Quantitative associations between objective sleep measures and early-morning mobility in Parkinson’s disease: cross-sectional analysis of the PHASE study

Abstract Study Objectives Previous studies have suggested associations between sleep measures and early-morning akinesia; however, objective evidence is limited. The purpose of this study was to evaluate the associations between objective sleep measures and morning mobility among patients with Parkinson’s disease (PD). Methods In this cross-sectional study, we measured objective sleep parameters and morning mobility in 157 patients with PD (mean age, 71.4 years) for six consecutive days using an actigraph placed on the nondominant wrist. Low morning mobility was defined as less than 100 counts/min within the first 2 hours after rising. Results The mean duration of low morning mobility was 55.7 minutes (SD, 23.8), and the mean sleep parameters were as follows: sleep efficiency (SE), 72.1% (13.6); wake after sleep onset (WASO), 104.7 minutes (57.9); total sleep time (TST), 343.6 minutes (104.0); and fragmentation index (FI), 3.5 (3.4). Multivariable linear regression analysis adjusted for potential confounders demonstrated significant associations between better objective sleep measures and shorter low morning mobility (SE per %: β, −0.419; 95% CI = −0.635 to −0.204; p < 0.001; WASO per min: β, 0.056; 95% CI = 0.003 to 0.109; p = 0.039; and FI per unit; β, 1.161; 95% CI = 0.300 to 2.023; p = 0.009) but not TST (p = 0.78). These findings were not altered by different cutoff values of mobility (50 counts/min) or duration (1 h after rising). Conclusions In patients with PD, better objective sleep measures are significantly associated with shorter low morning mobility. Future studies investigating whether improved sleep reduces symptoms of low morning mobility are required.

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Sleep Parameters in Short Daily versus Conventional Dialysis: An Actigraphic Study

International Journal of Nephrology ◽

10.1155/2017/2473217 ◽

2017 ◽

Vol 2017 ◽

pp. 1-6

Author(s):

Ludimila D’Avila e Silva Allemand ◽

Otávio Toledo Nóbrega ◽

Juliane Pena Lauar ◽

Joel Paulo Russomano Veiga ◽

Einstein Francisco Camargos

Keyword(s):

Total Sleep Time ◽

Linear Regression Analysis ◽

Sleep Onset ◽

Objective Measure ◽

Sleep Time ◽

Cross Sectional ◽

Convenience Sample ◽

Wake Time ◽

Daily Dialysis ◽

Sleep Parameters

Previous studies have observed worse sleep quality in patients undergoing conventional dialysis as compared to daily dialysis. Our aim was to compare the sleep parameters of patients undergoing daily or conventional dialysis using an objective measure (actigraphy). This cross-sectional study was performed in three dialysis centers, including a convenience sample (nonprobability sampling) of 73 patients (36 patients on daily hemodialysis and 37 patients on conventional hemodialysis). The following parameters were evaluated: nocturnal total sleep time (NTST), expressed in minutes; wake time after sleep onset (WASO), expressed in minutes; number of nighttime awakenings; daytime total sleep time (DTST), expressed in minutes; number of daytime naps; and nighttime percentage of sleep (% sleep). The Mini-Mental State Examination and the Beck Depression Inventory were also administered. The mean age was 53.4 ± 17.0 years. After adjustment of confounding factors using multiple linear regression analysis, no difference in actigraphy parameters was detected between the groups: NTST (p=0.468), WASO (p=0.88), % sleep (p=0.754), awakenings (p=0.648), naps (p=0.414), and DTST (p=0.805). Different from previous studies employing qualitative analysis, the present assessment did not observe an influence of hemodialysis modality on objective sleep parameters in chronic renal patients.

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Links between sleep and body mass index in bipolar disorders: An exploratory study

European Psychiatry ◽

10.1016/j.eurpsy.2014.04.006 ◽

2015 ◽

Vol 30 (1) ◽

pp. 89-93 ◽

Cited By ~ 20

Author(s):

C. Boudebesse ◽

P.-A. Geoffroy ◽

C. Henry ◽

A. Germain ◽

J. Scott ◽

...

Keyword(s):

Body Mass Index ◽

Body Mass ◽

Sleep Disturbances ◽

Sleep Onset ◽

Bipolar Disorders ◽

Sleep Time ◽

Sleep Efficiency ◽

Sleep Onset Latency ◽

Cross Sectional ◽

Sleep Parameters

AbstractStudy objectives:Obesity and excess bodyweight are highly prevalent in individuals with bipolar disorders (BD) and are associated with adverse consequences. Multiple factors may explain increased bodyweight in BD including side effects of psychotropic medications, and reduced physical activity. Research in the general population demonstrates that sleep disturbances may also contribute to metabolic burden. We present a cross-sectional study of the associations between body mass index (BMI) and sleep parameters in patients with BD as compared with healthy controls (HC).Methods:Twenty-six French outpatients with remitted BD and 29 HC with a similar BMI completed a 21-day study of sleep parameters using objective (actigraphy) and subjective (PSQI: Pittsburgh Sleep Quality Index) assessments.Results:In BD cases, but not in HC, higher BMI was significantly correlated with lower sleep efficiency (P = 0.009) and with several other sleep parameters: shorter total sleep time (P = 0.01), longer sleep onset latency (P = 0.05), higher fragmentation index (P = 0.008), higher inter-day variability (P = 0.05) and higher PSQI total score (P = 0.004).Conclusions:The findings suggest a link between a high BMI and several sleep disturbances in BD, including lower sleep efficiency. Physiological mechanisms in BD cases may include an exaggeration of phenomena observed in non-clinical populations. However, larger scale studies are required to clarify the links between metabolic and sleep-wake cycle disturbances in BD.

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Recognition of emotions expressed on the face impairments in Parkinson’s disease

Iranian Journal of Neurology ◽

10.18502/ijnl.v19i1.3288 ◽

2020 ◽

Author(s):

Kaveh Shafiei ◽

Mohammad Ali Shafa ◽

Forugh Mohammadi ◽

Ali Arabpour

Keyword(s):

Parkinson’S Disease ◽

Parkinson's Disease ◽

Emotion Recognition ◽

Cross Sectional Study ◽

Primary Objective ◽

Cross Sectional ◽

Complex Process ◽

The Face ◽

The Mean ◽

Multimodal Emotion Recognition

Background: Facial emotion recognition (FER) is a complex process, involving many brain circuits, including the basal ganglia that its motor involvement causes Parkinson's disease (PD). The previous studies used different tools for assessment of FER in PD. There is a discrepancy between the results of these studies due to different tools. In this study, we used a modified version of the Multimodal Emotion Recognition Test (MERT) to compare patients with PD to healthy controls (HCs). Methods: It was a cross-sectional study with primary objective of the mean percentage of the correct answers in MERT. Subjects had to name the emotions presented with different modalities. Results: 30 subjects were recruited and assessed in each group. The mean total MERT score was significantly lower in subjects with PD compared to HCs (35.0% vs. 44.5%). FER was significantly better when emotions were presented by video and worse when presented by still pictures. Both subjects with PD and HCs had lower MERT scores in recognizing negative emotions. There was no significant correlation between the duration and severity of PD and MERT score. Conclusion: Our study provided more pieces of evidence for impairment of FER in PD for recognizing emotions like sadness, disgust, and fear compared to happy expressions.

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Frequency of Orthostatic Hypotension in Parkinson’s Disease

10.53350/pjmhs2115112886 ◽

2021 ◽

Vol 15 (11) ◽

pp. 2886-2889

Author(s):

Ali Qayyum ◽

Ehsan Ul Haq ◽

Shoaib Zafar ◽

Javaria . ◽

Muhammad Moss ◽

...

Keyword(s):

Blood Pressure ◽

Parkinson’S Disease ◽

Parkinson's Disease ◽

Orthostatic Hypotension ◽

Diastolic Blood Pressure ◽

Cross Sectional Study ◽

Cross Sectional ◽

Female Ratio ◽

Parkinson’S Diseases ◽

The Mean

Background: Parkinson’s Diseases (PD) cause some non-motor issues that could lead to disability. One of such determinal non-motor symptoms is orthostatic hypotension (OH) which is still understudied in our local setting despite of its high prevalence worldwide among patients of PD. Aim: To determine frequency of orthostatic hypotension in Parkinson’s disease Methods: This Cross-sectional study was conducted at Department of Neurology, Mayo Hospital, Lahore for 6 months after the approval of synopsis [April 9, 2018 till Oct 9, 2018]. A sample of 95 cases was selected using non probability consecutive sampling from 95 patients of Parkinson’s Disease aged 25 years and more. After taking consent from patient and recording sociodemographic information, a lying-to-standing orthostatic test was performed to evaluate the orthostatic hypotension and SBP and DBP was recorded. All data was collected using a self structured proforma and analyzed using SPSS v 21. Results: The mean age of cases was 47.46 ± 8.97 years with male to female ratio of 1.97:1. The mean systolic and diastolic blood pressure was 120.60 ± 11.80 and 86.20 ± 8.68 respectively. The frequency of orthostatic hypotension was seen in 51(53.7%) while other 44(46.3%) cases did not have orthostatic hypotension. Conclusion: Through the findings of this study we conclude that frequency of orthostatic hypotension in Parkinson’s disease is very much high i.e. 53.7% with highest frequency in cases with longer duration of disease. Keywords: Autonomic diseases, Parkinson’s disease, Systolic blood pressure, diastolic blood pressure, Orthostatic hypotension,

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slEEp-rElatEd BrEathing disordErs in hungarian patiEnts With parKinson’s disEasE

New Medicine ◽

10.5604/01.3001.0009.7837 ◽

2017 ◽

Vol 21 (1) ◽

pp. 8-13

Author(s):

terézia seres

Keyword(s):

Parkinson’S Disease ◽

Parkinson's Disease ◽

Negative Correlation ◽

Rem Sleep ◽

Sleep Latency ◽

Sleep Time ◽

Mean Value ◽

Motor Symptoms ◽

Specific Symptom ◽

The Mean

Introduction. typical symptoms of parkinson’s disease (pd) are motor symptoms. however, the non-motor symptoms, which may occur in any phase of the disease, are now in the center of the clinical attention. these symptoms include neuropsychiatric dysfunctions, dysautonomy, sleep disorders, and sensory symptoms, such as pain. sleep disorders are common in pd patients. Aim. the aim of our study was to estimate the prevalence and characteristics of obstructive sleep apnea syndrome (osas) in patients with pd. We also wanted to analyze the sleep architecture in parkinson’s disease using polysomnography. Material and methods. 50 patients who had visited the neurology department of hungarian defence forces military hospital between february 2014 and april 2016 were recruited for the study. Every patient with idiopathic parkinson’s disease stage 1 to 3 was included, regardless of their sleeping complaints. Every patient underwent nocturnal, in-laboratory polysomnography, the results of which were subsequently assessed by a somnologist. sleep stages were distinguished and the apneahypopnea index (ahi) was calculated according to the recommendations of the task force of the american academy of sleep medicine. Results. the total in-laboratory sleep time ranged from 189 minutes to 501 minutes, with the mean value of 298 minutes. total sleep time was reduced (< 5 hours) in 28 patients (56%). sleep latency was prolonged (< 0.5 hours) in 33 patients (> 66%). in older patients (≥ 75 years old), the sleep latency was longer. the normal sleep efficiency of > 85% was seen in only 8 patients. the sleep efficiency ranged from 56% to 89%, with a mean value of 74.1%. 9 patients in our study group had 3 rapid eye movement (rEm) sleep episodes, 37 patients had 2 rEm episodes and 4 patients had only 1 rEm episode. there was a negative correlation between the score on Epworth sleepiness scale (Ess) and the number of rEm episodes. rEm sleep onset latency was prolonged (> 2 hours) in 82% (n = 42) of our patients. periodic limb movements in sleep (plms) were seen in 18 patients. there was a negative correlation between age and plms index. all the patients in our study who had been diagnosed with restless leg syndrome (rls) had plms . sleep latency was prolonged in 7 out of 17 patients suffering from rls. 64% (n = 32) of our patients were diagnosed with osas. the prevalence of severe, moderate and mild osas was 22%, 32% and 10%, respectively. patients with moderate and severe osas (ahi > 15 hours) had higher age than patients without osas (p < 0.005). the mean Ess score was higher in osas patients (p = 0.05). snoring was present in 78% of the osas patients. apnea witnessed by a partner was the most specific symptom, present in 92% of osas patients. We did not find significant differences between the groups with and without osas in regard of updrs (unified pd rating scale) and hoehn & yahr’s modified evaluation scale and schwab & England’s functional evaluation scale. Conclusions. osas is a common sleep disorder in pd patients. it has a higher prevalence in older pd patients and it is associated with greater daytime sleepiness. snoring is the most sensitive symptom, and apneas witnessed by a partner are the most specific symptom of osas in pd patients.

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“Does the Response to Morning Medication Predict the ADL-Level of the Day in Parkinson’s Disease?”

Parkinson s Disease ◽

10.1155/2020/7140984 ◽

2020 ◽

Vol 2020 ◽

pp. 1-8 ◽

Cited By ~ 1

Author(s):

Trine Hørmann Thomsen ◽

Troels Wesenberg Kjær ◽

Lene Bastrup Jørgensen ◽

Anita Haahr ◽

Kristian Winge

Keyword(s):

Parkinson’S Disease ◽

Parkinson's Disease ◽

Rating Scale ◽

Strong Predictor ◽

Early Morning ◽

Cross Sectional Study ◽

Poor Responders ◽

Slow Response ◽

Cross Sectional ◽

Disease Rating

Background. Individuals with Parkinson’s Disease (PD) have bradykinesia during mobility tasks in the morning before intake of dopaminergic treatment and have difficulties managing Activities of Daily Living (ADLs). Early morning off (EMO) refers to off-states in the morning where the severity of bradykinesia is increased and causes a decrease in mobility related to wearing off of effects of medication. Measurements from devices capable of continuously recording motor symptoms may provide insight into the patient’s response to medication and possible impact on ADLs. Objectives. To test whether poor or slow response to medication in the morning predicts the overall ADL-level and to assess the association between change in bradykinesia score (BKS) and the risk of having disabilities within three selected ADL-items. Methods. In this cross-sectional study, the sample consists of 34 patients with light to moderate PD. Data collection encompasses measurements from the Parkinson KinetiGraph, and the ADL-limitations are assessed by the Movement Disorder Society Unified Parkinson Disease Rating Scale (MDS-UPDRS) Part II. Results. The association between UPDRS- II and BKS from the algorithm was −0.082 (p<0.01), 95% CL:−0.113; −0.042). The individuals experienced disabilities in performing “Speech” (p=0.004) and “Doing hobbies” (p=0.038) when being slow or poor responders to dopaminergic therapy. The PD patients’ L-dopa equivalent dose seems to be a strong predictor of the ADL-level in the morning. Conclusion. Slow response to the medication dosages in the morning is correlated with disabilities in the overall ADL-level in PD. The combination of PD-drugs and precise, timely dosages must be considered in the improvement of the ADL-level in PD patients.

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Timing and Composition of Last Meal before Bedtime Affect Sleep Parameters of Night Workers

Clocks & Sleep ◽

10.3390/clockssleep3040038 ◽

2021 ◽

Vol 3 (4) ◽

pp. 536-546

Author(s):

Luciana F. R. Nogueira ◽

Pollyanna Pellegrino ◽

José Cipolla-Neto ◽

Claudia R. C. Moreno ◽

Elaine C. Marqueze

Keyword(s):

Linear Regression Analysis ◽

Night Shift ◽

Sleep Onset ◽

Multiple Linear Regression Analysis ◽

Sleep Onset Latency ◽

Nocturnal Sleep ◽

Double Blind ◽

Cross Sectional ◽

Sleep Parameters ◽

Diurnal Sleep

Night workers tend to eat irregularly, both in terms of meal times and composition. The disruption in energy metabolism caused by inappropriate eating habits can negatively affect the sleep quality of these individuals. The objectives of this study were to determine the interval between the last meal and bedtime and its relationship with both diurnal and nocturnal sleep parameters, as well as to evaluate the association of the adequacy of this meal with sleep parameters. The analyses were carried out for a usual sleep routine on a workday and a day off. This cross-sectional study was part of a controlled, randomized, double-blind, crossover clinical trial. The sample comprised 30 female nursing professionals who worked permanent night shifts of 12 × 36 h. Timing and composition of the last meal were obtained from food diaries, and sleep parameters were collected via actigraphy. On multiple linear regression analysis, every hour decrease in the interval between the last meal and sleep onset there was an increase of 0.39 h on diurnal sleep duration. Regarding food intake, every 1 g of fat and 1 g of carbohydrate consumed was associated with an increase in diurnal sleep onset latency of 0.13 h and 0.02 h, respectively. These findings suggest that both timing and composition of the last meal before bedtime may be potential key factors for good diurnal and nocturnal sleep among night-shift workers.

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The mean velocity of posterior cerebral artery and basilar artery in Parkinson's disease with sleep disorders

Medicina Clínica Práctica ◽

10.1016/j.mcpsp.2021.100207 ◽

2021 ◽

Vol 4 ◽

pp. 100207

Author(s):

Muhammad Iqbal Basri ◽

Ida Farida ◽

Yudy Goysal ◽

Jumraini Tammasse ◽

Muhammad Akbar

Keyword(s):

Parkinson’S Disease ◽

Parkinson's Disease ◽

Sleep Disorders ◽

Cerebral Artery ◽

Basilar Artery ◽

Posterior Cerebral Artery ◽

Mean Velocity ◽

The Mean

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Day-to-day variability in sleep parameters and depression risk: a prospective cohort study of training physicians

npj Digital Medicine ◽

10.1038/s41746-021-00400-z ◽

2021 ◽

Vol 4 (1) ◽

Author(s):

Yu Fang ◽

Daniel B. Forger ◽

Elena Frank ◽

Srijan Sen ◽

Cathy Goldstein

Keyword(s):

Mental Health ◽

Smartphone Application ◽

Sleep Time ◽

Self Report ◽

First Year ◽

Cross Sectional ◽

Wake Time ◽

Mood Variability ◽

Patient Health ◽

Sleep Parameters

AbstractWhile 24-h total sleep time (TST) is established as a critical driver of major depression, the relationships between sleep timing and regularity and mental health remain poorly characterized because most studies have relied on either self-report assessments or traditional objective sleep measurements restricted to cross-sectional time frames and small cohorts. To address this gap, we assessed sleep with a wearable device, daily mood with a smartphone application and depression through the 9-item Patient Health Questionnaire (PHQ-9) over the demanding first year of physician training (internship). In 2115 interns, reduced TST (b = −0.11, p < 0.001), later bedtime (b = 0.068, p = 0.015), along with increased variability in TST (b = 0.4, p = 0.0012) and in wake time (b = 0.081, p = 0.005) were associated with more depressive symptoms. Overall, the aggregated impact of sleep variability parameters and of mean sleep parameters on PHQ-9 were similar in magnitude (both r2 = 0.01). Within individuals, increased TST (b = 0.06, p < 0.001), later wake time (b = 0.09, p < 0.001), earlier bedtime (b = − 0.07, p < 0.001), as well as lower day-to-day shifts in TST (b = −0.011, p < 0.001) and in wake time (b = −0.004, p < 0.001) were associated with improved next-day mood. Variability in sleep parameters substantially impacted mood and depression, similar in magnitude to the mean levels of sleep parameters. Interventions that target sleep consistency, along with sleep duration, hold promise to improve mental health.

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Correlates of the discrepancy between objective and subjective cognitive functioning in non-demented patients with Parkinson’s disease

Journal of Neurology ◽

10.1007/s00415-021-10519-4 ◽

2021 ◽

Author(s):

Mattia Siciliano ◽

Lugi Trojano ◽

Rosa De Micco ◽

Valeria Sant’Elia ◽

Alfonso Giordano ◽

...

Keyword(s):

Parkinson’S Disease ◽

Parkinson's Disease ◽

Linear Regression ◽

Cognitive Functioning ◽

Rating Scale ◽

Regression Analyses ◽

Chi Square ◽

Cognitive Measure ◽

Objective Evidence ◽

Cognitive Discrepancy

Abstract Background Subjective complaints of cognitive deficits are not necessarily consistent with objective evidence of cognitive impairment in Parkinson’s disease (PD). Here we examined the factors associated with the objective-subjective cognitive discrepancy. Methods We consecutively enrolled 90 non-demented patients with PD who completed the Parkinson’s Disease Cognitive Functional Rating Scale (subjective cognitive measure) and the Montreal Cognitive Assessment (MoCA; objective cognitive measure). The patients were classified as “Overestimators”, “Accurate estimators”, and “Underestimators” on the basis of the discrepancy between the objective vs. subjective cognitive measures. To identify the factors distinguishing these groups from each other, we used chi-square tests or one-way analyses of variance, completed by logistic and linear regression analyses. Results Forty-nine patients (54.45%) were classified as “Accurate estimators”, 29 (32.22%) as “Underestimators”, and 12 (13.33%) as “Overestimators”. Relative to the other groups, the “Underestimators” scored higher on the Fatigue Severity Scale (FSS), Beck Depression Inventory (BDI), and Parkinson Anxiety Scale (p < 0.01). Logistic regression confirmed that FSS and BDI scores distinguished the “Underestimators” group from the others (p < 0.05). Linear regression analyses also indicated that FSS and BDI scores positively related to objective-subjective cognitive discrepancy (p < 0.01). “Overestimators” scored lower than other groups on the MoCA’s total score and attention and working memory subscores (p < 0.01). Conclusion In more than 45% of consecutive non-demented patients with PD, we found a ‘mismatch’ between objective and subjective measures of cognitive functioning. Such discrepancy, which was related to the presence of fatigue and depressive symptoms and frontal executive impairments, should be carefully evaluated in clinical setting.

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