Objective: To examine if dyskinesia severity, assessed both clinically and using wearable technology, is independently associated with global and domain-specific sleep disturbance in people with Parkinson’s disease (PD).

Background: Levodopa-induced dyskinesias affect up to 80% of patients within 10 years of treatment. Sleep disturbances affect approximately 60% of people with PD. Although experimental data suggest a bidirectional relationship between sleep physiology and dyskinesia, the clinical relationship between overall dyskinesia burden and sleep impairment remains unclear.

Method: We studied 47 people with idiopathic PD (median age 68 years [62-76]); 45% female; median disease duration 5 years; 61.7% were White or White British, 31.9% Asian or Asian British, and 6.4% Black, African, Caribbean or Black British; median Hoehn and Yahr stage 3 [2-3]). Dyskinesia severity was measured using Movement Disorder Society-Unified Parkinson’s Disease Rating Scale (MDS-UPDRS) Part IV Items 4.1 (time with dyskinesia) and 4.2 (functional impact), and 7-day Parkinson’s KinetiGraph monitoring to derive median dyskinesia score (DK_50) and Fluctuation Dyskinesia Score (FDS). The Pittsburgh Sleep Quality Index (PSQI) total score, which reflects average sleep quality over the past month, was prespecified as the primary sleep outcome; component scores were analysed as secondary outcomes. Multivariable linear-regression models adjusted for age, sex, disease duration, motor severity, levodopa equivalent daily dose, mood, and cognition.

Results: In covariate-adjusted models, increased time spent with dyskinesias (MDS-UPDRS IV Item 4.1) was associated with higher PSQI total scores (B=1.26, p=.038) and greater sleep medication use (B=0.32, p=.003), while greater functional impact (Item 4.2) was strongly associated with sleep medication use (B=0.41, p<.001). Wearable-derived measures demonstrated concordant findings: higher FDS was independently associated with higher PSQI total scores (B=0.54, p=.007), and higher DK_50 was also associated higher PSQI total scores (B=0.17, p=.042). Secondary analyses showed associations between FDS and PSQI sleep disturbance (B=0.10, p=.043) and habitual sleep efficiency (B=0.08, p=.024).

Conclusion: Prospective longitudinal studies are required to clarify directionality and determine whether optimisation of dyskinesia management improves sleep outcomes.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/sleep-disturbances-and-dyskinesia-burden-in-parkinsons-disease-relevance-for-motor-complication-management/