---------------------------------------------------------------------------- Sleep disorder related to Parkinson's disease. ---------------------------------------------------------------------------- Sleep disorders occur in 74-98% of patients with idiopathic Parkinson's disease (PD), adversely affecting their quality of life. Sleep disruption takes the form of sleep fragmentation with frequent and prolonged awakenings and daytime sleepiness. Nocturia, difficulty in turning over in bed, painful leg cramps, vivid dreams/nightmares, back pain, limb/facial dystonia and leg jerks are the main causes of nocturnal awakening in PD patients. Sleep disturbance gradually worsens with disease progression, suggesting that it is related to the severity of the disease. Sleep disturbances may be generally considered as part of the normal aging process, being more common in the elderly. However, no significant associations between sleep disturbances and either age or disease duration was found in a survey of 100 PD patients. Disturbed sleep maintenance in PD patients was more severe than in age-matched controls, and nocturnal awakening was frequently caused by nocturia, pain, stiffness and difficulty in turning over in bed. Sleep disturbance is also a complication of chronic levodopa therapy. Recent data suggest that controlled-release levodopa is less likely to cause nocturnal symptoms than standard levodopa, particularly in mild-to-moderate disease. Depression, which is common in PD patients, contributes to sleep disturbance but has a lesser influence than the disease process itself. Hypnotic and sedative agents, as well as anti-depressants if required, are useful in ameliorating sleep disturbances in PD patients; intranasal desmopressin appears to be effective in reducing nocturia. J Neurol 1997 Apr;244(4 Suppl 1):S3-S6 Partinen M Haaga Centre for Neurological Research, Helsinki, Finland. PMID: 9112582, MUID: 97266863 ---------------------------------------------------------------------------- Sleep disturbances in Parkinson's disease patients and spouses. ---------------------------------------------------------------------------- OBJECTIVES: The prevalence of self-rated sleep disturbance in patients with Parkinson's disease (PD) and their spouses was compared with healthy controls, and the association of sleep disturbance with demographic, psychological, and disease variables was assessed. DESIGN: The sleep ratings from three groups, PD patients, their spouses, and healthy controls, were compared using analyses of variance. Stepwise regressions were used to predict sleep disturbance for each group and= gender. SETTING: Participants completed questionnaires as part of a nationwide survey in Germany. PARTICIPANTS: Participants included 153 PD-spouse pairs and a group of 103 healthy controls. MEASUREMENTS: Zung Self-Rating Depression Scale and self-ratings of sleep disturbance, stress level, and disease symptoms (for PD patients). RESULTS: Sleep disturbances were significantly higher in women than in men in all groups. For PD patients, sleep disturbance occurred frequently in 25% of male and 41% of female participants and was best predicted by the patient's depression rating. For spouses, frequent sleep disturbance was reported by 27% of male and 48% of females and was likewise predicted by the spouse's own rating of depression. A second, relatively less common type of sleep disturbance was also reported by spouses. This disturbance was associated with waking during the night to help the patient and was best predicted by patient factors. CONCLUSION: Improvement of sleep quality of caregivers may be an important component of treatment to reduce distress caused by PD. J Am Geriatr Soc 1997 Feb;45(2):194-199 Smith MC, Ellgring H, Oertel WH Dept. of Psychology, University of Portsmouth, UK. PMID: 9033518, MUID: 97185837 ---------------------------------------------------------------------------- Complications of disease and therapy: A comparison of younger [41-64] and older [65+] patients with PD ---------------------------------------------------------------------------- The incidence of complications associated with disease and treatment was compared in younger versus elderly patients with Parkinson's disease (PD). One hundred sixty-five patient records were divided according to patient age into two groups ("younger," 41-64, and "elderly," 65+ years) and reviewed for the incidence of dyskinesias, fluctuations, freezing, psychosis, dementia, depression, and insomnia. Younger patients had a greater incidence of: chorea (75.8 percent vs 49.5 percent), dystonia (82.3 percent vs 49.0 percent), fluctuations (90.1 percent vs 68.1 percent), depression (73.2 percent vs 36.8 percent), and insomnia (57.9 percent vs 18.1 percent). There were no significant differences in the incidence of freezing, dementia, or psychosis. At the time of the first adverse event, there was no difference in patient characteristics such as gender, lag time from disease diagnosis to levodopa initiation, disease symptoms at the time of diagnosis, levodopa dose, or concomitant drug use despite the fact that the older group had a longer duration of disease, higher Hoehn and Yahr stage, an older age at onset of PD, and longer duration of levodopa use. Younger patients with PD experience a greater incidence of adverse effects than do elderly PD patients. The spectrum of adverse effects is comparable to those of young-onset (40 or under) patients. Ann Clin Lab Sci 1996 Sep;26(5):389-395 Wagner ML, Fedak MN, Sage JI, Mark MH College of Pharmacy, Rutgers State University, New Jersey 08855, USA. PMID: 8879356, MUID: 97033698 ---------------------------------------------------------------------------- Sleep disorders, pain, and depression in Parkinson's disease. ---------------------------------------------------------------------------- A consecutive series of patients with Parkinson's disease (PD) were examined for the presence of sleep disturbances, pain, and depression. We found that patients with PD and major depression had significantly more sleep disturbances and severe pain than non-depressed patients with PD. Moreover, depression scores accounted for most of the variance in a stepwise regression analysis of the effect of numerous clinical variables on either sleep disorders or pain severity. These findings suggest that depression is the most important factor associated with the common problems of sleep disorder and pain among patients with PD. Eur Neurol 1991;31(6):352-355 Starkstein SE, Preziosi TJ, Robinson RG University of Buenos Aires, Argentina. PMID: 1756757, MUID: 92097600 ---------------------------------------------------------------------------- Sleep EEG in depressed and nondepressed patients with Parkinson's disease. ---------------------------------------------------------------------------- Sleep patterns of two consecutive nights were analyzed in 26 drug-free patients with Parkinson's disease (PD), who were clinically divided into depressed (n =3D 8) and nondepressed (n =3D 18) groups. Sleep electroencephalographic (EEG) recording showed significantly shorter rapid eye movement (REM) latency in depressed PD patients (41.1 +/- 21.7 min) compared to nondepressed PD patients (129.0 +/- 84.9 min, p less than 0.002). Furthermore, shortened REM latency (less than or equal to 65.0 min) was observed with significantly more frequency in depressed PD patients (6 out of 8) compared to nondepressed PD patients (4 out of 18, p less than 0.02). The other sleep parameters studied did not differ significantly between the two groups of patients. Because shortened REM latency is one of the most reliably documented biological features of major depression, these findings may be of some importance for understanding the nature of depression in the course of PD. J Neuropsychiatry Clin Neurosci 1991;3(2):176-179 Kostic VS, Susic V, Przedborski S, Sternic N Neurological Clinic UCC, School of Medicine, Belgrade, Yugoslavia. PMID: 1821232, MUID: 92330431 ---------------------------------------------------------------------------- Treatment with weak electromagnetic fields restores dream recall in a Parkinsonian patient. ---------------------------------------------------------------------------- Absent or markedly reduced REM sleep with cessation of dream recall has been documented in numerous neurological disorders associated with subcortical dementia including Parkinson's disease, progressive supranuclear palsy and Huntington's chorea. This report concerns a 69 year old Parkinsonian patient who experienced complete cessation of dreaming since the onset of motor disability 13 years ago. Long term treatment with levodopa and dopamine (DA) receptor agonists (bromocriptine and pergolide mesylate) did not affect dream recall. However, dreaming was restored after the patient received three treatment sessions with AC pulsed picotesla range electromagnetic fields (EMFs) applied extracranially over three successive days. Six months later, during which time the patient received 3 additional treatment sessions with EMFs, he reported dreaming vividly with intense colored visual imagery almost every night with some of the dreams having sexual content. In addition, he began to experience hypnagogic imagery prior to the onset of sleep. Cessation of dream recall has been associated with right hemispheric dysfunction and its restoration by treatment with EMFs points to right hemispheric activation, which is supported by improvement in this patient's visual memory known to be subserved by the right temporal lobe. Moreover, since DA neurons activate REM sleep mechanisms and facilitate dream recall, it appears that application of EMFs enhanced DA activity in the mesolimbic system which has been implicated in dream recall. Also, since administration of pineal melatonin has been reported to induce vivid dreams with intense colored visual imagery in normal subjects and narcoleptic patients, it is suggested that enhanced nocturnal melatonin secretion was associated with restoration of dream recall in this patient. These findings demonstrate that unlike chronic levodopa therapy, intermittent pulsed applications of AC picotesla EMFs may induce in Parkinsonism reactivation of reticular-limbic-pineal systems involved in the generation of dreaming. Int J Neurosci 1997 Jun;90(1-2):75-86 Sandyk R Institute for Biomedical Engineering and Rehabilitation Services, Touro College, Dix Hills, NY 11746, USA. PMID: 9285289, MUID: 97431196 ---------------------------------------------------------------------------- 'Sleep Benefit' [SB] in Parkinson's disease [PD] ---------------------------------------------------------------------------- Sleep benefit (SB) In Parkinson's disease (PD) is not well characterized. To determine SB frequency, as well as to characterize and correlate it with other disease variables, we evaluated prospectively a consecutive series of 312 PD patients by means of a structured questionnaire: 55% reported having SB and 35% reported that awakening was their best time of the day. Because of SB, 21% of the entire population were able to skip or delay medication. The mean duration of the phenomenon was 85.4 +/- 67 min. Patients with SB were significantly older (p < 0.0002), had disease longer (p < 0.05), and were often men (chi 2 =3D 3.5, df 1, p =3D 0.05). Patients with SB took sleep medication with similar frequency as those without SB. There were no differences in hours of sleep or sleep latency. Sleep problems such as nightmares or somnambulism, but not the number of sleep awakenings, were similar in both groups. In conclusion, SB is a frequent phenomenon, especially in men, elderly patients, and patients with longer disease duration. SB enables the morning L-dopa dose to be postponed in approximately 50% of patients. Mov Disord 1997 Jul;12(4):506-508 Merello M, Hughes A, Colosimo C, Hoffman M, Starkstein S, Leiguarda R Institute for Neurological Research, Buenos Aires, Argentina. PMID: 9251067, MUID: 97394754 ---------------------------------------------------------------------------- Clinical correlates of 'Sleep Benefit' [SB] in Parkinson's disease [PD] ---------------------------------------------------------------------------- The phenomenon of sleep benefit, a period of lessened disability or feeling "on" upon awakening from sleep in the morning, has received scant attention in the literature on Parkinson's disease. We interviewed 162 consecutive patients regarding disease onset, medication history, and symptoms, evaluated them using the Unified Parkinson's Disease Rating Scale, and assessed them as to the presence or absence of sleep benefit. Thirty-three percent reported experiencing sleep benefit. Compared with patients not having sleep benefit, patients with sleep benefit tended to be younger at disease onset, have longer disease duration, take higher total daily doses of levodopa, have longer duration of levodopa treatment, and exhibit less cognitive and physical disability. The findings of this study suggest that sleep benefit is a common phenomenon that may be anticipated in a subgroup of patients with Parkinson's disease. The mechanisms underlying sleep benefit do not appear to be simple and may be multifactorial. Clinicians need to be aware of the authenticity of patients' reports of sleep benefit and consider the existence of this phenomenon when prescribing or adjusting patients' medication schedules. Neurology 1997 Apr;48(4):1115-1117=7F Currie LJ, Bennett JP Jr, Harrison MB, Trugman JM, Wooten GF University of Virginia Health Sciences Center, Virginia 22908, USA. PMID: 9109914, MUID: 97264042 ---------------------------------------------------------------------------- [log in to unmask]