Effects of Sleep Disorders on the Non-Motor Symptoms of Parkinson Disease

Nov 16, 2013Journal of clinical sleep medicine : JCSM : official publication of the American Academy of Sleep Medicine

How Sleep Problems Relate to Non-Movement Symptoms in Parkinson’s Disease

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Abstract

Having sleep disorders was associated with a significant prediction of non-motor symptoms in patients with Parkinson disease (R(2) = 0.33, p < 0.001).

REM sleep behavior disorder (RBD) and restless legs syndrome (RLS) were significant predictors of increased non-motor symptoms.
Sleep disorders significantly predicted sleep complaints, depressive symptoms, fatigue, poor quality of life, and cognitive decline.
RBD was associated with increased non-motor symptoms (p = 0.006) while RLS also contributed to this increase (p = 0.014).
The presence of multiple sleep disorders (0, 1, or ≥ 2) was a significant factor for non-motor symptom impairment (R(2) = 0.28, p < 0.001).
Obstructive sleep apnea (OSA) was not found to significantly predict non-motor symptoms in this population.

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STUDY OBJECTIVES: To evaluate the impact of sleep disorders on non-motor symptoms in patients with Parkinson disease (PD).

DESIGN: This was a cross-sectional study. Patients with PD were evaluated for obstructive sleep apnea (OSA), restless legs syndrome (RLS), periodic limb movement syndrome (PLMS), and REM sleep behavior disorder (RBD). Cognition was assessed with the Montreal Cognitive Assessment and patients completed self-reported questionnaires assessing non-motor symptoms including depressive symptoms, fatigue, sleep complaints, daytime sleepiness, and quality of life.

SETTING: Sleep laboratory.

PARTICIPANTS: 86 patients with PD (mean age = 67.4 ± 8.8 years; range: 47-89; 29 women).

INTERVENTIONS: N/A.

MEASUREMENTS AND RESULTS: Having sleep disorders was a predictor of overall non-motor symptoms in PD (R(2) = 0.33, p < 0.001) while controlling for age, PD severity, and dopaminergic therapy. These analyses revealed that RBD (p = 0.006) and RLS (p = 0.014) were significant predictors of increased non-motor symptoms, but OSA was not. More specifically, having a sleep disorder significantly predicted sleep complaints (ΔR(2) = 0.13, p = 0.006), depressive symptoms (ΔR(2) = 0.01, p = 0.03), fatigue (ΔR(2) = 0.12, p = 0.007), poor quality of life (ΔR(2) = 0.13, p = 0.002), and cognitive decline (ΔR(2) = 0.09, p = 0.036). Additionally, increasing number of sleep disorders (0, 1, or ≥ 2 sleep disorders) was a significant contributor to non-motor symptom impairment (R(2) = 0.28, p < 0.001).

CONCLUSION: In this study of PD patients, presence of comorbid sleep disorders predicted more non-motor symptoms including increased sleep complaints, more depressive symptoms, lower quality of life, poorer cognition, and more fatigue. RBD and RLS were factors of overall increased non-motor symptoms, but OSA was not.

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Effects of Sleep Disorders on the Non-Motor Symptoms of Parkinson Disease

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