Objective: To investigate longitudinal changes in the prevalence of different sleep disorders in the PPMI cohort of patients with Parkinson’s Disease (PD).

Background: Sleep disturbances are common in advanced PD but they are frequently present also in the early and prodromal stages of disease. However, little is known about the prevalence and potential interactions between different types of sleep disorders and their evolution over time, particularly in the natural history of early PD.

Methods: Data was obtained from the Parkinson Progression Markers Initiative (PPMI) database. REM sleep behavior Disorder (RBD), excessive daytime sleepiness (EDS), and insomnia were defined using the RBD Screening Questionnaire (>5), Epworth Sleepiness Score (> or = 10) and UPDRS Part 1.7 (> or = 2).

Results: Two hundred and eighteen PD patients with a completed 5 year-clinical follow-up were included. At baseline, 55.5% PD patients did not report any sleep complaint. 31.7% of PD patients reported 1 sleep disorder: 12.8% reported insomnia only, 10.6% reported RBD only, and 8.3% EDS only. 11.5% PD patients reported 2 sleep disorders: 5.0% reported EDS and RBD, 4.1% reported both insomnia and RBD, and 2.3%reported both insomnia and EDS. Only 1.4% PD patients reported all 3 sleep disorders. At 5 years, the percentage of patients with no sleep complaints was reduced to 30.3%. 39.0% PD patients reported 1 sleep complaint: 19.3% reported insomnia only, 11.0% reported RBD only, and 8.7% reported EDS only. 23.4% of PD patients reported 2 sleep disorders: 10.6% reported insomnia and EDS, 7.3% reported insomnia and RBD, and 5.5% reported RBD and EDS. 7.3% PD patients reported 3 sleep disorders. The largest increase in reported prevalence was seen for insomnia, followed by EDS and then RBD. At baseline, 20.6% of PD subjects reported insomnia which increased to 55.5% at 5 years (p<0.001); 17.0% of PD subjects reported EDS which increased to 32.1% at 5 years (p<0.001); 21.1% of PD subjects reported RBD, which increased to 31.2% at 5 years (p=0.005).

Conclusions: Although sleep disorders are common in early PD, one-third of PD patients in the PPMI cohort remained free of sleep complaints 5 years after disease onset. Amongst the sleep disorders studied, the greatest reported increase in prevalence over the 5-year period was observed for insomnia, followed by EDS and RBD. The number of patients with multiple sleep disorders was relatively low suggesting that they can have different pathogenesis.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/progression-of-sleep-disorders-spectrum-in-parkinsons-disease-a-5-year-clinical-longitudinal-study/