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  • Impact of sleep-related symptoms on clinical motor subtypes and disability in Parkinson’s disease: a multicentre cross-sectional study

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Movement disorders
Research paper
Impact of sleep-related symptoms on clinical motor subtypes and disability in Parkinson’s disease: a multicentre cross-sectional study
  1. Keisuke Suzuki1,
  2. Yasuyuki Okuma2,
  3. Tomoyuki Uchiyama1,3,
  4. Masayuki Miyamoto4,
  5. Ryuji Sakakibara5,
  6. Yasushi Shimo6,
  7. Nobutaka Hattori6,
  8. Satoshi Kuwabara7,
  9. Toshimasa Yamamoto8,
  10. Yoshiaki Kaji1,
  11. Shigeki Hirano7,
  12. Taro Kadowaki1,
  13. Koichi Hirata1
  14. on behalf of the Kanto NMPD investigators
  1. 1 Department of Neurology, Dokkyo Medical University, Tochigi, Japan
  2. 2 Department of Neurology, Juntendo University Shizuoka Hospital, Shizuoka, Japan
  3. 3 Neuro-urology and Continence Center, Dokkyo Medical University Hospital, Tochigi, Japan
  4. 4 Department of Clinical Medicine for Nursing, Dokkyo Medical University School of Nursing, Tochigi, Japan
  5. 5 Department of Internal Medicine, Neurology Division, Sakura Medical Center, Toho University, Sakura, Japan
  6. 6 Department of Neurology, Juntendo University School of Medicine, Tokyo, Japan
  7. 7 Department of Neurology, Chiba University Graduate, School of Medicine, Chiba, Japan
  8. 8 Department of Neurology, Saitama Medical University, Saitama, Japan
  1. Correspondence to Dr Keisuke Suzuki, Department of Neurology, Dokkyo Medical University, 880 Kitakobayashi, Mibu, Shimotsuga, Tochigi 321-0293, Japan; keisuke{at}dokkyomed.ac.jp

Abstract

Objectives To investigate the impact of sleep disturbances on Parkinson’s disease (PD) clinical motor subtypes and disease-related disability in a multicentre setting.

Methods We report a cross-sectional relationship between sleep-related symptoms and clinical motor subtypes (tremor dominant (TD); intermediate; postural instability and gait disturbances (PIGDs)) identified in a multicentre study, including 436 patients with PD and 401 age-matched controls. PD-related sleep problems (PD-SP), excessive daytime sleepiness (EDS) and probable REM sleep behaviour disorder (pRBD) were evaluated using the PD sleep scale (PDSS)-2, Epworth Sleepiness Scale (ESS) and RBD screening questionnaire-Japanese version (RBDSQ-J), respectively.

Results PD-SP (PDSS-2 ≥18; 35.1% vs 7.0%), EDS (ESS ≥10; 37.8% vs 15.5%) and pRBD (RBDSQ-J ≥5; 35.1% vs 7.7%) were more common in patients with PD than in controls. The prevalence of restless legs syndrome did not differ between patients with PD and controls (3.4% vs 2.7%). After adjusting for age, sex, disease duration and Movement Disorder Society-Unified PD Rating Scale (MDS-UPDRS) part III score, the PIGD group had higher PDSS-2 and ESS scores than the TD group. The RBDSQ-J scores did not differ among the TD, intermediate and PIGD groups. A stepwise regression model predicting the MDS-UPDRS part II score identified the Hoehn and Yahr stage, followed by the number of sleep-related symptoms (PD-SP, EDS and pRBD), disease duration, MDS-UPDRS part III score, PIGD subtype, depression and MDS-UPDRS part IV score as significant predictors.

Conclusion Our study found a significant relationship between sleep disturbances and clinical motor subtypes. An increased number of sleep-related symptoms had an impact on disease-related disability.

  • Parkinson’s disease
  • sleep disorders
  • excessive daytime sleepiness
  • clinical motor phenotype

This is an Open Access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY 4.0) license, which permits others to distribute, remix, adapt and build upon this work, for commercial use, provided the original work is properly cited. See: http://creativecommons.org/licenses/by/4.0/

https://doi.org/10.1136/jnnp-2017-316136

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    Footnotes

    • Contributors Conceived and designed the study: KS, YO, TU, MM, NH, SK and KH. Performed the study: KS, YO, TU, MM, RS, YS, NH, SK, TY, YK, SH, TK and KH. Performed statistical analysis: KS. Wrote the paper: KS. Critical revision of the manuscript: YO, TU, MM, RS, YS, NH, SK, TY, YK, SH, TK and KH.

    • Competing interests None declared.

    • Patient consent Obtained.

    • Ethics approval The study was approved by the institutional review boards of the participating facilities, and written informed consent was obtained from all participants enrolled in the study.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Collaborators Ayaka Numao, MD (Department of Neurology, Dokkyo Medical University, Tochigi, Japan), Tatsuya Yamamoto (Department of Neurology, Chiba University Graduate School of Medicine, Chiba), Taku Hatano, MD (Department of Neurology, Juntendo University School of Medicine, Tokyo, Japan), Tomoyuki Miyamoto, MD (Department of Neurology, Dokkyo Medical University Koshigaya Hospital, Saitama, Japan), Shiho Suzuki, MD (Department of Neurology, Dokkyo Medical University, Tochigi, Japan), Yuka Watanabe, MD (Department of Neurology, Dokkyo Medical University Nikko Medical Center, Tochigi, Japan), Hideki Shimura, MD and Takao Urabe, MD (Department of Neurology, Juntendo University Urayasu Hospital, Tokyo, Japan)