Poorer Sleep With Mild Parkinson’s Affects Day’s Physical Activity

People with mild Parkinson’s disease sleep less, are less active, and show more sedentary behavior than their healthy peers, a small study showed.

Poorer sleep also significantly associated with more sedentary time in both populations.

While further research is needed to confirm these early findings, they suggest that screening for sleep deficits may be relevant when designing interventions to promote physical activity in Parkinson’s patients, the researchers noted.

The study, “The association between sleep deficits and sedentary behavior in people with mild Parkinson disease,” was published in the journal Disability and Rehabilitation.

Sleep problems such as difficulty falling asleep, daytime sleepiness, and troubled dreams are among the most common and early non-motor symptoms of Parkinson’s disease. Notably, insomnia — defined as difficulty falling or staying asleep, early awakening, or non-refreshing sleep — has been shown to have a greater negative impact than motor symptoms on patients’ quality of life.

Previous studies have shown that people with newly diagnosed and mild Parkinson’s are significantly less active relative to their healthy peers, and that this decline is not fully explained by physical disability, “suggesting that other factors, such as poor sleep, might be at play,” the researchers wrote.

Notably, increasing evidence suggests that exercise may work against Parkinson’s progression, and its maximization is recommended for this patient population.

While in healthy adults, more sleep is known to improve physical activity levels and vice versa, whether this is also true for people living with Parkinson’s remains unclear.

Such a link’s existence “would highlight the importance of identifying, monitoring, and addressing sleep deficits as a component of personalized interventions to increase PA [physical activity] in people with PD [Parkinson’s disease],” the researchers wrote.

Researchers at the University of Washington evaluated the association between sleep and physical activity in people with mild Parkinson’s and in healthy adults by analyzing data collected through a commercially available activity monitor.

This analysis was part of a prospective observational study that compared the quantity and intensity of physical activity between 30 people with mild Parkinson’s and 30 healthy adults.

Participants wore  the activity and sleep monitor — the Fitbit Charge HR — on their wrist for two weeks, and their nighttime sleep, number and length of awakenings during sleep, daytime naps, step count, and physical activity intensity were assessed.

The current analysis included 25 patients, with a mean age of 69, and 27 healthy peers who wore the monitor for at least 11 nights. There were no significant differences between the groups in terms of age, cognitive function, simultaneous health conditions, and monitor wear time.

Results showed that people with mild Parkinson’s slept 18% less (75 fewer minutes), took 49% fewer steps (5,792 fewer steps), and spent fewer active minutes at all intensity levels, and 32% more time (204 more minutes) in sedentary behavior per day compared with their peers.

All these group differences were statistical significant.

These data were consistent with those reported in previous studies, the team noted, including those who detected sleep changes using polysomnography, the gold standard for measuring sleep — further supporting the utility of commercially available wrist-worn monitors to monitor activity and sleep.

In addition, while mean nighttime sleep was not significantly associated with daily steps or high, moderate or light intensity active minutes in either group, a significant link was found for mean sedentary time.

Particularly, each additional 30 minutes of nighttime sleep were significantly associated with 25 fewer sedentary minutes in Parkinson’s patients and 26 fewer sedentary minutes in healthy adults.

“This suggests that it is important to consider both the intensity and duration of PA when examining the relationship between PA and sleep, as steps alone could be spread out across the day and accumulated in short bouts,” the researchers wrote.

These findings highlighted that people with mild Parkinson’s sleep less and are less active and more sedentary than their healthy peers, and a link exists between lesser sleep and more sedentary behavior.

Researchers also suggest that “rehabilitation interventions may be optimized by targeting both physical activity and sleep deficits.”

Further studies using robust measures of sleep and activity are needed “to determine the nature of this relationship and to examine whether interventions to improve sleep can reduce sedentary behavior and improve physical activity, or vice versa,” both in Parkinson’s patients and in healthy adults, the researchers added.

They also noted that future studies should assess whether this association exists among people with more advanced Parkinson’s, and examine potential influencing factors, such as mood, medications, or consumption of goods that stimulate wakefulness.