Multiple sleep difficulties common in people with early Parkinson’s
Researchers say evaluating sleep issues will aid disease management
Most people with early-stage Parkinson’s disease have sleep disturbances, with many having more than one at the same time, a study in France suggests.
Sleep disorders were mainly associated with body changes, including motor symptoms and problems regulating involuntary bodily functions, rather than depression or anxiety.
“The timely and comprehensive clinical evaluation of sleep disorders in early [Parkinson’s] patients is critical to improve management strategy and achieve a more personalized medicine,” the researchers wrote. The study, “Sleep disorders in Parkinson’s disease, an early and multiple problem,” was published in npj Parkinson’s disease.
Sleep issues are common among people with Parkinson’s and can manifest in a number of ways, including as insomnia, excessive daytime sleepiness, and rapid eye movement (REM) sleep behavior disorder, where dreams are physically acted out. Restless legs syndrome and problems breathing during sleep may also occur.
These symptoms may be present at early disease stages and their frequency may increase as the disease progresses. Sleep issues may be worse in patients with depression or anxiety, research has shown, and may be associated with the disease’s motor symptoms or the side effects of medicine.
An early Parkinson’s problem
To better understand if sleep conditions might interact with each other and if they’re associated with other aspects of Parkinson’s, researchers analyzed data from patients in the ICEBERG observational study (NCT02305147), between November 2014 and March 20021. The study observes and follows patients with early Parkinson’s to examine their symptoms, medical images, and biological markers to track disease progression over time.
A total of 162 people with early-stage Parkinson’s and 58 healthy participants were analyzed. The mean age at the onset of Parkinson’s symptoms was 59.4 and the mean age at the patients’ diagnosis was 61. In general, other than cognition which was similar between groups, scores for motor, non-motor, cognitive, and behavioral changes were worse in those with Parkinson’s than controls.
The patients’ clinical characteristics were assessed through interviews, overnight sleep studies (polysomnography), and tests to assess sleep, motor abilities, and cognitive function, among other health issues.
Among those with early Parkinson’s, 72% had at least one sleep disturbance compared with 42% of healthy controls. About half of those (35%) had multiple sleep issues at the same time.
Insomnia was reported in 41% of patients, but by 21% in the control group. People with Parkinson’s were also more likely to have trouble staying asleep (35% vs. 16%), to have excessive daytime sleepiness (25% vs. 8%), REM sleep behavior disorder (25% vs. 0%), and a trend toward a higher frequency of restless leg syndrome (16% vs. 5%). Rates of sleep-disordered breathing weren’t significantly different between people with Parkinson’s and those without it, however.
Trends between sleep disorders, patient characteristics, and common Parkinson’s symptoms were also evaluated.
Those with Parkinson’s and multiple sleep disorders were older and tended to have a longer disease duration than those without sleep disorders.
Insomnia, especially trouble staying asleep, was more common in women and those with restless legs syndrome, although it wasn’t associated with motor symptoms or mood problems. Excessive daytime sleepiness was related to mood and motor symptoms, and the use of certain Parkinson’s medications, but not to the presence of other sleep disorders. REM sleep behavior disorder was tied to problems with involuntary bodily functions, like blood pressure or digestion, and older age, but not movement or cognitive difficulties.
“[S]leep disturbances are an early problem in [Parkinson’s disease] patients because they are frequent … and complex …,” the researchers wrote. “It remains to be determined whether sleep disorders (in addition to [REM sleep behavior disorder]) at this early stage influence motor and cognitive development of PD in the long term.”
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