Sleep-Wake Disturbances in Parkinson's Disease: Current Evidence regarding Diagnostic and Therapeutic Decisions

Departamento de Medicina, Universidade Federal do Ceara, Fortaleza, Brasil.
European Neurology (Impact Factor: 1.36). 03/2012; 67(5):257-67. DOI: 10.1159/000335078
Source: PubMed


Sleep disorders have been frequently reported in patients with Parkinson's disease (PD). However, there is insufficient evidence to guide precise recommendations on some diagnostic and treatment strategies. Here, we review clinical studies dealing with sleep abnormalities in PD and present clinical recommendations. Previous studies describing insomnia, excessive daytime sleepiness, narcolepsy-like episodes, circadian changes, sleep-disordered breathing, rapid eye movement sleep behavior disorder, vivid dreams and restless legs syndrome are evaluated. Longitudinal studies associating sleep disorders with PD onset or clinical deterioration are rare: only one longitudinal study associated daytime sleepiness with PD onset. Evidence suggests that clinical investigations must include direct questioning about depressive symptoms, nocturnal cramps, pain, nocturia and nighttime off periods. A patient interview must be conducted regarding sleep symptoms, including nightmares, abnormal behavior during sleep, snoring, restless legs syndrome and daytime sleepiness. Initial evidence indicates that light therapy improves motor function and depression. Advice on sleep hygiene, the treatment of concomitant depression and the careful use of dopaminergic drugs and hypnosedative agents should be considered. To date, very few controlled studies are available to make a recommendation for the management of sleep-wake disturbances in PD.

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    • "This is all important considering that motor sequence memory consolidation is physiologically essential . Notably, chronic insomnia has been recently associated with comorbidities and degenerative disorders (Bruin et al. 2012; Miyata et al. 2013). Also, animal experimentation has shown that the parkinsonian mouse model presents increased levels of nitrite in the striatum secondary to chronic exposure to paraquat (Yadav et al. 2013). "
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    Archiv für Experimentelle Pathologie und Pharmakologie 01/2014; 387(5). DOI:10.1007/s00210-013-0955-z · 2.47 Impact Factor
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    • "investigation with prospective longitudinal studies in drug naïve patients. In our patients, there was no change in NS or DS scores with DBS treatment, although reported evidence demonstrates that insomnia improves with surgery [12]. This is possibly due to the small sample of patients in our cohort that underwent intervention. "
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