Population Health, University of Kansas Medical Center, Kansas City, KS, USA.
| | - Kelly E Lyons
- Department of Neurology, University of Kansas Medical Center, Kansas City, KS, USA.
| | - Wen Liu
- Department of Physical Therapy and Rehabilitation Science, University of Kansas Medical Center, Kansas City, KS, USA.
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22
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Mastering nocturnal jigsaws in Parkinson's disease: a dusk-to-dawn review of night-time symptoms. J Neural Transm (Vienna) 2020; 127:763-777. [PMID: 32172472 DOI: 10.1007/s00702-020-02170-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Accepted: 03/05/2020] [Indexed: 12/11/2022]
Abstract
Finding out about night-time symptoms from Parkinson's disease (PD) patients can be a challenge as many patients and their carers cannot recall many symptoms that occur during the night, resulting in an under-recognition or a large variability of responses from clinical interviews and scales. Moreover, technology-based assessments for most night-time symptoms are still not universally available for use in a patient's home environment. Therefore, most physicians rely on their clinical acumen to capture these night-time symptoms based on pieces of patients' history, bedpartner's reports, clinical features, associated symptoms or conditions. To capture more night-time symptoms, the authors identified common nocturnal symptoms based on how they manifest from dusk to dawn with selected features relevant to PD. While some symptoms occur in healthy individuals, in PD patients, they may impact differently. The authors intend this narrative review to provide a practical guide on how these common night-time symptoms manifest and highlight pertinent issues by focusing on prevalence, clinical symptomatology, and specific relationships to PD. It is also important to recognise that PD-specific sleep disturbances increase with advancing disease with additional contributions from ageing, comorbidities, and medication side effects. However, the relative contribution of each factor to individual symptom may be different in individual patient, necessitating clinical expertise for individual interpretation. While there are debatable issues in certain areas, they underlie the complexity of night-time symptoms. Understanding night-time symptoms in PD is like re-arranging jigsaw pieces of clinical information to create, but never complete, a picture for physicians to instigate appropriate management.
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23
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Zhang Y, Ren R, Sanford LD, Yang L, Zhou J, Tan L, Li T, Zhang J, Wing YK, Shi J, Lu L, Tang X. Sleep in Parkinson's disease: A systematic review and meta-analysis of polysomnographic findings. Sleep Med Rev 2020; 51:101281. [PMID: 32135452 DOI: 10.1016/j.smrv.2020.101281] [Citation(s) in RCA: 65] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2019] [Revised: 01/21/2020] [Accepted: 01/23/2020] [Indexed: 02/08/2023]
Abstract
Polysomnographic studies have been conducted to explore sleep changes in Parkinson's disease (PD), but the relationships between sleep disturbances and PD are imperfectly understood. We conducted a systematic review of the literature exploring polysomnographic differences between PD patients and controls in EMBASE, MEDLINE, All EBM databases, CINAHL, and PsycIFNO. 67 studies were identified for systematic review, 63 of which were used for meta-analysis. Meta-analyses revealed significant reductions in total sleep time, sleep efficiency, N2 percentage, slow wave sleep, rapid eye movement sleep (REM) percentage, and increases in wake time after sleep onset, N1 percentage, REM latency, apnea hypopnea index, and periodic limb movement index in PD patients compared with controls. There were no remarkable differences in sleep continuity or sleep architecture between PD patients with and without REM sleep behavior disorder (RBD). Our study suggests that PD patients have poor sleep quality and quantity. Sex, age, disease duration, presence of RBD, medication status, cognitive impairment, and adaptation night are factors that contributed to heterogeneity between studies.
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Affiliation(s)
- Ye Zhang
- Sleep Medicine Center, Department of Respiratory and Critical Care Medicine, Mental Health Center, Translational Neuroscience Center, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, China
| | - Rong Ren
- Sleep Medicine Center, Department of Respiratory and Critical Care Medicine, Mental Health Center, Translational Neuroscience Center, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, China
| | - Larry D Sanford
- Sleep Research Laboratory, Center for Integrative Neuroscience and Inflammatory Diseases, Department of Pathology and Anatomy, Eastern Virginia Medical School, Norfolk, VA, USA.
| | - Linghui Yang
- Sleep Medicine Center, Department of Respiratory and Critical Care Medicine, Mental Health Center, Translational Neuroscience Center, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, China
| | - Junying Zhou
- Sleep Medicine Center, Department of Respiratory and Critical Care Medicine, Mental Health Center, Translational Neuroscience Center, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, China
| | - Lu Tan
- Sleep Medicine Center, Department of Respiratory and Critical Care Medicine, Mental Health Center, Translational Neuroscience Center, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, China
| | - Taomei Li
- Sleep Medicine Center, Department of Respiratory and Critical Care Medicine, Mental Health Center, Translational Neuroscience Center, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, China
| | - Jihui Zhang
- Department of Psychiatry, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong Special Administrative Region of China
| | - Yun-Kwok Wing
- Department of Psychiatry, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong Special Administrative Region of China
| | - Jie Shi
- National Institute on Drug Dependence, Peking University Sixth Hospital, Peking University, Beijing 100191, China
| | - Lin Lu
- National Institute on Drug Dependence, Peking University Sixth Hospital, Peking University, Beijing 100191, China
| | - Xiangdong Tang
- Sleep Medicine Center, Department of Respiratory and Critical Care Medicine, Mental Health Center, Translational Neuroscience Center, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, China.
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24
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Kataoka H, Saeki K, Kurumatani N, Sugie K, Obayashi K. Objective sleep measures between patients with Parkinson's disease and community-based older adults. Sleep Med 2020; 68:110-114. [PMID: 32035300 DOI: 10.1016/j.sleep.2019.09.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2019] [Revised: 09/18/2019] [Accepted: 09/19/2019] [Indexed: 10/25/2022]
Abstract
OBJECTIVES Previous studies comparing objective sleep measures between patients with Parkinson's disease (PD) and control participants were limited by their small sample size. The purpose of this study was to compare objective sleep measures between large-scale cohorts of PD outpatients and community-based older adults. METHODS In this cross-sectional study, we measured sleep parameters for 157 PD patients using an actigraph on the non-dominant wrist for six consecutive nights (95 Hoehn-Yahr stage I/II; 62 Hoehn-Yahr stage III-V). Moreover, two consecutive nights of actigraphy were performed on 1101 community-based control participants aged ≥60 years. RESULTS In multivariable analysis, sleep efficiency (SE) was significantly lower in patients with late-stage PD by 17.5% [95% confidence interval: 15.3%-19.7%] and early-stage PD by 9.4% [7.6%-11.1%] compared to the controls (67.1% and 75.3% vs. 84.6%, respectively). Similar results were observed for wake after sleep onset (WASO) and fragmentation index (FI). Total sleep time and sleep onset latency (SOL) were significantly shorter in patients with late- and early-stage PD stage compared to the controls. Among PD patients, significant association trends between advancement of individual Hoehn-Yahr stages and worsened sleep measures of SE, WASO, and FI were observed independently of age, gender, levodopa equivalent dose, and motor function parameter. CONCLUSION This study demonstrated significant and quantitative differences in objective sleep quality and quantity between PD patients and control participants. Furthermore, with advancement of disease stages, objectively measured sleep quality worsened in PD patients.
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Affiliation(s)
- Hiroshi Kataoka
- Department of Neurology, Nara Medical University School of Medicine, Nara, Japan.
| | - Keigo Saeki
- Department of Epidemiology, Nara Medical University School of Medicine, Nara, Japan
| | - Norio Kurumatani
- Department of Epidemiology, Nara Medical University School of Medicine, Nara, Japan
| | - Kazuma Sugie
- Department of Neurology, Nara Medical University School of Medicine, Nara, Japan
| | - Kenji Obayashi
- Department of Epidemiology, Nara Medical University School of Medicine, Nara, Japan.
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25
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Zulai LC, Albuquerque AM, Papcke C, Louzada FM, Scheeren EM. Postural impairments in Parkinson's disease are not associated with changes in circadian rhythms changes. Chronobiol Int 2019; 37:135-141. [PMID: 31766896 DOI: 10.1080/07420528.2019.1692350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Parkinson's disease (PD) is a progressive neurodegenerative disease, with a worldwide incidence of 1% in individuals >60 years of age. Its primary characteristics include postural impairments and changes in circadian rhythms. The authors investigated the association between postural impairment and changes in circadian rhythms in 24 PD subjects diagnosed with stages 1 to 3 on the Hoehn-Yard (HY) scale and regularly used dopaminergic medication for at least 1 year (experimental group - EG) and 24 healthy elderly individuals without a history of neurological impairment as the control group (CG). Static balance tests using a force plate were performed, and activity/rest rhythm, according to the relative amplitude of L5 and M10 values, was monitored for seven consecutive days using actimetry. The results indicated differences in posturographic indicators of mediolateral displacement (ML) [EG, 4.71 ± 0.85 mm; CG, 2.79 ± 0.53 mm (p < .0001)] and anteroposterior displacement of the center of pressure (COP) [EG, 5.61 ± 2.43 mm; CG, 8.23 ± 1.72 mm (< 0.0001)], ML velocity of the COP [EG, 2.39 ± 0.83 mm/s; CG, 1.40 ± 0.18 mm/s (p < .0001)], and total distance of the COP in the tandem stance condition [EG, 227.6 ± 75 mm; CG, 53.4 ± 6.1 mm (p < .0001)] between the EG and CG. There was no correlation between relative amplitude and posturographic data for the EG. Postural impairments were verified in comparing the EG and CG; however, there was no association between posturographic indicators and activity/rest rhythm.
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Affiliation(s)
- Luiz Claudio Zulai
- Graduate Program in Health Technology, Pontifical Catholic University of Paraná, Curitiba, Brazil
| | | | - Caluê Papcke
- Graduate Program in Health Technology, Pontifical Catholic University of Paraná, Curitiba, Brazil
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26
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Lebrun C, Gély‐Nargeot M, Rossignol A, Geny C, Bayard S. Efficacy of cognitive behavioral therapy for insomnia comorbid to Parkinson's disease: A focus on psychological and daytime functioning with a single‐case design with multiple baselines. J Clin Psychol 2019; 76:356-376. [DOI: 10.1002/jclp.22883] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
| | | | - Alexia Rossignol
- Neurology DepartmentParkinson's Disease Expert Centre, Gui de Chauliac HospitalMontpellier France
| | - Christian Geny
- Neurology DepartmentParkinson's Disease Expert Centre, Gui de Chauliac HospitalMontpellier France
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27
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Madrid-Navarro CJ, Puertas Cuesta FJ, Escamilla-Sevilla F, Campos M, Ruiz Abellán F, Rol MA, Madrid JA. Validation of a Device for the Ambulatory Monitoring of Sleep Patterns: A Pilot Study on Parkinson's Disease. Front Neurol 2019; 10:356. [PMID: 31031690 PMCID: PMC6470193 DOI: 10.3389/fneur.2019.00356] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Accepted: 03/22/2019] [Indexed: 12/13/2022] Open
Abstract
The development of wearable devices has increase interest in the use of ambulatory methods to detect sleep disorders more objectively than those permitted by subjective scales evaluating sleep quality, while subjects maintain their usual lifestyle. This study aims to validate an ambulatory circadian monitoring (ACM) device for the detection of sleep and wake states and apply it to the evaluation of sleep quality in patients with Parkinson disease (PD). A polysomnographic validation study was conducted on a group of patients with different sleep disorders in a preliminary phase, followed by a pilot study to apply this methodology to PD patients. The ACM device makes it possible to estimate the main sleep parameters very accurately, as demonstrated by: (a) the lack of significant differences between the mean values detected by PSG and ACM in time in bed (TIB), total sleep time (TST), sleep efficiency (SE), and time awake after sleep onset (WASO); (b) the slope of the correlation lines between the parameters estimated by the two procedures, very close to 1, which demonstrates the linearity of the predictions; (c) the low bias value in the estimates obtained through ACM. Sleep in PD is associated with lower distal skin temperature, efficiency and overall sleep time; greater WASO, activity during sleep and duration of naps and a worse circadian function index. In summary, the ACM device has proven to be clinically useful to evaluate sleep in an objective manner, thanks to the integrated management of different complementary variables, having advantages over conventional actigraphy.
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Affiliation(s)
- Carlos Javier Madrid-Navarro
- Neurology Service, Hospital Universitario Virgen de las Nieves, Granada, Spain.,Instituto de Investigación Biosanitaria ibs. GRANADA, Granada, Spain
| | - Francisco Javier Puertas Cuesta
- Unidad de Sueño, Hospital Universitario de la Ribera de Alzira, Valencia, Spain.,Centre de Sommeil, Service de Neurologie, CHU Liege, Liege, Belgium
| | - Francisco Escamilla-Sevilla
- Neurology Service, Hospital Universitario Virgen de las Nieves, Granada, Spain.,Instituto de Investigación Biosanitaria ibs. GRANADA, Granada, Spain
| | - Manuel Campos
- Chronobiology Laboratory, IMIB-Arrixaca, CIBERFES, Instituto de Salud Carlos III, Universidad de Murcia, Murcia, Spain
| | | | - Maria Angeles Rol
- Chronobiology Laboratory, IMIB-Arrixaca, CIBERFES, Instituto de Salud Carlos III, Universidad de Murcia, Murcia, Spain
| | - Juan Antonio Madrid
- Chronobiology Laboratory, IMIB-Arrixaca, CIBERFES, Instituto de Salud Carlos III, Universidad de Murcia, Murcia, Spain
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28
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Wu JQ, Li P, Stavitsky Gilbert K, Hu K, Cronin‐Golomb A. Circadian Rest-Activity Rhythms Predict Cognitive Function in Early Parkinson's Disease Independently of Sleep. Mov Disord Clin Pract 2018; 5:614-619. [PMID: 30637282 PMCID: PMC6277371 DOI: 10.1002/mdc3.12692] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Revised: 08/11/2018] [Accepted: 09/09/2018] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Cognitive impairment is a common and debilitating symptom of Parkinson's disease (PD), and its etiology is likely multifactorial. One candidate mechanism is circadian disruption. Although there is evidence of circadian abnormalities in PD, no studies have directly assessed their association with cognitive impairment. OBJECTIVES Investigate whether circadian rest-activity rhythm is associated with cognitive function in PD independently of sleep. METHODS Thirty-five participants with PD wore wrist actigraph monitors and completed sleep diaries for 7 to 10 days, then underwent neuropsychological testing. Rest-activity rhythm was characterized using nonparametric circadian rhythm analysis of actigraphy data. Objective sleep parameters were also estimated using actigraphy data. Hierarchical regression models assessed the independent contributions of sleep and rest-activity rhythm to cognitive performance. RESULTS Less stable day-to-day rest-activity rhythm was associated with poorer executive, visuospatial, and psychomotor functioning, but not with memory. Hierarchical regressions showed that interdaily stability's contribution to cognitive performance was independent of sleep's contributions. Whereas sleep contributed to executive function, but not psychomotor or visuospatial performance, rest-activity rhythm stability significantly contributed to variance in all three of these domains, uniquely accounting for 14.4% to 17.6% of their performance variance. CONCLUSIONS Our findings indicate that circadian rest-activity rhythm is associated with cognitive impairment independently of sleep. This suggests the possible utility of rest-activity rhythm as a biomarker for circadian function in PD. Future research should explore interventions to stabilize behavioral rhythms in order to strengthen circadian function, which, in turn, may reduce cognitive impairment in PD.
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Affiliation(s)
- Jade Q. Wu
- Department of Psychological and Brain SciencesBoston UniversityBostonMassachusettsUSA
- Psychiatry and Behavioral SciencesDuke University School of MedicineDurhamNorth CarolinaUSA
| | - Peng Li
- Division of Sleep and Circadian Disorders, Brigham & Women's Hospital, Harvard Medical SchoolBostonMassachusettsUSA
| | - Karina Stavitsky Gilbert
- Department of Psychological and Brain SciencesBoston UniversityBostonMassachusettsUSA
- VA Boston Healthcare SystemBostonMassachusettsUSA
- Boston University School of MedicineBostonMassachusettsUSA
| | - Kun Hu
- Division of Sleep and Circadian Disorders, Brigham & Women's Hospital, Harvard Medical SchoolBostonMassachusettsUSA
| | - Alice Cronin‐Golomb
- Department of Psychological and Brain SciencesBoston UniversityBostonMassachusettsUSA
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29
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Evaluation of sleep quality in individuals with Parkinson’s disease using objective and subjective measures. Sleep Biol Rhythms 2018. [DOI: 10.1007/s41105-018-0185-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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30
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Shen Y, Huang JY, Li J, Liu CF. Excessive Daytime Sleepiness in Parkinson's Disease: Clinical Implications and Management. Chin Med J (Engl) 2018; 131:974-981. [PMID: 29664059 PMCID: PMC5912065 DOI: 10.4103/0366-6999.229889] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Objective Excessive daytime sleepiness (EDS) is one of the most common sleep abnormalities in patients with Parkinson's disease (PD), yet its multifactorial etiology complicates its treatment. This review summarized recent studies on the epidemiology, etiology, clinical implications, associated features, and evaluation of EDS in PD. The efficacy of pharmacologic and non-pharmacologic treatments for EDS in PD was also reviewed. Data Sources English language articles indexed in PubMed and Cochrane databases and Chinese-language papers indexed in Wanfang and National Knowledge Infrastructure databases that were published between January 1987 and November 2017 were located using the following search terms: "sleepiness", "sleep and Parkinson's disease", and "Parkinson's disease and treatment". Study Selection Original research articles and critical reviews related to EDS in PD were selected. Results EDS is a major health hazard and is associated with many motor and nonmotor symptoms of PD. Its causes are multifactorial. There are few specific guidelines for the treatment of EDS in PD. It is first necessary to identify and treat any possible factors causing EDS. Recent studies showed that some nonpharmacologic (i.e., cognitive behavioral therapy, light therapy, and repetitive transcranial magnetic stimulation) and pharmacologic (i.e., modafinil, methylphenidate, caffeine, istradefylline, sodium oxybate, and atomoxetine) treatments may be effective in treating EDS in PD. Conclusions EDS is common in the PD population and can have an immensely negative impact on quality of life. Its causes are multifactorial, which complicates its treatment. Further investigations are required to determine the safety and efficacy of potential therapies and to develop novel treatment approaches for EDS in PD.
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Affiliation(s)
- Yun Shen
- Department of Neurology and Suzhou Clinical Research Center of Neurological Disease, The Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu 215004, China
| | - Jun-Ying Huang
- Department of Neurology and Suzhou Clinical Research Center of Neurological Disease, The Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu 215004, China
| | - Jie Li
- Department of Neurology and Suzhou Clinical Research Center of Neurological Disease, The Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu 215004, China
| | - Chun-Feng Liu
- Department of Neurology and Suzhou Clinical Research Center of Neurological Disease, The Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu 215004; Jiangsu Key Laboratory of Neuropsychiatric Diseases and Institute of Neuroscience, Soochow University, Suzhou, Jiangsu 215123, China
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31
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Mantovani S, Smith SS, Gordon R, O'Sullivan JD. An overview of sleep and circadian dysfunction in Parkinson's disease. J Sleep Res 2018; 27:e12673. [PMID: 29493044 DOI: 10.1111/jsr.12673] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Revised: 01/15/2018] [Accepted: 01/15/2018] [Indexed: 12/18/2022]
Abstract
Sleep and circadian alterations are amongst the very first symptoms experienced in Parkinson's disease, and sleep alterations are present in the majority of patients with overt clinical manifestation of Parkinson's disease. However, the magnitude of sleep and circadian dysfunction in Parkinson's disease, and its influence on the pathophysiology of Parkinson's disease remains often unclear and a matter of debate. In particular, the confounding influences of dopaminergic therapy on sleep and circadian dysfunction are a major challenge, and need to be more carefully addressed in clinical studies. The scope of this narrative review is to summarise the current knowledge around both sleep and circadian alterations in Parkinson's disease. We provide an overview on the frequency of excessive daytime sleepiness, insomnia, restless legs, obstructive apnea and nocturia in Parkinson's disease, as well as addressing sleep structure, rapid eye movement sleep behaviour disorder and circadian features in Parkinson's disease. Sleep and circadian disorders have been linked to pathological conditions that are often co-morbid in Parkinson's disease, including cognitive decline, memory impairment and neurodegeneration. Therefore, targeting sleep and circadian alterations could be one of the earliest and most promising opportunities to slow disease progression. We hope that this review will contribute to advance the discussion and inform new research efforts to progress our knowledge in this field.
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Affiliation(s)
- Susanna Mantovani
- Faculty of Medicine, The University of Queensland, UQ Centre for Clinical Research, Herston, QLD, Australia.,Wesley Medical Research, Auchenflower, QLD, Australia.,Department of Neurology, Royal Brisbane and Women's Hospital, Herston, QLD, Australia
| | - Simon S Smith
- Institute for Social Science Research (ISSR), The University of Queensland, Indooroopilly, Australia
| | - Richard Gordon
- Faculty of Medicine, The University of Queensland, UQ Centre for Clinical Research, Herston, QLD, Australia.,Wesley Medical Research, Auchenflower, QLD, Australia
| | - John D O'Sullivan
- Faculty of Medicine, The University of Queensland, UQ Centre for Clinical Research, Herston, QLD, Australia.,Wesley Medical Research, Auchenflower, QLD, Australia.,Department of Neurology, Royal Brisbane and Women's Hospital, Herston, QLD, Australia
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32
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The use of accelerometry as a tool to measure disturbed nocturnal sleep in Parkinson's disease. NPJ PARKINSONS DISEASE 2018; 4:1. [PMID: 29354683 PMCID: PMC5762674 DOI: 10.1038/s41531-017-0038-9] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/26/2017] [Revised: 11/29/2017] [Accepted: 12/12/2017] [Indexed: 11/09/2022]
Abstract
Sleep disturbances are common in Parkinson’s disease (PD). We used the Parkinson’s KinetiGraph (PKG), an objective movement recording system for PD to assess night time sleep in 155 people aged over 60 and without PD (controls), 72 people with PD (PwP) and 46 subjects undergoing a Polysomnogram (PSG: 36 with sleep disorder and 10 with normal sleep). The PKG system uses a wrist worn logger to capture acceleration and derive a bradykinesia score (BKS) every 2 min over 6 days. The BKS ranges from 0–160 with higher scores associated with lesser mobility. Previously we showed that BKS > 80 were associated with day time sleep and used this to produce scores for night time sleep: Efficiency (Percent time with BKS > 80), Fragmentation (Average duration of runs of BKS > 80) and Sleep Quality (BKS > 111 as a representation of atonia). There was a fair association with BKS score and sleep level as judged by PSG. Using these PKG scores, it was possible to distinguish between normal and abnormal PSG studies with good Selectivity (86%) and Sensitivity (80%). The PKG’s sleep scores were significantly different in PD and Controls and correlated with a subject’s self-assessment (PDSS 2) of the quality, wakefulness and restlessness. Using both the PDSS 2 and the PKG, it was apparent that sleep disturbances were apparent early in disease in many PD subjects and that subjects with poor night time sleep were more likely to have day time sleepiness. This system shows promise as a quantitative score for assessing sleep in Parkinson’s disease. A movement recording system reveals the occurrence of sleep disturbances in the early stages of Parkinson’s disease (PD). Malcolm Horne, a movement disorders expert at the University in Melbourne, and colleagues assessed night time sleep in 72 patients with PD using a wrist-worn device that captures movement patterns. The Parkinson’s KinetiGraph (PKG) system derives scores that are associated with sleep stages and correlate with patients’ self-assessment of sleep quality, wakefulness and restlessness. Significant differences between the PKG sleep scores of PD patients and age-matched healthy controls confirmed that night time sleep disturbances and day time sleepiness worsen as the disease progresses. Abnormal PKG scores were found in patients affected by the disease for only 3 years highlighting the extent to which sleep is disrupted in early-stage PD.
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33
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A Pilot Study to Determine the Consistency of Simultaneous Sleep Actigraphy Measurements Comparing All Four Limbs of Patients with Parkinson Disease. Geriatrics (Basel) 2017; 3:geriatrics3010001. [PMID: 31011049 PMCID: PMC6371119 DOI: 10.3390/geriatrics3010001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2017] [Revised: 12/24/2017] [Accepted: 12/25/2017] [Indexed: 11/17/2022] Open
Abstract
Wrist actigraphy is a form of objective sleep measurement that has gained a central role in sleep research and clinical settings. Guidelines for actigraphy recommend placing the monitor on the non-dominant wrist, however, this potentially will be the most involved limb for someone with Parkinson disease, and so alternative placement would be preferred. To-date, there is little published about sleep actigraphy use in Parkinson disease (PD). This study examines the degree of sleep actigraphy score variation in persons with PD when monitors are placed simultaneously on all four limbs. In this study, four participants wore a sleep actigraph on each limb for seven nights. Data from the four actigraphs was compared within each participant to determine the degree of consistency. We found that all of the participants’ sleep efficiency and total sleep time scores were higher in the lower limb than upper limb. There was no notable difference in sleep variables between the dominant arm and non-dominant arm. We concluded that simultaneous actigraphy measurement did not notably vary between dominant and non-dominant arms. However, a discrepancy was seen between upper limbs and lower limbs actigraph scores. Further study is warranted to develop guidelines for sleep actigraphy use in this population.
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Chahine LM, Amara AW, Videnovic A. A systematic review of the literature on disorders of sleep and wakefulness in Parkinson's disease from 2005 to 2015. Sleep Med Rev 2017; 35:33-50. [PMID: 27863901 PMCID: PMC5332351 DOI: 10.1016/j.smrv.2016.08.001] [Citation(s) in RCA: 195] [Impact Index Per Article: 27.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2016] [Revised: 08/10/2016] [Accepted: 08/12/2016] [Indexed: 01/06/2023]
Abstract
Sleep disorders are among the most common non-motor manifestations in Parkinson's disease (PD) and have a significant negative impact on quality of life. While sleep disorders in PD share most characteristics with those that occur in the general population, there are several considerations specific to this patient population regarding diagnosis, management, and implications. The available research on these disorders is expanding rapidly, but many questions remain unanswered. We thus conducted a systematic review of the literature published from 2005 to 2015 on the following disorders of sleep and wakefulness in PD: REM sleep behavior disorder, insomnia, nocturia, restless legs syndrome and periodic limb movements, sleep disordered breathing, excessive daytime sleepiness, and circadian rhythm disorders. We discuss the epidemiology, etiology, clinical implications, associated features, evaluation measures, and management of these disorders. The influence on sleep of medications used in the treatment of motor and non-motor symptoms of PD is detailed. Additionally, we suggest areas in need of further research.
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Affiliation(s)
- Lama M Chahine
- Parkinson's Disease and Movement Disorders Center, Department of Neurology, Perelman School of Medicine, University of Pennsylvania, 330 S. 9th st, Philadelphia, PA 19107, USA.
| | - Amy W Amara
- Division of Movement Disorders, Department of Neurology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Aleksandar Videnovic
- Neurobiological Clinical Research Institute, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
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Abstract
Purpose of review Sleep disorders are among the most challenging non-motor features of Parkinson's disease (PD) and significantly affect quality of life. Research in this field has gained recent interest among clinicians and scientists and is rapidly evolving. This review is dedicated to sleep and circadian dysfunction associated with PD. Recent findings Most primary sleep disorders may co-exist with PD; majority of these disorders have unique features when expressed in the PD population. Summary We discuss the specific considerations related to the common sleep problems in Parkinson's disease including insomnia, rapid eye movement sleep behavior disorder, restless legs syndrome, sleep disordered breathing, excessive daytime sleepiness and circadian rhythm disorders. Within each of these sleep disorders, we present updated definitions, epidemiology, etiology, diagnosis, clinical implications and management. Furthermore, areas of potential interest for further research are outlined.
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Ylikoski A, Martikainen K, Sieminski M, Partinen M. Sleeping difficulties and health-related quality of life in Parkinson's disease. Acta Neurol Scand 2017; 135:459-468. [PMID: 27282092 DOI: 10.1111/ane.12620] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/18/2016] [Indexed: 11/27/2022]
Abstract
OBJECTIVE Various sleep-related symptoms occur in Parkinson's disease (PD). Their occurrence with health-related quality of life (HRQL), comorbid sleep disorders, and other comorbidities was studied. METHODS Altogether, 1447 randomly selected patients with Parkinson's disease, aged 43-89 years, participated in a questionnaire study. A structured questionnaire with 207 items was based on the Basic Nordic Sleep Questionnaire. Questions on demographics, PD, sleep disorders, and comorbidities were included. RESULTS The response rate was 59.0%, and of these, 80% had answered to all questions that were used in the analyses (N=684). Occurrence of long sleep was found in 26.2% of the subjects, short sleep in 32.5%, poor sleep in 21.2%, sleep deprivation in 33.8%, disrupted sleep in 47.4%, and difficulties to fall asleep in 12.2%, respectively. Poor self-rated health and poor quality of life occurred in 44.4% and in 43.3% of all participants. In the logistic regression, age and gender differentially predicted long sleep and sleep deprivation, such that older age and being male were positively associated with long sleep but negatively associated with the report of sleep deprivation. Depression, subjective negative stress, and fatigue occurred with long sleep. On the other hand, poor sleep and excessive daytime sleepiness occurred with short sleep and sleep deprivation. CONCLUSIONS The sleep difficulties in PD are frequent. The long sleeping patients have depression, stress, and fatigue.
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Affiliation(s)
- A. Ylikoski
- Vitalmed Research Center; Helsinki Sleep Clinic; Helsinki Finland
- Department of Neurology; Hospital of Laakso; Helsinki Finland
| | | | - M. Sieminski
- Department of Adult Neurology; Medical University of Gdansk; Gdansk Poland
| | - M. Partinen
- Vitalmed Research Center; Helsinki Sleep Clinic; Helsinki Finland
- Department of Clinical Neurosciences; Institute of Clinical Medicine; University of Helsinki; Helsinki Finland
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Klingelhoefer L, Rizos A, Sauerbier A, McGregor S, Martinez-Martin P, Reichmann H, Horne M, Chaudhuri KR. 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. [PMID: 27160044 DOI: 10.1111/ene.13015] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2015] [Accepted: 03/02/2016] [Indexed: 12/01/2022]
Abstract
BACKGROUND AND PURPOSE Night-time sleep disturbances are important non-motor symptoms and key determinants of health-related quality of life (HRQoL) in patients with Parkinson's disease (PD). The Parkinson's KinetiGraph (PKG) can be used as an objective measure of different motor states and periods of immobility may reflect episodes of sleep. Our aim was to evaluate whether PKG can be used as an objective marker of disturbed night-time sleep in PD. METHODS In this prospective comparative study, data from PKG recordings over six consecutive 24 h periods are compared with Hauser diaries and scales focusing on motor state, sleep and HRQoL in PD patients. Thirty-three 'non-sleepy' PD patients (PD-NS) were compared with 30 PD patients presenting with excessive daytime sleepiness (PD-EDS). The groups were matched for age, gender and Hoehn and Yahr state. RESULTS In the PD-EDS group subjective sleep reports correlated with the PKG's parameters for quantity and quality night-time sleep, but not in the PD-NS group. There were no significant correlations of the night-time sleep quantity parameters of the Hauser diary with subjective sleep perception, neither in the PD-EDS nor in the PD-NS group. CONCLUSIONS This first PKG based study of night-time sleep in PD suggests that PKG could be used to provide an easy to use and rough evaluation of aspects of night-time sleep and one that could flag patients where polysomnography may be required. In sleepy PD patients for instance, quantity and quality PKG parameters correlate with different aspects of sleep such as insomnia, parasomnia and restless legs syndrome.
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Affiliation(s)
- L Klingelhoefer
- Department of Neurology, Technical University Dresden, Dresden, Germany.,Biomedical Research Unit, Department of Neurology, National Parkinson Foundation International Centre of Excellence, King's College Hospital and King's College, London, UK
| | - A Rizos
- Biomedical Research Unit, Department of Neurology, National Parkinson Foundation International Centre of Excellence, King's College Hospital and King's College, London, UK
| | - A Sauerbier
- Biomedical Research Unit, Department of Neurology, National Parkinson Foundation International Centre of Excellence, King's College Hospital and King's College, London, UK
| | - S McGregor
- Centre for Clinical Neurosciences and Neurological Research, St Vincent's Hospital Melbourne, Fitzroy, Vic., Australia
| | - P Martinez-Martin
- National Centre of Epidemiology and CIBERNED, Carlos III Institute of Health, Madrid, Spain
| | - H Reichmann
- Department of Neurology, Technical University Dresden, Dresden, Germany
| | - M Horne
- Centre for Clinical Neurosciences and Neurological Research, St Vincent's Hospital Melbourne, Fitzroy, Vic., Australia.,Florey Institute for Neuroscience and Mental Health, University of Melbourne, Parkville, Vic., Australia
| | - K R Chaudhuri
- Biomedical Research Unit, Department of Neurology, National Parkinson Foundation International Centre of Excellence, King's College Hospital and King's College, London, UK
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Rotigotine Objectively Improves Sleep in Parkinson's Disease: An Open-Label Pilot Study with Actigraphic Recording. PARKINSONS DISEASE 2016; 2016:3724148. [PMID: 26981312 PMCID: PMC4769773 DOI: 10.1155/2016/3724148] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/23/2015] [Accepted: 01/17/2016] [Indexed: 11/23/2022]
Abstract
Sleep disturbances represent important predictors of poor quality of life (QoL) in Parkinson's disease (PD). This open-label pilot study aimed to objectively assess, by means of actigraphic recording, effect of rotigotine on sleep in PD patients with self-reported sleep complaints. 15 PD patients underwent one-week actigraphic recording before (T0) and during (T1) rotigotine treatment, which was titrated to the dose subjectively improving motor symptoms (4–8 mg/24 h). Sleep disturbances, daytime sleepiness, cognitive performance, QoL, and depression were also evaluated with questionnaires. Actigraphic recordings showed a significant reduction in nocturnal motor activity and mean duration of wake episodes after sleep onset during rotigotine treatment compared to baseline. In 10 patients presenting objective evidence of poor sleep quality at T0 (sleep efficiency ≤ 85%), rotigotine also significantly improved other sleep parameters and further reduced nocturnal motor activity and mean duration of wake episodes. A significant decrease in number and duration of daytime sleep episodes was also observed at T1. Finally we confirmed that rotigotine significantly improves perceived sleep quality and QoL. Our study showed for the first time that rotigotine is associated with an objective improvement of nocturnal and diurnal sleep disturbances in PD patients with self-reported sleep complaints. This study is registered with AIFA-observational study registry number 12021.
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Reynolds GO, Otto MW, Ellis TD, Cronin-Golomb A. The Therapeutic Potential of Exercise to Improve Mood, Cognition, and Sleep in Parkinson's Disease. Mov Disord 2016; 31:23-38. [PMID: 26715466 PMCID: PMC4724300 DOI: 10.1002/mds.26484] [Citation(s) in RCA: 88] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2015] [Revised: 10/11/2015] [Accepted: 10/15/2015] [Indexed: 01/15/2023] Open
Abstract
In addition to the classic motor symptoms, Parkinson's disease (PD) is associated with a variety of nonmotor symptoms that significantly reduce quality of life, even in the early stages of the disease. There is an urgent need to develop evidence-based treatments for these symptoms, which include mood disturbances, cognitive dysfunction, and sleep disruption. We focus here on exercise interventions, which have been used to improve mood, cognition, and sleep in healthy older adults and clinical populations, but to date have primarily targeted motor symptoms in PD. We synthesize the existing literature on the benefits of aerobic exercise and strength training on mood, sleep, and cognition as demonstrated in healthy older adults and adults with PD, and suggest that these types of exercise offer a feasible and promising adjunct treatment for mood, cognition, and sleep difficulties in PD. Across stages of the disease, exercise interventions represent a treatment strategy with the unique ability to improve a range of nonmotor symptoms while also alleviating the classic motor symptoms of the disease. Future research in PD should include nonmotor outcomes in exercise trials with the goal of developing evidence-based exercise interventions as a safe, broad-spectrum treatment approach to improve mood, cognition, and sleep for individuals with PD.
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Affiliation(s)
| | - Michael W. Otto
- Boston University, Department of Psychological and Brain Sciences
| | - Terry D. Ellis
- Boston University College of Health and Rehabilitation Sciences: Sargent College, Department of Physical Therapy & Athletic Training and Center for Neurorehabilitation
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Kendzerska TB, Smith PM, Brignardello-Petersen R, Leung RS, Tomlinson GA. Evaluation of the measurement properties of the Epworth sleepiness scale: A systematic review. Sleep Med Rev 2014; 18:321-31. [DOI: 10.1016/j.smrv.2013.08.002] [Citation(s) in RCA: 182] [Impact Index Per Article: 18.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2013] [Revised: 07/27/2013] [Accepted: 08/13/2013] [Indexed: 12/26/2022]
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Daytime sleep in Parkinson's disease measured by episodes of immobility. Parkinsonism Relat Disord 2014; 20:578-83. [DOI: 10.1016/j.parkreldis.2014.02.011] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2013] [Revised: 01/03/2014] [Accepted: 02/12/2014] [Indexed: 11/22/2022]
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Gunn DG, Naismith SL, Terpening Z, Lewis SJG. The Relationships Between Poor Sleep Efficiency and Mild Cognitive Impairment in Parkinson Disease. J Geriatr Psychiatry Neurol 2014; 27:77-84. [PMID: 24196660 DOI: 10.1177/0891988713509135] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2012] [Accepted: 09/18/2013] [Indexed: 12/20/2022]
Abstract
BACKGROUND Mild cognitive impairment (MCI) and sleep disturbances are common features in Parkinson disease (PD). This study sought to investigate whether patients with MCI in PD (PD-MCI) have more pronounced sleep disturbance compared to those without PD-MCI and whether phenotypic presentations differ according to the PD-MCI subtypes. METHODS A total of 95 patients with idiopathic PD (53 meeting criteria for PD-MCI and 42 who were not cognitively impaired) and 22 controls underwent neurological and neuropsychological examination. They wore actigraphy watches for 2 weeks, from which measures of nocturnal sleep efficiency were calculated. RESULTS Patients with PD-MCI has significantly poorer sleep efficiency compared to those without PD-MCI. This effect was particularly apparent in those with multiple-domain PD-MCI, compared to those with single-domain PD-MCI. Furthermore, patients in the PD-MCI group had significantly more nontremor features. CONCLUSIONS These data suggest that PD-MCI is associated with greater sleep disturbance and nontremor features of PD. This is further evidence for the potential role that sleep disturbance plays in the heterogeneity of PD.
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Affiliation(s)
- David G Gunn
- Parkinson's Disease Research Clinic, Aging Brain Centre, Brain & Mind Research Institute, The University of Sydney, Sydney, New South Wales, Australia
| | - Sharon L Naismith
- Parkinson's Disease Research Clinic, Aging Brain Centre, Brain & Mind Research Institute, The University of Sydney, Sydney, New South Wales, Australia
| | - Zoe Terpening
- Parkinson's Disease Research Clinic, Aging Brain Centre, Brain & Mind Research Institute, The University of Sydney, Sydney, New South Wales, Australia
| | - Simon J G Lewis
- Parkinson's Disease Research Clinic, Aging Brain Centre, Brain & Mind Research Institute, The University of Sydney, Sydney, New South Wales, Australia
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Zea-Sevilla MA, Martínez-Martín P. Rating scales and questionnaires for assessment of sleep disorders in Parkinson's disease: what they inform about? J Neural Transm (Vienna) 2014; 121 Suppl 1:S33-40. [PMID: 24756217 DOI: 10.1007/s00702-014-1217-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2013] [Accepted: 04/07/2014] [Indexed: 10/25/2022]
Abstract
Sleep disorders are very prevalent in Parkinson's disease (PD) and include a diversity of disturbances. Rating scales and questionnaires are widely used to assess the presence and severity of the sleep disorders. The objective is to review rating scales and questionnaires used for assessment of sleep disorders in PD. To this purpose, a description and update of the sleep scales reviewed by the ad hoc Movement Disorder Society task force (MDS-TF) and other sleep disorder assessments was performed. Two specific (Parkinson's Disease Sleep Scale and Scales for Outcomes in PD Sleep) and two generic scales (Pittsburgh Sleep Quality Index and Epworth Sleepiness Scale) were "Recommended" by the MDS-TF as they were used in PD patients, by researchers others than their developers and properly validated. Two other generic scales (Inappropriate Sleep Composite Score and Stanford Sleepiness Scale), "Suggested" due to incomplete validation, are also reviewed. Other instruments included in this review are three comprehensive PD-specific instruments for assessing multiple domains in addition to sleep problems (e.g., Non-Motor Symptoms Questionnaire, Non-Motor Symptoms Scale, MDS-UPDRS), and three generic instruments focused on particular disturbances (e.g., International Restless Legs Syndrome Study Group Rating Scale, REM behavioral disorders questionnaires), although these latter lack formal validation in PD populations. The "Recommended" instruments cover satisfactorily the needs for screening and evaluation of the nocturnal sleep disorders and daytime sleepiness in PD patients. It would be convenient to validate or complete the validation in PD populations of those instruments that cannot be recommended due to the lack of information on their clinimetric attributes.
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Affiliation(s)
- María Ascensión Zea-Sevilla
- Alzheimer Disease Research Unit, CIEN Foundation, Alzheimer Center Reina Sofia Foundation, Carlos III Institute of Health, Madrid, Spain
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Louter M, Arends JBAM, Bloem BR, Overeem S. Actigraphy as a diagnostic aid for REM sleep behavior disorder in Parkinson's disease. BMC Neurol 2014; 14:76. [PMID: 24708629 PMCID: PMC3986453 DOI: 10.1186/1471-2377-14-76] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2013] [Accepted: 03/28/2014] [Indexed: 11/13/2022] Open
Abstract
Background Rapid eye movement (REM) sleep behavior disorder (RBD) is a common parasomnia in Parkinson’s disease (PD) patients. The current International Classification of Sleep Disorders (ICSD-II) requires a clinical interview combined with video polysomnography (video-PSG) to diagnose. The latter is time consuming and expensive and not always feasible in clinical practice. Here we studied the use of actigraphy as a diagnostic tool for RBD in PD patients. Methods We studied 45 consecutive PD patients (66.7% men) with and without complaints of RBD. All patients underwent one night of video-PSG and eight consecutive nights of actigraphy. Based on previous studies, the main outcome measure was the total number of bouts classified as “wake”, compared between patients with (PD + RBD) and without RBD (PD- RBD). Results 23 (51.1%) patients had RBD according to the ICSD-II criteria. The total number of wake bouts was significantly higher in RBD patients (PD + RBD 73.2 ± 40.2 vs. PD-RBD 48.4 ± 23.3, p = .016). A cut off of 95 wake bouts per night resulted in a specificity of 95.5%, a sensitivity of 20.1% and a positive predictive value of 85.7%. Seven patients were suspected of RBD based on the interview alone, but not confirmed on PSG; six of whom scored below 95 wake bouts per night on actigraphy. Conclusion PD patients with RBD showed a significantly higher number of bouts scored as “wake” using actigraphy, compared to patients without RBD. In clinical practice, actigraphy has a high specificity, but low sensitivity in the diagnosis of RBD. The combination of actigraphy and previously reported RBD questionnaires may be a promising method to diagnose RBD in patients with PD.
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Affiliation(s)
| | | | | | - Sebastiaan Overeem
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Nijmegen Medical Centre, PO Box 9101, 6500 Nijmegen, HB, The Netherlands.
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Maglione JE, Liu L, Neikrug AB, Poon T, Natarajan L, Calderon J, Avanzino JA, Corey-Bloom J, Palmer BW, Loredo JS, Ancoli-Israel S. Actigraphy for the assessment of sleep measures in Parkinson's disease. Sleep 2013; 36:1209-17. [PMID: 23904681 DOI: 10.5665/sleep.2888] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES To assess the usefulness of actigraphy for assessment of nighttime sleep measures in patients with Parkinson's disease (PD). DESIGN Participants underwent overnight sleep assessment simultaneously by polysomnography (PSG) and actigraphy. SETTING Overnight sleep study in academic sleep research laboratory. PARTICIPANTS Sixty-one patients (mean age 67.74 ± 8.88 y) with mild to moderate PD. MEASUREMENTS Sleep measures including total sleep time (TST), sleep efficiency (SE), wake after sleep onset (WASO), and sleep onset latency (SOL) were calculated independently from data derived from PSG and from actigraphy. Different actigraphy scoring settings were compared. RESULTS No single tested actigraphy scoring setting was optimal for all sleep measures. A customized setting of an activity threshold of 10, with five consecutive immobile minutes for sleep onset, yielded the combination of mean TST, SE, and WASO values that best approximated mean values determined by PSG with differences of 6.05 ± 85.67 min for TST, 1.1 ± 0.641% for SE, and 4.35 ± 59.56 min for WASO. There were significant but moderate correlations between actigraphy and PSG measurements (rs = 0.496, P < 0.001 for TST, rs = 0.384, P = 0.002 for SE, and rs = 0.400, P = 0.001 for WASO) using these settings. Greater disease stage was associated with greater differences between TST (R(2) = 0.099, beta = 0.315, P = 0.018), SE (R(2) = 0.107, beta = 0.327, P = 0.014), and WASO (R(2) = 0.094, beta = 0.307, P = 0.021) values derived by actigraphy and PSG explaining some of the variability. Using a setting of 10 immobile min for sleep onset yielded a mean SOL that was within 1 min of that estimated by PSG. However SOL values determined by actigraphy and PSG were not significantly correlated at any tested setting. CONCLUSIONS Our results suggest that actigraphy may be useful for measurement of mean TST, SE, and WASO values in groups of patients with mild to moderate Parkinson's disease. However, there is a significant degree of variability in accuracy among individual patients. The importance of determining optimal scoring parameters for each population studied is underscored.
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Affiliation(s)
- Jeanne E Maglione
- Department of Psychiatry, University of California San Diego, San Diego, CA 92093-0733, USA.
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Doxepin and cognitive behavioural therapy for insomnia in patients with Parkinson's disease -- a randomized study. Parkinsonism Relat Disord 2013; 19:670-5. [PMID: 23561946 DOI: 10.1016/j.parkreldis.2013.03.003] [Citation(s) in RCA: 115] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2013] [Revised: 02/24/2013] [Accepted: 03/11/2013] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Although a variety of pharmacologic and non-pharmacologic treatments are effective for insomnia in the general population, insomnia in Parkinson's disease differs in important ways and may need different treatments. No studies have conclusively demonstrated effective insomnia treatments in Parkinson's disease. METHODS We conducted a three-arm six-week randomized pilot study assessing non-pharmacologic treatment (cognitive behavioural therapy with bright light therapy) or doxepin (10 mg daily), compared to an inactive placebo in Parkinson's patients with insomnia. Sleep outcomes included insomnia scales, clinical global impression, sleep diaries and actigraphy. Secondary outcomes included motor severity, fatigue, depression and quality of life. RESULTS 18 patients were randomized, 6 to each group. Compared to placebo, doxepin improved the Insomnia Severity Index (-9 ± 5.4 vs. -2 ± 3.9, p = 0.03), the SCOPA-night score (-5.2 ± 1.5 vs. -2.3 ± 2.8, p = 0.049), the Pittsburgh Sleep Quality Index-sleep disturbances subscale (-0.5 ± 0.5 vs 0.2 ± 0.4, p = 0.02), and both patient and examiner-rated clinical global impression of change (1.7 ± 0.8 vs. 0.5 ± 0.8, p = 0.03 and 1.4 ± 0.5 vs. 0.3 ± 0.5, p = 0.003). On secondary outcomes doxepin reduced the fatigue severity scale (p = 0.02) and improved scores on the Montreal Cognitive Assessment (p = 0.007). Non-pharmacological treatment reduced the Insomnia Severity Index (-7.8 ± 3.8 vs. -2.0 ± 3.9, p = 0.03), and the examiner-reported clinical global impression of change (p = 0.006), but was associated with decline in Parkinson Disease Questionnaire-39. There were no changes in other primary and secondary outcomes, including actigraphy outcomes. Adverse events were comparable in all groups. CONCLUSION Doxepin and non-pharmacologic treatment substantially improved insomnia in Parkinson's disease. These potential benefits must be replicated in a full confirmatory randomized controlled trial.
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Diederich NJ, McIntyre DJ. Sleep disorders in Parkinson's disease: Many causes, few therapeutic options. J Neurol Sci 2012; 314:12-9. [DOI: 10.1016/j.jns.2011.10.025] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2011] [Revised: 09/20/2011] [Accepted: 10/24/2011] [Indexed: 10/15/2022]
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Abstract
In healthy individuals and those with insomnia, poor sleep quality is associated with decrements in performance on tests of cognition, especially executive function. Sleep disturbances and cognitive deficits are both prevalent in Parkinson's disease (PD). Sleep problems occur in over 75% of patients, with sleep fragmentation and decreased sleep efficiency being the most common sleep complaints, but their relation to cognition is unknown. We examined the association between sleep quality and cognition in PD. In 35 non-demented individuals with PD and 18 normal control adults (NC), sleep was measured using 24-hr wrist actigraphy over 7 days. Cognitive domains tested included attention and executive function, memory and psychomotor function. In both groups, poor sleep was associated with worse performance on tests of attention/executive function but not memory or psychomotor function. In the PD group, attention/executive function was predicted by sleep efficiency, whereas memory and psychomotor function were not predicted by sleep quality. Psychomotor and memory function were predicted by motor symptom severity. This study is the first to demonstrate that sleep quality in PD is significantly correlated with cognition and that it differentially impacts attention and executive function, thereby furthering our understanding of the link between sleep and cognition.
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Abstract
The etiology of sleep problems in Parkinson disease (PD) is not well understood, as they may arise from the pathology of the disease or from other disease-related factors such as motor dysfunction, dopaminergic medication, and mood disturbances. The aim of this study was to investigate factors associated with sleep, including disease-related variables such as motor symptom severity, dose of medication, and mood and disease subtypes. Thirty-five nondemented patients with PD were included. Sleep was measured using 24-hour wrist actigraphy over a 7-day period, during which time participants kept a sleep diary. Subjective sleep and arousal questionnaires included the PD Sleep Scale and Epworth Sleepiness Scale. Motor symptom severity and dopaminergic medication were significantly related to measures of sleep quality. Sex differences in sleep quality were found, with men having worse sleep quality and more excessive daytime sleepiness than women. We also found that actigraphy may serve as a useful tool for identifying individuals with possible rapid eye movement behavior disorder, a sleep disorder that has important implications in early detection of PD.
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Barnes J, Connelly V, Wiggs L, Boubert L, Maravic K. Sleep Patterns in Parkinson's Disease Patients with Visual Hallucinations. Int J Neurosci 2010; 120:564-9. [DOI: 10.3109/00207454.2010.494790] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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