Objective: This study aimed to comprehensively investigate the associations between sleep disturbance and several non-motor symptoms, with a particular focus on the relationship with fatigue.

Background: Sleep disturbance has also been suggested to be associated with depression and fatigue. However, comprehensive studies examining these associations in Japanese patients with PD remain limited.

Method: We conducted a cross-sectional study including approximately 45 PD patients attending our hospital. Sleep disturbance severity was assessed using the Parkinson’s Disease Sleep Scale-2 (PDSS-2), and participants were divided into two groups based on the presence or absence of sleep disturbance. We compared Hoehn and Yahr stage (HY), levodopa equivalent dose (LED), Mini-Mental State Examination (MMSE), Montreal Cognitive Assessment, Frontal Assessment Battery, Self-Rating Depression Scale (SDS), Apathy Scale, Parkinson Fatigue Scale (PFS), and Parkinson’s Disease Questionnaire-8 (PDQ-8) between the two groups. Between-group comparisons were performed using the Mann-Whitney U test. Additionally, correlations between PDSS-2 total and item scores and PFS were analyzed using Spearman’s rank correlation coefficient.

Results: A total of 45 patients were included (mean disease duration 8.8±1.0 years). The group with sleep disturbance showed significantly higher HY stage (p=0.015) and LED (p=0.039) compared to those without sleep disturbance. SDS (p=0.007) and PDQ-8 (p=0.003) scores were also significantly higher in the sleep disturbance group. Correlation analyses demonstrated moderate positive correlations between PDSS-2 total score and SDS (ρ = 0.512, p = 0.001), as well as PDQ-8 (ρ = 0.542, p < 0.001). In item-level analyses, PDSS-2 item 13 (ρ=0.437, p=0.004) and item 14 (ρ=0.573, p<0.001) showed significant positive correlations with PFS.

Conclusion: Sleep disturbance in PD patients was associated with greater disease severity and higher levodopa equivalent dose, and was correlated with depressive symptoms and reduced QOL. Specific nocturnal symptoms such as nocturnal tremor and morning tiredness or sleepiness were significantly associated with fatigue. These findings suggest that qualitative aspects of nocturnal symptoms, rather than the mere presence of sleep disturbance, may contribute to fatigue in PD.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/association-between-sleep-disturbance-and-fatigue-in-patients-with-parkinsons-disease/