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Insomnia and sleepiness in Parkinson disease: associations with symptoms and comorbidities.
J Clin Sleep Med. 2013 Nov 15; 9(11):1131-7.JC

Abstract

STUDY OBJECTIVES

Insomnia and daytime sleepiness are common complaints in Parkinson disease (PD), but the main causes remain unclear. We examined the potential impact of both motor and non-motor symptoms of PD on sleep problems.

METHODS

Patients with PD (n = 128) were assessed using the Insomnia Severity Index, Epworth Sleepiness Scale, Unified Parkinson Disease Rating Scale, Beck Depression Inventory, Fatigue Severity Scale, Survey of Autonomic Symptoms, and the 39-item Parkinson Disease Questionnaire. A subset of subjects (n = 38, 30%) also completed nocturnal polysomnography and a multiple sleep latency test (MSLT).

RESULTS

Multivariate stepwise logistic regression models revealed that subjective insomnia was independently associated with depressed mood (odds ratio [OR] = 1.79; 95% confidence interval (CI) [1.01-3.19]), autonomic symptoms (1.77 [1.08-2.90]), fatigue (1.19 [1.02-1.38]), and age (0.61 [0.39-0.96]). Subjective daytime sleepiness was associated with dosage of dopaminergic medication (1.74 [1.08-2.80]) and fatigue (1.14 [1.02-1.28]). On polysomnography, longer sleep latency correlated with autonomic symptoms (rho = 0.40, p = 0.01) and part I (non-motor symptoms) of the Unified PD Rating Scale (rho = 0.38, p = 0.02). Decreased sleep efficiency correlated with autonomic symptoms (rho = -0.42, p < 0.0001). However, no significant difference emerged on polysomnography and MSLTs between patients with or without insomnia or daytime sleepiness. Higher rates of apneic events did predict shorter sleep latencies on the MSLTs.

CONCLUSIONS

Non-motor symptoms appear to be associated with subjective insomnia, whereas fatigue and dopaminergic medication are associated with subjective daytime sleepiness. Objective sleep laboratory data provided little insight into complaints of insomnia and sleepiness, though obstructive sleep apnea predicted worsened sleepiness when measured objectively.

Authors+Show Affiliations

Sleep Disorders Center and Department of Neurology, University of Michigan, Ann Arbor, MI ; Department of Psychiatry, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

24235893

Citation

Chung, Seockhoon, et al. "Insomnia and Sleepiness in Parkinson Disease: Associations With Symptoms and Comorbidities." Journal of Clinical Sleep Medicine : JCSM : Official Publication of the American Academy of Sleep Medicine, vol. 9, no. 11, 2013, pp. 1131-7.
Chung S, Bohnen NI, Albin RL, et al. Insomnia and sleepiness in Parkinson disease: associations with symptoms and comorbidities. J Clin Sleep Med. 2013;9(11):1131-7.
Chung, S., Bohnen, N. I., Albin, R. L., Frey, K. A., Müller, M. L., & Chervin, R. D. (2013). Insomnia and sleepiness in Parkinson disease: associations with symptoms and comorbidities. Journal of Clinical Sleep Medicine : JCSM : Official Publication of the American Academy of Sleep Medicine, 9(11), 1131-7. https://doi.org/10.5664/jcsm.3150
Chung S, et al. Insomnia and Sleepiness in Parkinson Disease: Associations With Symptoms and Comorbidities. J Clin Sleep Med. 2013 Nov 15;9(11):1131-7. PubMed PMID: 24235893.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Insomnia and sleepiness in Parkinson disease: associations with symptoms and comorbidities. AU - Chung,Seockhoon, AU - Bohnen,Nicolaas I, AU - Albin,Roger L, AU - Frey,Kirk A, AU - Müller,Martijn L T M, AU - Chervin,Ronald D, Y1 - 2013/11/15/ PY - 2013/11/16/entrez PY - 2013/11/16/pubmed PY - 2014/8/6/medline KW - Parkinson disease KW - daytime sleepiness KW - depression KW - insomnia KW - non-motor symptoms SP - 1131 EP - 7 JF - Journal of clinical sleep medicine : JCSM : official publication of the American Academy of Sleep Medicine JO - J Clin Sleep Med VL - 9 IS - 11 N2 - STUDY OBJECTIVES: Insomnia and daytime sleepiness are common complaints in Parkinson disease (PD), but the main causes remain unclear. We examined the potential impact of both motor and non-motor symptoms of PD on sleep problems. METHODS: Patients with PD (n = 128) were assessed using the Insomnia Severity Index, Epworth Sleepiness Scale, Unified Parkinson Disease Rating Scale, Beck Depression Inventory, Fatigue Severity Scale, Survey of Autonomic Symptoms, and the 39-item Parkinson Disease Questionnaire. A subset of subjects (n = 38, 30%) also completed nocturnal polysomnography and a multiple sleep latency test (MSLT). RESULTS: Multivariate stepwise logistic regression models revealed that subjective insomnia was independently associated with depressed mood (odds ratio [OR] = 1.79; 95% confidence interval (CI) [1.01-3.19]), autonomic symptoms (1.77 [1.08-2.90]), fatigue (1.19 [1.02-1.38]), and age (0.61 [0.39-0.96]). Subjective daytime sleepiness was associated with dosage of dopaminergic medication (1.74 [1.08-2.80]) and fatigue (1.14 [1.02-1.28]). On polysomnography, longer sleep latency correlated with autonomic symptoms (rho = 0.40, p = 0.01) and part I (non-motor symptoms) of the Unified PD Rating Scale (rho = 0.38, p = 0.02). Decreased sleep efficiency correlated with autonomic symptoms (rho = -0.42, p < 0.0001). However, no significant difference emerged on polysomnography and MSLTs between patients with or without insomnia or daytime sleepiness. Higher rates of apneic events did predict shorter sleep latencies on the MSLTs. CONCLUSIONS: Non-motor symptoms appear to be associated with subjective insomnia, whereas fatigue and dopaminergic medication are associated with subjective daytime sleepiness. Objective sleep laboratory data provided little insight into complaints of insomnia and sleepiness, though obstructive sleep apnea predicted worsened sleepiness when measured objectively. SN - 1550-9397 UR - https://www.unboundmedicine.com/medline/citation/24235893/Insomnia_and_sleepiness_in_Parkinson_disease:_associations_with_symptoms_and_comorbidities_ L2 - https://doi.org/10.5664/jcsm.3150 DB - PRIME DP - Unbound Medicine ER -