Validation of the Parkinson’s Disease Sleep Scale by day-to-day sleep evaluation using a sleep log.

SANTIAGO PEREZ LLORET; MALCO ROSSI; MARÍA INÉS NOUZEILLES; CLAUDIA TRENKWALDER; DANIEL P. CARDINALI; MARCELO MERELLO

Chicago

Congreso; Congreso Internacional de Movimientos Anormales; 2008

Background: Parkinson’s Disease Sleep Scale (PDSS) is a simple and comprehensive tool in PD, but it has not been fully validated. As PDSS is based on a sleep historical self-evaluation, relevant evidence about its validity can come from correlating it with day-to-day sleep self-evaluation, which can be accomplished by a sleep log. Objective: In a two step validation process, sleep log utility of for day-to-day sleep quality evaluation in PD was explored and later, PDSS was validated by comparing it to sleep log results. Actigraphy was used for quantification of nocturnal activity. Finally, independent predictors of sleep disorders were identified. Methods: 71 idiopathic PD patients and 21 age- and sex- matched normal individuals lacking any type of sleep disturbance were recruited from our out-patient clinic. Sleep was evaluated by PDSS, 7-day sleep log and actigraphy. Results: Sleep log showed reduced sleep quality, daily wellbeing and total score in moderate/severe PD patients as compared to healthy controls. Significant correlations were found between sleep log’s sleep quality, morning alertness, daily wellbeing, total score and awakenings number with PDSS domains for sleep quality, nocturnal restlessness, nocturnal psychosis, nocturnal motor symptoms and diurnal somnolence. PDSS daytime somnolence and sleep log daily wellbeing could segregate PD patients from healthy controls, but only daily wellbeing segregated moderately/severely affected PD patients from the less affected ones. Nocturnal activity was increased only in PD patients taking higher doses of levodopa, independently of their disease’s severity. Multivariate regression analysis showed that PD severity and depression were the only predictors of reduced sleep quality, whereas increased nocturnal activity was related to higher daily levodopa dose, reduced mini-mental state examination score and longer disease duration. Conclusions: Historical and day-to-day sleep self-evaluation coincided and could disclosed the expected sleep problems in PD, further supporting their utility. Reduced sleep quality was related to increased PD severity and depression scores.