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

• DOI: 10.1136/jnnp-2017-316136
• Publication Date: 2017-08-29T00:45:22Z
• Authors: Keisuke Suzuki; Yasuyuki Okuma; Tomoyuki Uchiyama; Masayuki Miyamoto; Ryuji Sakakibara; Yasushi Shimo; Nobutaka Hattori; Satoshi Kuwabara; Toshimasa Yamamoto; Yoshiaki Kaji; Shigeki Hirano; Taro Kadowaki; Koichi Hirata
• Keywords: Male; Neurologic Examination; Movement Disorders; Statistics as Topic; Parkinson Disease; Disorders of Excessive Somnolence; REM Sleep Behavior Disorder; Middle Aged; 3. Good health; Disability Evaluation; 03 medical and health sciences; Cross-Sectional Studies; 0302 clinical medicine; Case-Control Studies; Humans; Female; Aged

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