Antiparkinsonian drugs as potent contributors to nocturnal sleep in patients with Parkinson’s disease

Objective To clarify whether antiparkinsonian drugs contribute to nocturnal sleep disturbances in patients with Parkinson’s disease (PD). Background Although the major antiparkinsonian drugs L-dopa and dopamine agonists (DAs) have been found to affect sleep, little is known about the effects of specific drugs on sleep in PD patients. Methods The study participants consisted of 112 PD patients (median age 72.5 years [inter-quartile range: IQR 65–79]; mean disease duration 8.44 years [standard deviation: 7.33]; median Hoehn and Yahr stage 3 [IQR 2–3.75]) taking one of three types of non-ergot extended-release DAs (rotigotine 32; pramipexole 44; ropinirole 36) with or without L-dopa (median daily total dosage of antiparkinsonian drugs 525.5 mg [IQR 376.25–658] levodopa equivalent dose [LED]). Participants were assessed using the PD Sleep Scale-2 (PDSS-2). Results For the whole PD patient cohort, the PDSS-2 sleep disturbance domain score and the scores for item 1 assessing sleep quality and item 8 assessing nocturia were positively correlated with daily total dosage of antiparkinsonian drugs and dosage of L-dopa, but not with the dosage of DAs. Sub-analysis according to DA treatment revealed that DA dosage was not correlated with item 1 or 8 score in any of the subgroups. The LED ratio of rotigotine to the total dosage of antiparkinsonian drugs was inversely correlated with the item 1 score. Conclusions These data suggest that antiparkinsonian drugs, in particular L-dopa, adversely affect nocturnal sleep in PD patients, especially in terms of sleep quality and nocturia. Thus, adjusting both the total dosage of antiparkinsonian drugs and the dose-ratio of L-dopa might be key actions for alleviating poor sleep quality in patients with PD. Among DAs, we found a clear positive correlation between the dose-ratio of rotigotine and sleep quality. Thus, partial L-dopa replacement with rotigotine could improve sleep quality in patients with PD.

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Prolonged-release melatonin in Parkinson's disease patients with a poor sleep quality: A randomized trial

Parkinsonism & Related Disorders ◽

10.1016/j.parkreldis.2020.03.029 ◽

2020 ◽

Vol 75 ◽

pp. 50-54 ◽

Cited By ~ 1

Author(s):

Jong Hyeon Ahn ◽

Minkyeong Kim ◽

Suyeon Park ◽

Wooyoung Jang ◽

Jinse Park ◽

...

Keyword(s):

Parkinson’S Disease ◽

Parkinson's Disease ◽

Sleep Quality ◽

Randomized Trial ◽

Poor Sleep ◽

Prolonged Release ◽

Poor Sleep Quality

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The Impact of Sleep Quality on Cognitive Functioning in Parkinson's Disease

Journal of the International Neuropsychological Society ◽

10.1017/s1355617711001482 ◽

2011 ◽

Vol 18 (1) ◽

pp. 108-117 ◽

Cited By ~ 44

Author(s):

Karina Stavitsky ◽

Sandy Neargarder ◽

Yelena Bogdanova ◽

Patrick McNamara ◽

Alice Cronin-Golomb

Keyword(s):

Parkinson’S Disease ◽

Parkinson's Disease ◽

Executive Function ◽

Sleep Quality ◽

Sleep Efficiency ◽

Motor Symptom ◽

Poor Sleep ◽

Psychomotor Function ◽

Wrist Actigraphy ◽

The Impact

AbstractIn 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. (JINS, 2012, 18, 108–117)

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FREQUENCY AND CORRELATES OF POOR SLEEP QUALITY AMONG PATIENTS OF PARKINSON’S DISEASE

Pakistan Armed Forces Medical Journal ◽

10.51253/pafmj.v70i6.3866 ◽

2020 ◽

Vol 70 (6) ◽

pp. 1640-44

Author(s):

Syed Sakhawat Kazmi ◽

Zahid Hassan ◽

Waseem Alamgir ◽

Asif Hashmat ◽

Muhammad Ali Yousaf ◽

...

Keyword(s):

Parkinson’S Disease ◽

Parkinson's Disease ◽

Sleep Quality ◽

Quality Index ◽

Pittsburgh Sleep Quality Index ◽

Military Hospital ◽

Poor Sleep ◽

Motor Disorder ◽

Poor Sleep Quality ◽

Duration Of Illness

Objective: To determine the frequency of poor sleep quality among the patients of Parkinson’s disease (PD) and analyze its relationship with the socio-demographic factors.Study Design: Correlational study. Place and Duration of Study: Pak Emirates Military Hospital Rawalpindi, from Jan 2019 to Jun 2019. Methodology: One hundred and fifty patients of Parkinson’s disease were approached to participate in this study. Pittsburgh sleep quality index (PSQI) was the psychometric tool used to assess the study parameter for the patients. Age, gender, duration of illness, poly pharmacy and tobacco smoking were corelated with presence of poor quality of sleep among the patients of Parkinson’s disease. Results: Out of 150 patients of Parkinson’s disease screened through Pittsburgh sleep quality index, 85 (56.7%)showed the presence of poor sleep quality while 65 (43.3%) had good sleep quality. Mean age of the patients was 66.2 ± 4.648 years. After applying the logistic regression, we found that increasing age and longer duration of illness had significant association with the presence of poor sleep quality among the patients of Parkinson disease. Conclusion: Previously considered a pure motor disorder, Parkinsonism has a lot of other neuro-psychiatricmanifestations as well. Poor sleep quality turned out to be one of these non-motor problems associated with this chronic debilitating illness. Increasing age and longer duration of illness among these patients emerged asindependent risk factors for poor sleep quality in Parkinsonism.

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The effect of laughter yoga exercises on anxiety and sleep quality in patients suffering from Parkinson’s disease

Biomedical Research and Therapy ◽

10.15419/bmrat.v4i07.200 ◽

2017 ◽

Vol 4 (07) ◽

pp. 1463 ◽

Cited By ~ 4

Author(s):

Azadeh Memarian ◽

Afsaneh Sanatkaran ◽

Seyyed Mohialdin Bahari

Keyword(s):

Parkinson’S Disease ◽

Parkinson's Disease ◽

Sleep Quality ◽

Sleep Disturbances ◽

Nonparametric Test ◽

Complementary Therapy ◽

Control Group ◽

Significant Difference ◽

Improve Sleep Quality

Background: The aim of the present study is to evaluate the effects of laughter yoga exercises on anxiety and sleep quality in patients suffering from Parkinson’s disease. Methods: In the study a semi-empirical and applied research design was used, which involved a pre-test and post-test, and appropriate control group. The study consisted of 24 patients suffering from Parkinson’s disease who were referred and admitted to Hazarate Raoul Allah Hospital in Tehran, Iran. The patients ranged in age from 55 to 75 and met the study criteria prior to entering the research study. The patients were randomly divided into two groups – control or experimental (n=12 per group). After completing exercises (laughter yoga), post-evaluation of anxiety and sleep quality of patients in both groups were conducted using questionnaires. For normalization of research data, the Mann-Whitney nonparametric test was used. Statistical analyses were conducted using the SPSS software, with the statistically significant level set at P<0.05. Results: The Mann-Whitney tests indicated that there was a significant difference between the average stress change as well as sleep quality in patients suffering from Parkinson’s disease (versus control subjects) following laughter yoga exercises. Indeed, regarding sleep quality laughter yoga was only effective on the subjective quality of sleep and latency in sleeping. There was no observation of a significant effect on the duration of sleep, sleep efficiency, sleep disturbances, use of sleeping pills, or daily functions of the patients. Conclusion: The results of the present study demonstrate that laughter yoga exercises can reduce anxiety and improve sleep quality in patients suffering from Parkinson’s disease. As a result, laughter yoga exercises may be beneficial as a complementary therapy with standard treatment methods to reduce anxiety and improve sleep quality in patients with Parkinson's.

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Prevalence and Risk Factors for Minor Hallucinations in Patients with Parkinson’s Disease

Behavioural Neurology ◽

10.1155/2021/3469706 ◽

2021 ◽

Vol 2021 ◽

pp. 1-10

Author(s):

Min Zhong ◽

Ruxin Gu ◽

Sha Zhu ◽

Yu Bai ◽

Zhuang Wu ◽

...

Keyword(s):

Parkinson’S Disease ◽

Parkinson's Disease ◽

Sleep Quality ◽

Rating Scale ◽

Life Quality ◽

Behavior Disorder ◽

Poor Sleep ◽

Dopamine Receptor Agonist ◽

Binary Logistic Regression Model ◽

Sleep Behavior

Purpose. As the most frequent and earliest type of psychotic phenomenon in Parkinson’s disease (PD), minor hallucination (MH) can occur before the onset of motor symptoms. This sensation may be an early predictor of severe psychotic and cognitive states and is often overlooked in clinics. This study was aimed at providing a comprehensive and in-depth understanding of MHs. Patients and Methods. Demographic information was obtained from 262 patients with PD, and a series of clinical assessment questionnaires were provided. According to the result of the Movement Disorders Society Unified Parkinson’s Disease Rating Scale Part I, the patients were classified into the MH and nonhallucination (NH) groups. Results. MHs were the most common psychotic symptom with 38.9% prevalence. The most frequent MH was visual illusion, especially object misidentification. Three minor phenomena were somewhat consistent in terms of external factors, temporal factors, and content. Disease duration, daily levodopa equivalent dose, and percentage of levodopa and dopamine-receptor agonist use were remarkably greater in the MH group than in the NH group. After covariate control, the MH group had worse life quality and more severe nonmotor symptoms, including poor sleep quality and rapid eye movement sleep behavior disorder (RBD), than the NH group. The binary logistic regression model showed that RBD, sleep quality, and health-related life quality were associated with MHs. Conclusion. A high prevalence of MHs was observed in patients with PD. Further studies are needed to confirm and expand the identified clinical factors related to MH, which have potential prognostic and therapeutic implication.

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Sleep and risk of parkinsonism and Parkinson’s disease: a population-based study

Brain ◽

10.1093/brain/awz113 ◽

2019 ◽

Vol 142 (7) ◽

pp. 2013-2022 ◽

Cited By ~ 13

Author(s):

Thom S Lysen ◽

Sirwan K L Darweesh ◽

M Kamran Ikram ◽

Annemarie I Luik ◽

M Arfan Ikram

Keyword(s):

Parkinson’S Disease ◽

Parkinson's Disease ◽

Sleep Disturbances ◽

Population Based ◽

Poor Sleep ◽

Poor Sleep Quality ◽

Short Sleep Duration ◽

Population Based Study ◽

Short Sleep ◽

Increased Risk

While specific sleep disorders are known to precede Parkinson’s disease, it remains unclear how sleep disturbances in the general population affect risk. Lysen et al. report that poor sleep quality and short sleep duration, and their deterioration over time, are associated with increased risk of parkinsonism, including Parkinson’s disease.

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Rotigotine Objectively Improves Sleep in Parkinson’s Disease: An Open-Label Pilot Study with Actigraphic Recording

Parkinson s Disease ◽

10.1155/2016/3724148 ◽

2016 ◽

Vol 2016 ◽

pp. 1-5 ◽

Cited By ~ 6

Author(s):

Giovanna Calandra-Buonaura ◽

Pietro Guaraldi ◽

Andrea Doria ◽

Stefano Zanigni ◽

Stefania Nassetti ◽

...

Keyword(s):

Parkinson’S Disease ◽

Parkinson's Disease ◽

Pilot Study ◽

Motor Activity ◽

Sleep Quality ◽

Sleep Disturbances ◽

Open Label ◽

Sleep Complaints ◽

Objective Evidence ◽

Rotigotine Treatment

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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Subjective poor sleep quality in Chinese patients with Parkinson's disease without dementia

Journal of Biomedical Research ◽

10.7555/jbr.27.20120143 ◽

2013 ◽

Cited By ~ 4

Keyword(s):

Parkinson’S Disease ◽

Parkinson's Disease ◽

Sleep Quality ◽

Chinese Patients ◽

Poor Sleep ◽

Poor Sleep Quality

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Prevalence of non-motor symptoms in Parkinson’s disease

International Journal of Research in Medical Sciences ◽

10.18203/2320-6012.ijrms20191488 ◽

2019 ◽

Vol 7 (5) ◽

pp. 1459

Author(s):

Shakthi C. ◽

Sritharan B. ◽

Muthuveeran M. ◽

Manivannan M. R. ◽

Justin C. ◽

...

Keyword(s):

Quality Of Life ◽

Parkinson’S Disease ◽

Parkinson's Disease ◽

Sleep Disturbances ◽

Motor Symptom ◽

Motor Symptoms ◽

Nocturnal Sleep ◽

Males And Females ◽

Non Motor Symptoms

Background: Parkinson’s disease is a common neurodegenerative movement disorder characterised by motor symptoms of rest tremor, bradykinesia, rigidity and postural instability and non-motor symptoms (NMS) which include neuropsychiatric symptoms, sleep disturbances, autonomic symptoms, sensory symptoms and symptoms of mixed aetiology. Parkinson’s Disease Non Motor Group (PD-NMG) devised a comprehensive clinic-based self-completed NMS questionnaire that allows easy identification of NMS by the physician. Most NMS have a poor response to dopaminergic therapy as it is due to dysfunction of the serotonergic and noradrenergic pathways. Treatment of these nonmotor symptoms help in improving the quality of life in patients with Parkinson’s disease.Methods: There were 100 patients with Parkinson’s disease who had presented to our neuromedicine movement clinic were included in the study. Patients were diagnosed as PD based on UK Parkinson’s disease brain bank criteria. The inclusion criteria were diagnosis as PD, age >18 yrs, inclusion of both males and females and consent for the study. Patients with atypical parkinsonism and secondary parkinsonism, stroke, intake of antipsychotics were excluded from the study. Non motor symptom questionnaire was given to the study group and frequency of occurrence of each non motor symptoms and their predominance in both males and females were studied. The frequency of each NMS was calculated by computing the number of yes response and calculating the percentage related to the number of patients in the sample. Analysis was done to calculate the frequency of all NMS among the enrolled patient.Results: Nocturnal sleep disturbances (43%) were most common followed by constipation (29%).The most common non motor symptoms in males were constipation (20%), urinary urgency (18%) and nocturia (11%).The most common non motor symptoms in females were nocturnal sleep disturbance (25%), feeling sad (19%), unexplained pains (17%) and being anxious (13%).Conclusions: Non motor symptom questionnaire helps in screening patients with Parkinson’s disease of non-motor symptoms and aims at providing holistic treatment improving the quality of life.

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