Steep breathing disorders in patients with idiopathic Parkinson's disease

McGill University, Montréal, Quebec, Canada
Respiratory Medicine (Impact Factor: 3.09). 10/2003; 97(10):1151-7. DOI: 10.1016/S0954-6111(03)00188-4
Source: PubMed


to investigate the presence of sleep breathing disorders in patients with idiopathic Parkinson's disease (PD) and their correlation with the severity of the disease.
Fifteen patients (mean age 63 +/- 4 years) with idiopathic PD (Group A) and 15 healthy matched controls (Group B) were studied. All patients were under treatment with L-Dopa/Carbidopa and classified according to the UPDRS motor scale: 8 had mild disease (UPDRS < 12), 6 moderate (UPDRS: 12-22) and 1 severe (UPDRS > 22).
All participants underwent full night polysomnography (PSG). The sleep-wake history was assessed. Spirometry, maximal respiratory pressures and arterial blood gases were also measured. Snoring was more common in Group A patients (73.3% vs. 33.3%, p = 0.002). Among the parameters studied apnea hypopnea index (AHI), mean O2 saturation, minimum O2 saturation, REM% sleep and Arousal Index (Arousal Index) were statistically different between the two groups. Furthermore, 9 PD patients fulfilled the criteria for obstructive sleep apnea-hypopnea syndrome (OSAHS) predominately mild, 1 for central sleep apnea hypopnea syndrome (CSAHS) and 5 were normal. In all patients a marked reduction in percentage REM sleep was observed. Among the patients with OSAHS 5 had mild PD, 3 moderate and 1 severe. The patient with CSAHS had moderate disease. Finally, 3 patients with mild and 2 with moderate PD had no evidence of sleep breathing disorders. Correlations between severity of disease and sleep parameters are provided.
Our results suggest that sleep breathing disorders, predominantly obstructive, seem to be common in PD and those events correlate with the severity of the disease.

Download full-text


Available from: Sophia E Schiza
    • "In PD, the most common subtype of apnea observed is the obstructive, 90% of total apnea.[18] The most common subtype of SDB observed in our study of drug-naïve early PD was of obstructive variety, OSA was 69.3% and CSA was 30.7% of total apnoea events. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Objective: We studied the changes in Polysomnographic (PSG) profile in drug-naïve patients of Parkinson's disease (PD) who underwent evaluation with sleep overnight PSG. Materials and Methods: This prospective study included 30 with newly diagnosed levodopa-naïve patients with PD, fulfilling the UK-PD society brain bank clinical diagnostic criteria (M:F = 25:5; age: 57.2 ± 10.7 years). The disease severity scales and sleep related questionnaires were administered, and then patients were subjected to overnight PSG. Results: The mean duration of illness was 9.7 ± 9.5 months. The mean Hoehn and Yahr stage was 1.8 ± 0.4. The mean Unified Parkinson's Disease Rating Scale (UPDRS) motor score improved from 27.7 ± 9.2 to 17.5 ± 8.9 with sustained usage of levodopa. Nocturnal sleep as assessed by Pittsburgh Sleep Quality Index (PSQI) was impaired in 10 (33.3%) patients (mean PSQI score: 5.1 ± 3.1). Excessive day time somnolence was recorded in three patients with Epworth Sleepiness Scale (ESS) score ≥ 10 (mean ESS score: 4.0 ± 3.4). PSG analysis revealed that poor sleep efficiency of <85% was present in 86.7% of patients (mean: 68.3 ± 21.3%). The latencies to sleep onset (mean: 49.8 ± 67.0 minutes) and stage 2 sleep (36.5 ± 13.1%) were prolonged while slow wave sleep was shortened. Respiration during sleep was significantly impaired in which 43.3% had impaired apnoea hyperpnoea index (AHI) ≥5, mean AHI: 8.3 ± 12.1). Apnoeic episodes were predominantly obstructive (obstructive sleep apnea, OSA index = 2.2 ± 5.1). These patients had periodic leg movement (PLM) disorder (56.7% had PLM index of 5 or more, mean PLMI: 27.53 ± 4 9.05) that resulted in excessive daytime somnolence. Conclusions: To conclude, sleep macro-architecture is altered in frequently and variably in levodopa-naïve patients of PD and the alterations are possibly due to disease process per se.
    No preview · Article · Jul 2014 · Annals of Indian Academy of Neurology
  • Source
    • "The reported frequency of sleep-disordered breathing (SDB) in PD varies from 20% to 60% [65, 93, 94]. This is an unexpected association because the usual patient with PD is not obese, a factor that is a major factor in the development for SDB. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Academic Editor: Birgit Frauscher Copyright © 2012 Todd J. Swick. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Parkinson's disease (PD) has traditionally been characterized by its cardinal motor symptoms of bradykinesia, rigidity, resting tremor, and postural instability. However, PD is increasingly being recognized as a multidimensional disease associated with myriad nonmotor symptoms including autonomic dysfunction, mood disorders, cognitive impairment, pain, gastrointestinal disturbance, impaired olfaction, psychosis, and sleep disorders. Sleep disturbances, which include sleep fragmentation, daytime somnolence, sleep-disordered breathing, restless legs syndrome (RLS), nightmares, and rapid eye movement (REM) sleep behavior disorder (RBD), are estimated to occur in 60% to 98% of patients with PD. For years nonmotor symptoms received little attention from clinicians and researchers, but now these symptoms are known to be significant predictors of morbidity in determining quality of life, costs of disease, and rates of institutionalization. A discussion of the clinical aspects, pathophysiology, evaluation techniques, and treatment options for the sleep disorders that are encountered with PD is presented.
    Full-text · Article · Dec 2012 · Parkinson's Disease
  • Source
    • "Previous studies have reported a high incidence of sleep apnea syndrome (SAS) in PD patients (approximately 20%–60%) compared with age- and sex-matched control patients [21, 101, 102]. In these studies, the body mass index of patients with PD was similar to or even lower than that of control patients, suggesting that upper airway muscle dysfunction caused by nocturnal akinesia or dyskinesia of the respiratory muscle may play a role in the development of obstructive sleep apnea (OSA) in PD [103]. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Sleep disturbances are common problems affecting the quality life of Parkinson's disease (PD) patients and are often underestimated. The causes of sleep disturbances are multifactorial and include nocturnal motor disturbances, nocturia, depressive symptoms, and medication use. Comorbidity of PD with sleep apnea syndrome, restless legs syndrome, rapid eye movement sleep behavior disorder, or circadian cycle disruption also results in impaired sleep. In addition, the involvement of serotoninergic, noradrenergic, and cholinergic neurons in the brainstem as a disease-related change contributes to impaired sleep structures. Excessive daytime sleepiness is not only secondary to nocturnal disturbances or dopaminergic medication but may also be due to independent mechanisms related to impairments in ascending arousal system and the orexin system. Notably, several recent lines of evidence suggest a strong link between rapid eye movement sleep behavior disorder and the risk of neurodegenerative diseases such as PD. In the present paper, we review the current literature concerning sleep disorders in PD.
    Full-text · Article · Aug 2011
Show more