Daytime Napping, Nighttime Sleeping, and Parkinson Disease

Epidemiology Branch, National Institute of Environmental Health Sciences, Research Triangle Park, North Carolina 27709, USA.
American journal of epidemiology (Impact Factor: 5.23). 03/2011; 173(9):1032-8. DOI: 10.1093/aje/kwq478
Source: PubMed


Preliminary evidence suggests that daytime sleepiness may predate clinical diagnosis of Parkinson disease. The authors examined daytime napping and nighttime sleeping durations, reported in 1996-1997 by 220,934 US NIH-AARP Diet and Health Study participants, in relation to Parkinson disease diagnoses at 3 clinical stages: established (cases diagnosed before 1995, n = 267), recent (1995-1999, n = 396), and prediagnostic (2000 and after, n = 770). Odds ratios and 95% confidence intervals were derived from multivariate logistic regression models. Longer daytime napping was associated with higher odds of Parkinson disease at all 3 clinical stages: the odds ratios comparing long nappers (>1 hour/day) with nonnappers were 3.9 (95% confidence interval: 2.8, 5.6) for established cases, 2.2 (95% confidence interval: 1.7, 3.0) for recent cases, and 1.5 (95% confidence interval: 1.2, 1.9) for prediagnostic cases. Further control for health status or nighttime sleeping duration attenuated the association for established cases but made little difference for recent or prediagnostic cases. In the nighttime sleeping analysis, a clear U-shaped association with Parkinson disease was observed for established cases; however, this association was attenuated markedly for recent cases and disappeared for prediagnostic cases. This study supports the notion that daytime sleepiness, but not nighttime sleeping duration, is one of the early nonmotor symptoms of Parkinson disease.

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    • "A long-established practice in Mediterranean areas, daytime napping, namely siesta, is often linked with good health through a postulated “stress relief” mechanism (6). However, daytime sleepiness, often characterized by daytime napping, has been suggested as an early sign or risk indicator of a range of health problems (7–9). To date, the association between daytime napping and mortality risk is uncertain. "
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    ABSTRACT: Epidemiologic studies have reported conflicting results on the relationship between daytime napping and mortality risk, and there are few data on the potential association in the British population. We investigated the associations between daytime napping and all-cause or cause-specific mortality in the European Prospective Investigation Into Cancer-Norfolk study, a British population-based cohort study. Among the 16,374 men and women who answered questions on napping habits between 1998 and 2000, a total of 3,251 died during the 13-year follow-up. Daytime napping was associated with an increased risk of all-cause mortality (for napping less than 1 hour per day on average, hazard ratio = 1.14, 95% confidence interval: 1.02, 1.27; for napping 1 hour or longer per day on average, hazard ratio = 1.32, 95% confidence interval: 1.04, 1.68), independent of age, sex, social class, educational level, marital status, employment status, body mass index, physical activity level, smoking status, alcohol intake, depression, self-reported general health, use of hypnotic drugs or other medications, time spent in bed at night, and presence of preexisting health conditions. This association was more pronounced for death from respiratory diseases (for napping less than 1 hour, hazard ratio = 1.40, 95% confidence interval: 0.95, 2.05; for napping 1 hour or more, hazard ratio = 2.56, 95% confidence interval: 1.34, 4.86) and in individuals 65 years of age or younger. Excessive daytime napping might be a useful marker of underlying health risk, particularly of respiratory problems, especially among those 65 years of age or younger. Further research is required to clarify the nature of the observed association.
    Full-text · Article · Mar 2014 · American journal of epidemiology
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    • "The development of daytime somnolence in PD has been associated with increasing age, disease duration, disease progression, postural instability, depression and the use of dopamine agonists [8,19,20]. However, much like the emergence of idiopathic REM sleep behavior disorder (RBD) in later life [21], daytime sleep disturbance can also represent a pre-motor feature heralding the development of PD [3,4,14]. Daytime sleep disturbance has been linked to executive dysfunction in PD [16] and impairments in frontostriatal neural circuitry have been implicated in the reduced arousal, attentional modulation and general working memory seen in PD [16,22,23]. "
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    ABSTRACT: Sleep-wake disturbances and concomitant cognitive dysfunction in Parkinson’s disease (PD) contribute significantly to morbidity in patients and their carers. Subjectively reported daytime sleep disturbance is observed in over half of all patients with PD and has been linked to executive cognitive dysfunction. The current study used daytime actigraphy, a novel objective measure of napping and related this to neuropsychological performance in a sample of PD patients and healthy, age and gender-matched controls. Furthermore this study aimed to identify patients with PD who may benefit from pharmacologic and behavioural intervention to improve these symptoms.
    Full-text · Article · Nov 2013 · PLoS ONE
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    • "Data on the timing of other key premotor symptoms are limited or inconsistent . For example, several studies showed that constipation might precede PD clinical diagnosis by 10–20 years in men (Abbott et al. 2001; Gao X et al. 2011; Savica et al. 2009), but data are not consistent in women (Gao X et al. 2011; Savica et al. 2009). The population-based HAAS showed that hyposmia was highly predictive of PD onset within 4 years after symptom assessment (Ross et al. 2008). "
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    ABSTRACT: The etiology and natural history of Parkinson's disease (PD) are not well understood. Some non-motor symptoms such as hyposmia, rapid eye movement sleep behavior disorder, and constipation may develop during the prodromal stage of PD and precede PD diagnosis by years. To discuss the promise and pitfalls of research on pre-motor symptoms of PD and to develop priorities and strategies to understand their clinical and etiological implications. This review was based on a workshop held on June 7-8, 2012 at the National Institute of Environmental Health Sciences. Research on pre-motor symptoms of PD may offer an excellent opportunity to characterize higher-risk populations and to better understand PD etiology. Such research may lead to evaluation of novel etiological hypotheses such as the possibility that environmental toxicants or viruses may initiate PD pathogenesis in the gastrointestinal tract or olfactory bulb. At present, our understanding of pre-motor symptoms of PD is in its infancy and faces many obstacles. These symptoms are often not specific to PD and have low positive predictive value for early PD diagnosis. Further, the pathological bases and biological mechanisms of these pre-motor symptoms and their relevance to PD pathogenesis are poorly understood. This is an emerging research area with important data gaps to be filled. Future research is needed to understand the prevalence of multiple pre-motor symptoms and their etiological relevance to PD. Animal experiments and mechanistic studies will help understand the biology of these non-motor symptoms and test novel etiological hypothesis.
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