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Vargas Gonzalez E, Yang Z, Dodet P, Leu-Semenescu S, Brink-Kjaer A, Roujansky P, Jennum PJ, Lejeune FX, Vidailhet M, Arnulf I. Rapid Eye Movements (REMs) during Non-REM Sleep as a Marker of Alpha-Synucleinopathies. Mov Disord 2025. [PMID: 40370056 DOI: 10.1002/mds.30211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2024] [Revised: 03/23/2025] [Accepted: 04/08/2025] [Indexed: 05/16/2025] Open
Abstract
BACKGROUND Alpha-synuclein-related neurodegeneration affects sleep figures, whether in the prodromal (rapid eye movement [REM] sleep behavior disorder, iRBD) or established (Parkinson's disease [PD] and multiple system atrophy [MSA]) stages. OBJECTIVE To look for abnormal intrusions of REMs in non-REM sleep in alpha-synucleinopathies. METHODS Clinical measures and polysomnography were collected from 554 participants with PD (N = 257), iRBD (N = 110), and MSA (N = 71) and 115 controls. Initially, the polysomnography was visually examined for REMs in N2 (presence and index). Subsequently, REMs were automatically detected in all wake and sleep stages, and thresholds discriminating between the disorders were sought. RESULTS The REMs index in N2 (visually measured) was lower in controls than all patients groups. The REMs index in N2 (automatically measured) was lower in controls than in patients with PD and MSA, but not different from iRBD participants. The optimal cutoff of 4.6 REMs/h of N2 yielded a 77% specificity to discriminate controls from all neurodegenerative groups but sensitivity was 60%. The cutoff to discriminate MSA from PD participants had a low specificity (58%). The optimal cutoff of 2.1/h in iRBD patients had an 80% specificity for distinguishing them from controls. CONCLUSIONS Abnormal intrusion of REMs into non-REM sleep distinguishes participants with alpha-synucleinopathies from controls. This automated technique could be used to identify patients with neurodegenerative disorders in the large number of polysomnograms obtained for other purposes in the elderly. © 2025 International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Estefania Vargas Gonzalez
- Sorbonne University, Paris, France
- Bioserenity Ltd, Paris, France
- Institut du Cerveau-Paris Brain Institute-ICM, Inserm, CNRS, Paris, France
| | - Zhongmei Yang
- Department of Neurology, University-Town Hospital of Chongqing Medical University, Chongqing, China
- Département R3S, Service des Pathologies du Sommeil, AP-HP, Sorbonne Université, Hôpital Pitié-Salpêtrière, Paris, France
| | - Pauline Dodet
- Sorbonne University, Paris, France
- Département R3S, Service des Pathologies du Sommeil, AP-HP, Sorbonne Université, Hôpital Pitié-Salpêtrière, Paris, France
| | - Smaranda Leu-Semenescu
- Sorbonne University, Paris, France
- Département R3S, Service des Pathologies du Sommeil, AP-HP, Sorbonne Université, Hôpital Pitié-Salpêtrière, Paris, France
| | - Andreas Brink-Kjaer
- Department of Health Technology, Technical University of Denmark, Kongens Lyngby, Denmark
- Department of Clinical Neurophysiology, Danish Center for Sleep Medicine, Rigshospitalet, Denmark
| | | | - Poul Joergen Jennum
- Department of Clinical Neurophysiology, Danish Center for Sleep Medicine, Rigshospitalet, Denmark
| | - François-Xavier Lejeune
- Institut du Cerveau-Paris Brain Institute-ICM, Inserm, CNRS, Paris, France
- Paris Brain Institute's Data Analysis Core Facility, Inserm, Paris, France
| | - Marie Vidailhet
- Sorbonne University, Paris, France
- Institut du Cerveau-Paris Brain Institute-ICM, Inserm, CNRS, Paris, France
- Département de Neurologie, AP-HP, Sorbonne Université, Hôpital Pitié-Salpêtrière, Paris, France
| | - Isabelle Arnulf
- Sorbonne University, Paris, France
- Institut du Cerveau-Paris Brain Institute-ICM, Inserm, CNRS, Paris, France
- Département R3S, Service des Pathologies du Sommeil, AP-HP, Sorbonne Université, Hôpital Pitié-Salpêtrière, Paris, France
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Guan L, Yu H, Chen Y, Gong C, Hao H, Guo Y, Xu S, Zhang Y, Yuan X, Yin G, Zhang J, Tan H, Li L. Subthalamic γ Oscillation Underlying Rapid Eye Movement Sleep Abnormality in Parkinsonian Patients. Mov Disord 2025; 40:456-467. [PMID: 39707598 PMCID: PMC7617463 DOI: 10.1002/mds.30091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2024] [Revised: 11/13/2024] [Accepted: 12/04/2024] [Indexed: 12/23/2024] Open
Abstract
BACKGROUND Abnormal rapid eye movement (REM) sleep, including REM sleep behavior disorder (RBD) and reduced REM sleep, is common in Parkinson's disease (PD), highlighting the importance of further study on REM sleep. However, the biomarkers of REM disturbances remain unknown, leading to the lack of REM-specific neuromodulation interventions. OBJECTIVE This study aims to investigate the neurophysiological biomarkers of REM disturbance in parkinsonian patients. METHODS Ten PD patients implanted with bilateral subthalamic nucleus-deep brain stimulation (STN-DBS) were included in this study, of whom 4 were diagnosed with RBD. Sleep monitoring was conducted 1 month after surgery. Subthalamic local field potentials (LFP) were recorded through sensing-enabled DBS. The neurophysiological features of subthalamic LFP during phasic and tonic microstates of REM sleep and their correlation with REM sleep fragmentation and RBD were analyzed. RESULTS Differences in subthalamic γ oscillation between phasic and tonic REM correlated positively with the severity of REM sleep fragmentation. Patients with RBD also exhibited stronger γ oscillations during REM sleep compared with non-RBD patients, and both increased β and γ were found before the onset of RBD episodes. Stimulation changes in simulated γ-triggered feedback modulation followed more closely with phasic REM density, whereas an opposite trend was found in simulated β-triggered feedback modulation. CONCLUSION Excess subthalamic γ oscillations may contribute to REM instability and RBD, suggesting that γ oscillation could serve as a feedback signal for adaptive DBS for REM sleep disorders. © 2024 The Author(s). Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Lingxiao Guan
- National Engineering Research Center of Neuromodulation, School of Aerospace EngineeringTsinghua UniversityBeijingChina
| | - Huiling Yu
- National Engineering Research Center of Neuromodulation, School of Aerospace EngineeringTsinghua UniversityBeijingChina
| | - Yue Chen
- National Engineering Research Center of Neuromodulation, School of Aerospace EngineeringTsinghua UniversityBeijingChina
| | - Chen Gong
- National Engineering Research Center of Neuromodulation, School of Aerospace EngineeringTsinghua UniversityBeijingChina
| | - Hongwei Hao
- National Engineering Research Center of Neuromodulation, School of Aerospace EngineeringTsinghua UniversityBeijingChina
| | - Yi Guo
- Department of NeurosurgeryPeking Union Medical College HospitalBeijingChina
| | - Shujun Xu
- Department of NeurosurgeryQilu Hospital of Shandong University (Qingdao)QingdaoChina
| | - Yuhuan Zhang
- Department of Otolaryngology, Head and Neck SurgeryBeijing Tsinghua Changgung HospitalBeijingChina
| | - Xuemei Yuan
- Department of Otolaryngology, Head and Neck SurgeryBeijing Tsinghua Changgung HospitalBeijingChina
| | - Guoping Yin
- Department of Otolaryngology, Head and Neck SurgeryBeijing Tsinghua Changgung HospitalBeijingChina
| | - Jianguo Zhang
- Department of Neurosurgery, Beijing Tiantan HospitalCapital Medical UniversityBeijingChina
| | - Huiling Tan
- Medical Research Council Brain Network Dynamics Unit, Nuffield Department of Clinical NeurosciencesUniversity of OxfordOxfordUnited Kingdom
| | - Luming Li
- National Engineering Research Center of Neuromodulation, School of Aerospace EngineeringTsinghua UniversityBeijingChina
- IDG/McGovern Institute for Brain ResearchTsinghua UniversityBeijingChina
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Kharchenko V, Zhdanova IV. The Wave Model of Sleep Dynamics and an Invariant Relationship between NonREM and REM Sleep. Clocks Sleep 2023; 5:686-716. [PMID: 37987397 PMCID: PMC10660848 DOI: 10.3390/clockssleep5040046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Revised: 11/05/2023] [Accepted: 11/10/2023] [Indexed: 11/22/2023] Open
Abstract
Explaining the complex structure and dynamics of sleep, which consist of alternating and physiologically distinct nonREM and REM sleep episodes, has posed a significant challenge. In this study, we demonstrate that a single-wave model concept captures the distinctly different overnight dynamics of the four primary sleep measures-the duration and intensity of nonREM and REM sleep episodes-with high quantitative precision for both regular and extended sleep. The model also accurately predicts how these polysomnographic measures respond to sleep deprivation or abundance. Furthermore, the model passes the ultimate test, as its prediction leads to a novel experimental finding-an invariant relationship between the duration of nonREM episodes and the intensity of REM episodes, the product of which remains constant over consecutive sleep cycles. These results suggest a functional unity between nonREM and REM sleep, establishing a comprehensive and quantitative framework for understanding normal sleep and sleep disorders.
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Affiliation(s)
- Vasili Kharchenko
- Department of Physics, University of Connecticut, Storrs, CT 06269, USA;
- Institute for Theoretical Atomic, Molecular & Optical Physics, Harvard-Smithsonian Center for Astrophysics, Cambridge, MA 02138, USA
| | - Irina V. Zhdanova
- Department of Anatomy and Neurobiology, Boston University School of Medicine, Boston, MA 02118, USA
- BioChron LLC, Worcester, MA 01605, USA
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Montini A, Iranzo A, Cortelli P, Gaig C, Muñoz-Lopetegi A, Provini F, Santamaria J. Scoring sleep in neurodegenerative diseases: A pilot study in the synucleinopathies. Sleep Med 2023; 110:268-286. [PMID: 37678074 DOI: 10.1016/j.sleep.2023.08.022] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2023] [Revised: 08/03/2023] [Accepted: 08/23/2023] [Indexed: 09/09/2023]
Abstract
BACKGROUND Neurodegenerative diseases often alter sleep architecture, complicating the application of the standard sleep scoring rules. There are no recommendations to overcome this problem. Our aim was to develop a scoring method that incorporates the stages previously applied in dementia with Lewy Bodies (DLB), anti-IgLON5 disease, and fatal insomnia, and to test it in patients with alpha-synucleinopathies. METHODS Video-polysomnographies (VPSG) of nine patients (DLB:3, Parkinson's disease (PD):3, and multiple system atrophy (MSA):3) selected for their difficulty in applying standard rules were scored independently by two authors, using additional Sleep/Wake stages. These included Abnormal Wake, Subwake, Undifferentiated NREM sleep (UNREM), Poorly structured N2 (P-S N2) and abnormal REM sleep including REM without atonia (RWA), REM without low-amplitude, mixed-frequency EEG activity (RWL) and REM without rapid eye movements (RWR). RESULTS Patients (4 females) had a median age of 74 (range 63-85). Six patients (all with PD or DLB) had abnormal EEG awake and Subwake stage. UNREM sleep was present in all patients, typically at sleep onset, and was the most common sleep stage in five. P-S N2 was recorded only in the three patients with MSA. Periods of normal and abnormal NREM coexisted in three patients. RWA was the predominant REM subtype, RWR occurred mainly in patients with MSA and RWL in those with DLB. Six patients had brief REM episodes into NREM sleep which we termed "Encapsulated RBD". CONCLUSION Our scoring system allows an accurate description of the complex sleep-wake changes in patients with alpha-synucleinopathies.
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Affiliation(s)
- Angelica Montini
- Department of Biomedical and NeuroMotor Sciences (DiBiNeM), University of Bologna, Bologna, Italy.
| | - Alex Iranzo
- Sleep Disorders Center, Neurology Service, Hospital Clínic de Barcelona, Barcelona, Spain; Clinical Neurophysiology Group, Institut D'Investigacions Biomediques August Pi I Sunyer (IDIBAPS), Barcelona, Spain; CIBERNED CB06/05/0018-ISCIII, Spain; Universitat de Barcelona, Barcelona, Spain.
| | - Pietro Cortelli
- Department of Biomedical and NeuroMotor Sciences (DiBiNeM), University of Bologna, Bologna, Italy; IRCCS Istituto Delle Scienze Neurologiche di Bologna, Bologna, Italy.
| | - Carles Gaig
- Sleep Disorders Center, Neurology Service, Hospital Clínic de Barcelona, Barcelona, Spain; Clinical Neurophysiology Group, Institut D'Investigacions Biomediques August Pi I Sunyer (IDIBAPS), Barcelona, Spain; CIBERNED CB06/05/0018-ISCIII, Spain; Universitat de Barcelona, Barcelona, Spain.
| | - Amaia Muñoz-Lopetegi
- Sleep Disorders Center, Neurology Service, Hospital Clínic de Barcelona, Barcelona, Spain; Clinical Neurophysiology Group, Institut D'Investigacions Biomediques August Pi I Sunyer (IDIBAPS), Barcelona, Spain; CIBERNED CB06/05/0018-ISCIII, Spain.
| | - Federica Provini
- Department of Biomedical and NeuroMotor Sciences (DiBiNeM), University of Bologna, Bologna, Italy; IRCCS Istituto Delle Scienze Neurologiche di Bologna, Bologna, Italy.
| | - Joan Santamaria
- Emeritus Consultant and Researcher, Hospital Clínic of Barcelona and Biomedical Research Institute (IDIBAPS), Spain.
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Dagay A, Oz S, Katzav S, Wasserman D, Tauman R, Thaler A, Giladi N, Mirelman A. Overnight Distribution of REM Sleep Features in People with Parkinson's Disease (PD) and Non-PD Controls. JOURNAL OF PARKINSON'S DISEASE 2023; 13:1213-1223. [PMID: 37807787 PMCID: PMC10657693 DOI: 10.3233/jpd-230116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 08/23/2023] [Indexed: 10/10/2023]
Abstract
BACKGROUND Rapid eye movement (REM) sleep behavior disorder (RBD) is a leading predictor of Parkinson's disease (PD). Diagnosis is performed in the sleep laboratory by detecting pathological REM sleep without atonia (RSWA). The evidence on the overnight distribution of RSWA% is conflicting. OBJECTIVE To investigate the temporal distribution of the number of ocular movements per REM sleep minute (REM density), and RSWA% in people with PD and non-PD controls. METHODS All participants underwent a single overnight evaluation in a sleep laboratory. Clinical evaluation was performed on a separate day. REM density and RSWA% were compared between PD and controls both across four sleep periods and individual REM cycles. RESULTS A total of 51 participants with recorded RSWA in polysomnography laboratory were included, 28 with PD aged 64±9 years with a disease duration of 3.3±2.9 years, and 23 controls aged 55±8 years. People with PD had lower REM density and higher RSWA% compared to controls. As expected, REM density was higher towards the morning. In contrast, RSWA% was equally distributed across the night, for both PD and controls. CONCLUSIONS PD pathology affects REM sleep features, but not the overnight distribution of those features. While REM density increased towards the end of the night, RSWA% was equally distributed across the night for both PD and controls. Our findings have clinical implications for diagnosing RBD, as quantification of RSWA% in any sleep cycle is sufficient for reliably evaluating total RSWA% and reduced REM density may be a marker of PD.
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Affiliation(s)
- Andrew Dagay
- Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel
- Laboratory for Early Markers of Neurodegeneration (LEMON), Neurological Institute, Tel Aviv Sourasky Medical, Tel Aviv, Israel
| | - Shani Oz
- Laboratory for Early Markers of Neurodegeneration (LEMON), Neurological Institute, Tel Aviv Sourasky Medical, Tel Aviv, Israel
- Department of Biomedical Engineering, Tel Aviv University, Tel Aviv, Israel
| | - Shlomit Katzav
- Sieratzki Sagol Institute for Sleep Medicine, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Danielle Wasserman
- Sieratzki Sagol Institute for Sleep Medicine, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Riva Tauman
- Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel
- Sieratzki Sagol Institute for Sleep Medicine, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Avner Thaler
- Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel
- Laboratory for Early Markers of Neurodegeneration (LEMON), Neurological Institute, Tel Aviv Sourasky Medical, Tel Aviv, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Nir Giladi
- Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel
- Sieratzki Sagol Institute for Sleep Medicine, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Anat Mirelman
- Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel
- Laboratory for Early Markers of Neurodegeneration (LEMON), Neurological Institute, Tel Aviv Sourasky Medical, Tel Aviv, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Dijkstra F, de Volder I, Viaene M, Cras P, Crosiers D. Polysomnographic Predictors of Sleep, Motor, and Cognitive Dysfunction Progression in Parkinson's Disease. Curr Neurol Neurosci Rep 2022; 22:657-674. [PMID: 35994190 DOI: 10.1007/s11910-022-01226-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/04/2022] [Indexed: 01/27/2023]
Abstract
PURPOSE OF REVIEW Sleep disturbances are an important nonmotor feature of Parkinson's disease (PD) that can cause polysomnographic (PSG) alterations. These alterations are already present in early PD and may be associated with a specific disease course. This systematic review describes the role of PSG variables as predictors of sleep dysfunction, motor and cognitive dysfunction progression in PD. RECENT FINDINGS Nineteen longitudinal cohort studies were included. Their main findings were that (1) REM sleep behavioral events, REM sleep without atonia (RSWA), and electroencephalography (EEG) changes (mainly microsleep instability) are predictors of the development of REM sleep behavior disorder (RBD); (2) RBD, RSWA, and lower slow-wave sleep energy predict motor progression; (3) RBD, EEG slowing, and sleep spindles changes are predictors of cognitive deterioration; and (4) OSA is associated with severe motor and cognitive symptoms at baseline, with inconsistent findings on the effect of continuous positive airway pressure (CPAP) therapy for these symptoms. The results of our systematic review support a role of the video-PSG in disease progression prediction in PD and its usefulness as a biomarker. However, future studies are needed to investigate whether treatment of these PSG abnormalities and sleep disturbances may have a neuroprotective effect on disease progression.
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Affiliation(s)
- Femke Dijkstra
- Department of Neurology, Antwerp University Hospital, Drie Eikenstraat 655, 2650, Edegem, Belgium.
- Faculty of Medicine and Health Sciences, Translational Neurosciences, University of Antwerp, Universiteitsplein 1, 2610, Wilrijk, Belgium.
- Laboratory for Sleep Disorders and Department of Neurology, St.-Dimpna Regional Hospital, J.-B. Stessensstraat 2, 2440, Geel, Belgium.
| | - Ilse de Volder
- Department of Neurology, Antwerp University Hospital, Drie Eikenstraat 655, 2650, Edegem, Belgium
- Faculty of Medicine and Health Sciences, Translational Neurosciences, University of Antwerp, Universiteitsplein 1, 2610, Wilrijk, Belgium
- Department of Psychiatry, Antwerp University Hospital, Drie Eikenstraat 655, 2650, Edegem, Belgium
- Multidisciplinary Sleep Disorders Center, Antwerp University Hospital, Drie Eikenstraat 655, 2650, Edegem, Belgium
| | - Mineke Viaene
- Laboratory for Sleep Disorders and Department of Neurology, St.-Dimpna Regional Hospital, J.-B. Stessensstraat 2, 2440, Geel, Belgium
| | - Patrick Cras
- Department of Neurology, Antwerp University Hospital, Drie Eikenstraat 655, 2650, Edegem, Belgium
- Faculty of Medicine and Health Sciences, Translational Neurosciences, University of Antwerp, Universiteitsplein 1, 2610, Wilrijk, Belgium
- Born-Bunge Institute, University of Antwerp, Universiteitsplein 1, 2610, Wilrijk, Belgium
| | - David Crosiers
- Department of Neurology, Antwerp University Hospital, Drie Eikenstraat 655, 2650, Edegem, Belgium
- Faculty of Medicine and Health Sciences, Translational Neurosciences, University of Antwerp, Universiteitsplein 1, 2610, Wilrijk, Belgium
- Born-Bunge Institute, University of Antwerp, Universiteitsplein 1, 2610, Wilrijk, Belgium
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Boini SY, Mahale R, Doniparthi Venkata S, Kamble N, Holla V, Pal PK, Kutty B, Yadav R. Oculomotor abnormalities and its association with sleep stages in progressive supranuclear palsy. Sleep Med 2022; 98:34-38. [PMID: 35779379 DOI: 10.1016/j.sleep.2022.06.008] [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: 12/21/2021] [Revised: 06/08/2022] [Accepted: 06/11/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND Oculomotor abnormalities are one of the cardinal clinical features of progressive supranuclear palsy (PSP). Vertical saccadic slowing is an early sign of PSP. The association between oculomotor abnormalities and sleep architecture has not been studied so far. OBJECTIVES To study the association of oculomotor abnormalities of PSP with the sleep stages by using video polysomnography (vPSG). METHODS This was a cross-sectional single-center study. Twenty-two patients with PSP and 15 age and gender-matched controls were recruited. Saccades, vestibulo-ocular reflex, and optokinetic nystagmus were assessed and graded clinically in all patients and one overnight vPSG was done in all cases. RESULTS Vertical saccades, upward more than downwards, were affected in all cases. While horizontal saccades were normal only in 41% of cases. Vertical optokinetic nystagmus (OKN) was affected in all cases. Horizontal OKN was normal in 36% of patients. The vertical upward saccades had a negative correlation with N1% and duration (r = -0.418; p = 0.05, r = -0.457; p = 0.03), N3% and duration (r = -0.486; p = 0.02, r = -0.510; p = 0.01), REM% (r = -0.449; p = 0.04), total sleep time (r = -0.487; p = 0.02) and sleep efficiency (r = -0.444; p = 0.04). There was a positive correlation between horizontal OKN and sleep onset latency (r = 0.432; p = 0.05). CONCLUSIONS Vertical saccadic restriction in PSP has significant negative correlation with total sleep time and sleep efficiency. The oculomotor and sleep abnormalities in PSP are probably interlinked and their assessment is useful in determining the characteristics of the disease.
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Affiliation(s)
- Srikanth Yadav Boini
- Department of Neurology, National Institute of Mental Health and Neurosciences, Bengaluru, 560029, India.
| | - Rohan Mahale
- Department of Neurology, National Institute of Mental Health and Neurosciences, Bengaluru, 560029, India.
| | | | - Nitish Kamble
- Department of Neurology, National Institute of Mental Health and Neurosciences, Bengaluru, 560029, India.
| | - Vikram Holla
- Department of Neurology, National Institute of Mental Health and Neurosciences, Bengaluru, 560029, India.
| | - Pramod Kumar Pal
- Department of Neurology, National Institute of Mental Health and Neurosciences, Bengaluru, 560029, India.
| | - Bindu Kutty
- Department of Neurophysiology, National Institute of Mental Health and Neurosciences, Bengaluru, 560029, India.
| | - Ravi Yadav
- Department of Neurology, National Institute of Mental Health and Neurosciences, Bengaluru, 560029, India.
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Nakahara K, Morokuma S, Maehara K, Okawa H, Funabiki Y, Kato K. Association of fetal eye movement density with sleeping and developmental problems in 1.5-year-old infants. Sci Rep 2022; 12:8236. [PMID: 35581284 PMCID: PMC9114104 DOI: 10.1038/s41598-022-12330-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Accepted: 05/10/2022] [Indexed: 11/10/2022] Open
Abstract
Eye movement density (EMD) is an evaluation index of rapid eye movements observed during sleep. This study aimed to investigate the association of fetal EMD with sleeping and developmental problems in infancy. We observed 60 normal singleton pregnancies (gestational age 28-37 weeks) using ultrasonography for 1 h. Fetal eye movements were counted, and EMD was calculated. Participants answered questionnaires regarding their child's sleep and development 1.5 years after their delivery. The outcomes of an infant's sleep were night awakening (yes or no), bedtime (before or after 22:00), and nighttime sleep duration (< 9 or ≥ 9 h). An infant's development was evaluated using the Child Behavior Checklist (CBCL) T-score. We found that decreased fetal EMD was associated with increased night awakening at the age of 1.5 years (odds ratio 0.84, 95% confidence interval 0.69-1.00 per unit decrease in EMD). However, fetal EMD was not associated with bedtime or nighttime sleep duration. In addition, fetal EMD was independently associated with the total problems T-score of the CBCL at the age of 1.5 years in the multivariate model (p = 0.047). In conclusion, fetal EMD may be associated with sleep and developmental problems in infants.
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Affiliation(s)
- Kazushige Nakahara
- Department of Obstetrics and Gynecology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Seiichi Morokuma
- Department of Health Sciences, Graduate School of Medical Sciences, Kyushu University, Fukuoka, 812-8582, Japan.
| | - Kana Maehara
- Department of Obstetrics and Gynecology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Hikohiro Okawa
- Department of Obstetrics and Gynecology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Yasuko Funabiki
- Graduate School of Human and Environmental Studies, Kyoto University, Kyoto, Japan.,Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Kiyoko Kato
- Department of Obstetrics and Gynecology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
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9
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Time to reconsider REM density in sleep research. Clin Neurophysiol 2022; 137:63-65. [DOI: 10.1016/j.clinph.2022.02.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Revised: 01/25/2022] [Accepted: 02/17/2022] [Indexed: 11/19/2022]
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10
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Hunt J, Coulson EJ, Rajnarayanan R, Oster H, Videnovic A, Rawashdeh O. Sleep and circadian rhythms in Parkinson's disease and preclinical models. Mol Neurodegener 2022; 17:2. [PMID: 35000606 PMCID: PMC8744293 DOI: 10.1186/s13024-021-00504-w] [Citation(s) in RCA: 53] [Impact Index Per Article: 17.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Accepted: 11/30/2021] [Indexed: 12/21/2022] Open
Abstract
The use of animals as models of human physiology is, and has been for many years, an indispensable tool for understanding the mechanisms of human disease. In Parkinson's disease, various mouse models form the cornerstone of these investigations. Early models were developed to reflect the traditional histological features and motor symptoms of Parkinson's disease. However, it is important that models accurately encompass important facets of the disease to allow for comprehensive mechanistic understanding and translational significance. Circadian rhythm and sleep issues are tightly correlated to Parkinson's disease, and often arise prior to the presentation of typical motor deficits. It is essential that models used to understand Parkinson's disease reflect these dysfunctions in circadian rhythms and sleep, both to facilitate investigations into mechanistic interplay between sleep and disease, and to assist in the development of circadian rhythm-facing therapeutic treatments. This review describes the extent to which various genetically- and neurotoxically-induced murine models of Parkinson's reflect the sleep and circadian abnormalities of Parkinson's disease observed in the clinic.
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Affiliation(s)
- Jeremy Hunt
- School of Biomedical Sciences, Faculty of Medicine, University of Queensland, Brisbane, Australia
| | - Elizabeth J. Coulson
- School of Biomedical Sciences, Faculty of Medicine, University of Queensland, Brisbane, Australia
- Queensland Brain Institute, University of Queensland, Brisbane, Australia
| | | | - Henrik Oster
- Institute of Neurobiology, University of Lübeck, Lübeck, Germany
| | - Aleksandar Videnovic
- Movement Disorders Unit and Division of Sleep Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA USA
| | - Oliver Rawashdeh
- School of Biomedical Sciences, Faculty of Medicine, University of Queensland, Brisbane, Australia
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Zahed H, Zuzuarregui JRP, Gilron R, Denison T, Starr PA, Little S. The Neurophysiology of Sleep in Parkinson's Disease. Mov Disord 2021; 36:1526-1542. [PMID: 33826171 DOI: 10.1002/mds.28562] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Revised: 02/02/2021] [Accepted: 02/16/2021] [Indexed: 12/14/2022] Open
Abstract
Sleep disturbances are among the most common nonmotor complications of Parkinson's disease (PD), can present in prodromal stages, and progress with advancing disease. In addition to being a symptom of neurodegeneration, sleep disturbances may also contribute to disease progression. Currently, limited options exist to modulate sleep disturbances in PD. Studying the neurophysiological changes that affect sleep in PD at the cortical and subcortical level may yield new insights into mechanisms for reversal of sleep disruption. In this article, we review cortical and subcortical recording studies of sleep in PD with a particular focus on dissecting reported electrophysiological changes. These studies show that slow-wave sleep and rapid eye movement sleep are both notably disrupted in PD. We further explore the impact of these electrophysiological changes and discuss the potential for targeting sleep via stimulation therapy to modify PD-related motor and nonmotor symptoms. © 2021 International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Hengameh Zahed
- Department of Neurology, University of California, San Francisco, San Francisco, California, USA
| | | | - Ro'ee Gilron
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, California, USA
| | - Timothy Denison
- Institute of Biomedical Engineering and MRC Brain Network Dynamics Unit, University of Oxford, Oxford, UK
| | - Philip A Starr
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, California, USA
| | - Simon Little
- Department of Neurology, University of California, San Francisco, San Francisco, California, USA
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12
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REM sleep without atonia and nocturnal body position in prediagnostic Parkinson's disease. Sleep Med 2021; 84:308-316. [PMID: 34217921 DOI: 10.1016/j.sleep.2021.06.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2021] [Revised: 05/20/2021] [Accepted: 06/09/2021] [Indexed: 12/18/2022]
Abstract
BACKGROUND Sleep disturbances are features of Parkinson's disease (PD), that can already occur before PD diagnosis. The most investigated prodromal PD sleep disorder is REM sleep behavior disorder (RBD). The relation between other polysomnographic (PSG) alterations and the prediagnostic stages of PD, however, is less clear. METHODS We performed a retrospective case-control study to characterize polysomnographic alterations in PD and prediagnostic PD. We included 63 PD subjects (33 subjects that underwent a video-PSG before PD diagnosis [13 with and 20 without RBD] and 30 subjects that underwent a PSG after PD diagnosis) and 30 controls. PSGs were analyzed for sleep stages, different RSWA variables, body position, arousals, periodic limb movements, and REM density. RESULTS Higher subscores of all RSWA variables were observed in subjects with PD and prediagnostic PD (with and without RBD). Total RSWA, tonic RSWA and chin RSWA severity were significant predictors for all PD and prediagnostic PD groups. Our study also shows a higher percentage of nocturnal supine body position in all PD and prediagnostic PD groups. Supine body position percentage is the highest in the PD group and has a positive correlation with time since diagnosis. CONCLUSIONS These findings suggest that increased total, tonic and chin RSWA as well as nocturnal supine body position are already present in prediagnostic PD, independently of RBD status. Prospective longitudinal studies are necessary to confirm the additional value of these PSG abnormalities as prodromal PD biomarkers.
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13
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Barone DA. Isolated REM sleep without atonia: The unsung hero of polysomnography. Clin Neurophysiol 2020; 131:2486-2487. [DOI: 10.1016/j.clinph.2020.07.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Accepted: 07/23/2020] [Indexed: 11/28/2022]
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14
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Dijkstra F, Viaene M, De Volder I, Fransen E, Cras P, Crosiers D. Polysomnographic phenotype of isolated REM sleep without atonia. Clin Neurophysiol 2020; 131:2508-2515. [DOI: 10.1016/j.clinph.2020.07.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Revised: 06/23/2020] [Accepted: 07/16/2020] [Indexed: 01/05/2023]
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Zhu J, Lu L, Zhong M, Jiang X, Wu Z, Dong J, Pan Y, Zhang L. Increased rapid eye movement density in Chinese patients with Parkinson's disease and RBD. Neurol Sci 2020; 42:961-968. [PMID: 32676757 DOI: 10.1007/s10072-020-04597-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Accepted: 07/13/2020] [Indexed: 01/09/2023]
Abstract
OBJECTIVE Impaired rapid eye movement sleep is common among patients with Parkinson's disease (PD). However, information on rapid eye movement density (REM) among PD patients is currently lacking. The current study sought to characterize REM density in PD patients and to examine the associations between REM density sleep parameters and clinical manifestations. PARTICIPANTS AND METHODS We retrospectively recruited 172 PD patients. All participants were assessed with a two-night polysomnography, and REM density was calculated. Clinical assessments were completed in PD patients before polysomnography. RESULTS Rapid eye movement sleep behavior disorder (RBD) was observed in 93 patients (54.1%). The disease duration, UPDRS part III score, Hoehn and Yahr (H-Y) stage, and HAMA, HAMD, PDQ-39 scores, and REM density in the Parkinson's disease patients with rapid eye movement sleep behavior disorder (RBD) were significantly higher than in the patients without RBD (P < 0.05). However, NREM sleep stage 3 time (N3 time) and percentage of N3 time of total sleep time (N3%) were significantly lower in the RBD patients than in the patients without RBD (P < 0.05). The forward binary logistic regression model showed that REM density, UPDRS-III score, and N3 sleep time were associated with RBD in the PD patients. CONCLUSIONS Our results confirm the high prevalence of RBD in patients with PD. Increased REM density was the main risk factor of RBD.
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Affiliation(s)
- Jun Zhu
- Department of Geriatric Neurology, Nanjing Brain Hospital Affiliated to Nanjing Medical University, 264 Guangzhou Road, Nanjing, 210029, Jiangsu, People's Republic of China
| | - Liyu Lu
- Department of Geriatric Neurology, Nanjing Brain Hospital Affiliated to Nanjing Medical University, 264 Guangzhou Road, Nanjing, 210029, Jiangsu, People's Republic of China
| | - Min Zhong
- Department of Geriatric Neurology, Nanjing Brain Hospital Affiliated to Nanjing Medical University, 264 Guangzhou Road, Nanjing, 210029, Jiangsu, People's Republic of China
| | - Xu Jiang
- Department of Geriatric Neurology, Nanjing Brain Hospital Affiliated to Nanjing Medical University, 264 Guangzhou Road, Nanjing, 210029, Jiangsu, People's Republic of China
| | - Zhuang Wu
- Department of Geriatric Neurology, Nanjing Brain Hospital Affiliated to Nanjing Medical University, 264 Guangzhou Road, Nanjing, 210029, Jiangsu, People's Republic of China
| | - Jingde Dong
- Department of Geriatric Neurology, Nanjing Brain Hospital Affiliated to Nanjing Medical University, 264 Guangzhou Road, Nanjing, 210029, Jiangsu, People's Republic of China
| | - Yang Pan
- Department of Geriatric Neurology, Nanjing Brain Hospital Affiliated to Nanjing Medical University, 264 Guangzhou Road, Nanjing, 210029, Jiangsu, People's Republic of China
| | - Li Zhang
- Department of Geriatric Neurology, Nanjing Brain Hospital Affiliated to Nanjing Medical University, 264 Guangzhou Road, Nanjing, 210029, Jiangsu, People's Republic of China.
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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: 92] [Impact Index Per Article: 18.4] [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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Zanatta A, Camargo CHF, Germiniani FMB, Raskin S, de Souza Crippa AC, Teive HAG. Abnormal Findings in Polysomnographic Recordings of Patients with Spinocerebellar Ataxia Type 2 (SCA2). THE CEREBELLUM 2019; 18:196-202. [PMID: 30264264 DOI: 10.1007/s12311-018-0982-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Spinocerebellar ataxia type 2 (SCA2) is characterized by a progressive cerebellar syndrome, and additionally saccadic slowing, cognitive dysfunction, and sleep disorders. The aim of this study was to assess the frequency of abnormal findings in sleep recordings of patients with SCA2. Seventeen patients with genetically confirmed SCA2 from the Movement Disorders Outpatient group of the Hospital de Clínicas da UFPR were evaluated with a structured medical interview and the Scale for the Assessment and Rating of Ataxia (SARA). Polysomnographic recordings were performed and sleep stages were scored according to standard criteria. There were 10 male subjects and 7 females, aged 24-66 years (mean 47.44). A sex- and age-matched control group of healthy subjects was used for comparison. There was a reduction of rapid eye movement (REM) sleep in 12 (70.58%), increased REM latency in 9 (52.94%), increased obstructive sleep apnea-index in 14 (82.35%), absent REM density (REM density was calculated as the total number of 3-s miniepochs of REM sleep with at least 1 REM per minute) in 13 (76.47%), and markedly reduced REM density in 4 (23.52%). There was an indirect correlation according to the SARA scale and the REM density decrease (r = - 0.6; P = < 0.001); and with a disease progression correlating with a reduction in the REM density (r = - 0.52, P = 0.03). In SCA2, changes occur mainly REM sleep. The absence/decrease of REM sleep density, even in oligosymptomatic patients, and the correlation of this finding with disease time and with the SARA scale were the main findings of the study.
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Affiliation(s)
- Alessandra Zanatta
- Movement Disorders Unit, Neurology Service, Hospital de Clínicas, Federal University of Parana, Rua General Carneiro, 181 - Alto da Glória, Curitiba, 80060-900, Brazil.
| | | | - Francisco Manoel Branco Germiniani
- Movement Disorders Unit, Neurology Service, Hospital de Clínicas, Federal University of Parana, Rua General Carneiro, 181 - Alto da Glória, Curitiba, 80060-900, Brazil
| | - Salmo Raskin
- Advanced Molecular Research Center, Center for Biological and Health Sciences, Catholic University of Parana, Curitiba, Brazil
| | | | - Hélio Afonso Ghizoni Teive
- Movement Disorders Unit, Neurology Service, Hospital de Clínicas, Federal University of Parana, Rua General Carneiro, 181 - Alto da Glória, Curitiba, 80060-900, Brazil
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Merola A, Sturchio A, Hacker S, Serna S, Vizcarra JA, Marsili L, Fasano A, Espay AJ. Technology-based assessment of motor and nonmotor phenomena in Parkinson disease. Expert Rev Neurother 2018; 18:825-845. [PMID: 30269610 DOI: 10.1080/14737175.2018.1530593] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
INTRODUCTION The increasing development and availability of portable and wearable technologies is rapidly expanding the field of technology-based objective measures (TOMs) in neurological disorders, including Parkinson disease (PD). Substantial challenges remain in the recognition of disease phenomena relevant to patients and clinicians, as well as in the identification of the most appropriate devices to carry out these measurements. Areas covered: The authors systematically reviewed PubMed for studies employing technology as outcome measures in the assessment of PD-associated motor and nonmotor abnormalities. Expert commentary: TOMs minimize intra- and inter-rater variability in clinical assessments of motor and nonmotor phenomena in PD, improving the accuracy of clinical endpoints. Critical unmet needs for the integration of TOMs into clinical and research practice are the identification and validation of relevant endpoints for individual patients, the capture of motor and nonmotor activities from an ecologically valid environment, the integration of various sensor data into an open-access, common-language platforms, and the definition of a regulatory pathway for approval of TOMs. The current lack of multidomain, multisensor, smart technologies to measure in real time a wide scope of relevant changes remain a significant limitation for the integration of technology into the assessment of PD motor and nonmotor functional disability.
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Affiliation(s)
- Aristide Merola
- a James J and Joan A Gardner Family Center for Parkinson's Disease and Movement Disorders, Department of Neurology , University of Cincinnati , Cincinnati , OH , USA
| | - Andrea Sturchio
- a James J and Joan A Gardner Family Center for Parkinson's Disease and Movement Disorders, Department of Neurology , University of Cincinnati , Cincinnati , OH , USA
| | - Stephanie Hacker
- a James J and Joan A Gardner Family Center for Parkinson's Disease and Movement Disorders, Department of Neurology , University of Cincinnati , Cincinnati , OH , USA
| | - Santiago Serna
- a James J and Joan A Gardner Family Center for Parkinson's Disease and Movement Disorders, Department of Neurology , University of Cincinnati , Cincinnati , OH , USA
| | - Joaquin A Vizcarra
- a James J and Joan A Gardner Family Center for Parkinson's Disease and Movement Disorders, Department of Neurology , University of Cincinnati , Cincinnati , OH , USA
| | - Luca Marsili
- a James J and Joan A Gardner Family Center for Parkinson's Disease and Movement Disorders, Department of Neurology , University of Cincinnati , Cincinnati , OH , USA
| | - Alfonso Fasano
- b Edmond J. Safra Program in Parkinson's disease and the Morton and Gloria Shulman Movement Disorders Clinic , Toronto Western Hospital, University of Toronto; Krembil Brain Institute , Toronto , ON , Canada
| | - Alberto J Espay
- a James J and Joan A Gardner Family Center for Parkinson's Disease and Movement Disorders, Department of Neurology , University of Cincinnati , Cincinnati , OH , USA
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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: 50] [Impact Index Per Article: 7.1] [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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