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Review
Sleep disturbance in movement disorders: insights, treatments and challenges
  1. Grace A Bailey1,
  2. Emily K Hubbard2,
  3. Alfonso Fasano3,4,5,
  4. Marina AJ Tijssen6,
  5. Timothy Lynch7,
  6. Kirstie N Anderson8,
  7. Kathryn J Peall1
  1. 1Neuroscience and Mental Health Research Institute, Cardiff University, Cardiff, UK
  2. 2School of Medicine, Cardiff University, Cardiff, South Glamorgan, UK
  3. 3Edmond J Safra Program in Parkinson’s Disease, Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, Toronto, Ontario, Canada
  4. 4Division of Neurology, University of Toronto, Toronto, Ontario, Canada
  5. 5Krembil Research Institute, Toronto, Ontario, Canada
  6. 6Department of Neurology, University Medical Centre Groningen, Groningen, The Netherlands
  7. 7Dublin Neurological Institute, The Mater Misericordiae University Hospital, Dublin, Dublin, Ireland
  8. 8Department of Neurology, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, Newcastle upon Tyne, UK
  1. Correspondence to Dr Kathryn J Peall, Neuroscience and Mental Health Research Institute, Cardiff University, Cardiff CF24 4HQ, UK; PeallKJ{at}cardiff.ac.uk

Abstract

Sleep and circadian rhythm disturbances are central features of many movement disorders, exacerbating motor and non-motor symptoms and impairing quality of life. Understanding these disturbances to sleep is clinically important and may further our understanding of the underlying movement disorder. This review evaluates the current anatomical and neurochemical understanding of normal sleep and the recognised primary sleep disorders. In addition, we undertook a systematic review of the evidence for disruption to sleep across multiple movement disorders. Rapid eye movement sleep behaviour disorder has emerged as the most reliable prodromal biomarker for the alpha synucleinopathies, including Parkinson’s disease and multiple system atrophy, often preceding motor symptom onset by several years. Abnormal sleep has also been described for many other movement disorders, but further evidence is needed to determine whether this is a primary or secondary phenotypic component of the underlying condition. Medication used in the treatment of motor symptoms also affects sleep and can aggravate or cause certain sleep disorders. Within the context of movement disorders, there is also some suggestion of a shared underlying mechanism for motor and sleep pathophysiology, with evidence implicating thalamic and brainstem structures and monoaminergic neurotransmission. This review highlights the need for an understanding of normal and abnormal sleep within the movement disorder clinic, an ability to screen for specific causes of poor sleep and to treat sleep disturbance to improve quality of life. Key sleep disorders also act as important biomarkers and have implications in diagnosis, prognosis and the development of future therapies.

  • movement disorders
  • sleep
  • sleep disorders

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Footnotes

  • Contributors GAB: Conception, acquisition, analysis and interpretation of the data, drafting and revising critically for important intellectual content. EKH: acquisition, analysis and interpretation of the data, drafting and revising critically for important intellectual content. AF: drafting and revising critically for important intellectual content. MAT: drafting and revising critically for important intellectual content. TL: drafting and revising critically for important intellectual content. KNA: Conception, acquisition, analysis and interpretation of the data, drafting and revising critically for important intellectual content. KJP: Conception, acquisition, analysis and interpretation of the data, drafting and revising critically for important intellectual content.

  • Funding GAB is funded by a KESS2, European Social Fund and Cardiff University PhD Studentship. KJP is funded by an MRC Clinician-Scientist Fellowship (MR/P008593/1).

  • Competing interests None declared.

  • Patient consent for publication Not required.

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

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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