Sleep patterns in Parkinson’s Disease patients.

SANTIAGO PEREZ-LLORET; MALCO ROSSI; DANIEL CARDINALI; , MARÍA INÉS NOUZEILLES; MARCELO MERELLO

Kyoto

Congreso; Congreso Internacional de Movimientos Anormales; 2006

Objectives: To define sleep patterns in PD by combining data from several sleep evaluation tools and to relate them to PD clinical characteristics. Background: Parkinson’s disease (PD) patients usually show disturbed sleep. Several sleep abnormalities have been reported but a coherent view on sleep patterns in PD remains to be established. Methods: 31 consecutive PD out-patients were evaluated by PD Sleep Scale, 7-day actigraphy and sleep logbook. Disease severity was evaluated by UPDRS II and III scores and levodopa-equivalent-dose (LDED) was calculated. Exploratory factor analysis was employed to find sleep patterns by combining the results from the different evaluations. Afterwards, pattern scores were related PD characteristics by multiple linear regression analysis. Results: PD patients mean age was 67±9 years; 48% of them were males. UPDRS II and III scores were 11±6 and 19±10 respectively and LDED was 722±409 mg/day. Factor analysis disclosed five sleep patterns, accounting for 50% of total variability: A first sleep pattern included: 1) low sleep quality, morning freshness, daily well-being, longer awakenings, high frequency of urine incontinence and dystonia and tremor at wake-up; 2) high levels of nighttime activity, sleep latency and awakenings number, low total sleep time and longer naps; 3) high frequency of vivid dreams, nightmares and nocturnal hallucinations. Higher scores in the first pattern were associated with higher UPDRS II score (r=0.47 p<.01). A second sleep pattern was related to LDED (r=0.40 p<.01) and was higher in males (p<.01). The third sleep pattern scores were higher in subjects with Postural Instability Gait Disorder (p<.01). The 4th and 5th patterns (consisting of reduced sleep quality, high frequency of subjective sleep complaints, nocturnal extremities numbness, agitation and cramps) were unrelated to PD clinical features. Conclusion: Sleep patterns could be identified. The first (low subjective sleep quality with altered motility), the second (objective sleep deficit) and the third (altered dream content and hallucinations) patterns were related to PD clinical characteristics. These patterns could be the base for further sleep disturbance syndromes characterization in PD.