Nocturnal sleep disturbances and daytime dysfunction in patients with Parkinson's disease and in their caregivers

Mar 24, 2004Parkinsonism & related disorders

Nighttime sleep problems and daytime difficulties in people with Parkinson’s disease and their caregivers

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Abstract

Eighty-four percent of Parkinson's disease patients were identified as 'poor sleepers' with global sleep scores greater than 5.

Disturbed sleep in Parkinson's disease patients is associated with high rates of excessive daytime sleepiness (57.5%) and fatigue (72.5%).
Mood disturbances, such as depression (51.5%) and anxiety (63.1%), are prevalent among these patients and correlate with sleep dysfunction.
A significant proportion of caregivers also experience sleep disturbances, with 40% scoring above 5 on the global sleep scale.
The data suggest that sleep and mood issues may negatively impact the quality of life for both patients and their caregivers.
No correlation was found between sleep dysfunction and the patients' age, severity, duration of Parkinson's disease, or their treatment.

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BACKGROUND: The role of aging, disease, medications, and mood disturbances in sleep disturbances (SD) in patients with Parkinson's disease (PD) is poorly understood, and the impact of SD on the quality of life of their caregivers (CG) largely undocumented.

OBJECTIVES: To evaluate the pattern and determinants of disturbed sleep in PD patients complaining of SD, and in their primary CG.

METHODS: A prospective evaluation of 40 non-demented patients with PD complaining of SD and 23 of their primary CG (all were spouses) was conducted using Pittsburgh Sleep Quality Index, Zung's self-rating depression and anxiety scales, Parkinson's Impact Scale (PIMS) (only for PD), and an additional sleep questionnaire.

RESULTS: Eighty-four percent of patients were 'poor sleepers' with global sleep scores (GLSc) > 5. Other abnormalities were: excessive daytime sleepiness-57.5%, excessive daytime fatigue-72.5%, depression-51.5%, anxiety-63.1%, and abnormal PIMS score-83.8%. There was no correlation between the degree of sleep dysfunction and the age, severity, duration of PD or its treatment. Several component sleep scores correlated with anxiety scores, PIMS score with depression, and, subjects with GLSc > or = 10 had higher mean anxiety index. Daytime dysfunction (97.5%) was mainly associated with reduced enthusiasm, rather than excessive sleepiness. Among CG, 40% had a GLSc > 5, 21% had depression, and 10.5% had anxiety. Their depression, anxiety and sleep scores correlated with those of their spouses.

CONCLUSIONS: PD patients with significant SD may represent a subset of patients with early, progressive degeneration of sleep centres, rather than an enhanced aging process. They are more susceptible mood disturbances, which correlate with the severity of sleep dysfunction. Sleep and mood disturbances also adversely affect the quality of life of spousal caregivers.

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Nocturnal sleep disturbances and daytime dysfunction in patients with Parkinson's disease and in their caregivers

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