Sleep-wake rhythm abnormalities in Parkinson ’s disease patients.

SANTIAGO PEREZ-LLORET; MALCO ROSSI; MALCO ROSSI; MALCO ROSSI

Chicago

Congreso; Congreso Internacional de Movimientos Anormales; 2008

Background: Deterioration of many circadian rhythms occurs in animal models of Parkinson’s Disease (PD). In levodopa-treated PD patients a disturbance of melatonin rhythm has been described, but sleep-wake rhythm remains unstudied. Objectives: To compare sleep and immobility periods onset and offset times in PD with healthy controls. These parameters were related to sleep disturbances. Methods: 15 De Novo, 21 stable and 39 fluctuating idiopathic PD patients as well as 23 age- and sex- matched normal sleeper individuals were recruited. Sleep times were evaluated by 7-day sleep logs. Nocturnal immobility period onset and offset times were assessed by actigraphy. Severity of daytime somnolence, sleep fragmentation, nocturnal restlessness, psychosis and motor symptoms were measured by the PD sleep scale (PDSS). Results: De novo patients showed no differences in sleep and immobility onsets and offsets times as compared to controls. Stable patients showed earlier waking up and finalization of the immobility period times (aprox 45 min, p<0.04) with reduced sleep time by 45-60 min. Flucuators also showed earlier offset times, but sleep time did not differ compared to controls, because of an advance in the sleep/immobility period onset times. Only PDSS scores for nocturnal psychosis correlated with onsets and offsets of sleep and immobility in fluctuating patients, patients with more severe symptoms showing earlier onset and offset times. In stable PD patients, only diurnal somnolence (PDSS) correlated with onset and offset times, somnolent patients showing delayed going to bed and start of the immobility times, while times for waking up and the end of the immobility period were significantly advanced. No relationships between sleep or immobility onset or offset and disease severity (UPDRS) or daily levodopa dose could be detected. Napping did not affect onsets and offsets. Acrophase of the activity rhythm as assessed by cosinor, was similar to controls in the studied groups of PD patients. Conclusions: The results revealed an altered sleep-wake rhythm phase in PD, which correlated with increased somnolence in stable patients and with worst nocturnal psychosis in the fluctuating ones.