Objective:

Analyze the impact of sleep disorders (SD) on the severity of non-motor symptoms (NMS) in Parkinson’s Disease (PD) patients

Background:

Sleep is a physiological process that requires complex interactions within the brain, it is of great importance for overall health and quality of life, serving a purpose in memory consolidation, neuroplasticity, and molecular clearance(1). It is mainly divided into stages of rapid eye movement (REM) and non-REM. SD are the second most common non-motor affliction within PLPD(2). Other NMS include neuropsychiatric disorders, autonomic dysfunction, sensory symptoms, and pain (3). A relationship between SD and NMS severity is shown in various studies(4–6).

Method:

We performed a retrospective longitudinal study.  PD patients were selected regardless of age, sex, or disease progression. This group was divided into two categories: Patients with and without SD diagnosis; the first category was later subdivided into specific diagnoses: insomnia, OSA, RLS, EDS, RBD, and sleep fragmentation (SF). NMS were evaluated using the Movement Disorder Society Nonmotor Rating Scale (MDS-NMS)

Results:

181 patients included: 98 males (54.1%) and 83 females (45.8%). The mean age is  62 ± 12.2 years.  Hoehn and Yahr stage: II mainly (57%). SD was identified in 92 patients (50.8%), insomnia being the most common (27.1 %), followed by RBD (14.4%), and SF (8.8%).  NMS-MDS scores mean 73 ± 50.3.  Kolmogorov- Smirnov normality test was performed showing non-parametric variables.  A Mann-Whitney U test was used to correlate the NMS-MDS score with the patients with an SD diagnosis, which showed a p(0.72). On further analysis, a correlation was made between NMS-MDS domain L. Pain with a p of (0.023).

Conclusion:

Even though the results from our first correlation were not statistically significant, we can find an association between SD and pain in deeper analysis. An explanation for this is found at a neuroanatomical level: the mesolimbic dopaminergic pathways are part of the sleep-wake cycle and endogenous analgesia system(7). Sleep disturbances can be a predictor and etiology in chronic pain(8), causing a state of central sensitization and a neuroinflammatory state. The dopaminergic dysfunction in PD further aggravates the cycle. Further studies are needed.

References: References
1. Okechukwu CE. The neurophysiologic basis of the human sleep–wake cycle and the physiopathology of the circadian clock: a narrative review. Vol. 58, Egyptian Journal of Neurology, Psychiatry and Neurosurgery. Springer Science and Business Media Deutschland GmbH; 2022.
2. Zahed H, Zuzuarregui JRP, Gilron R, Denison T, Starr PA, Little S. The Neurophysiology of Sleep in Parkinson’s Disease. Vol. 36, Movement Disorders. John Wiley and Sons Inc; 2021. p. 1526–42.
3. Poewe W. Non-motor symptoms in Parkinson’s disease.
4. Neikrug AB, Avanzino JA, Liu L, Maglione JE, Natarajan L, Corey-Bloom J, et al. Parkinson’s disease and REM sleep behavior disorder result in increased non-motor symptoms. Sleep Med. 2014;15(8):959–66.
5. Bohnen NI, Hu MTM. Sleep Disturbance as Potential Risk and Progression Factor for Parkinson’s Disease. Vol. 9, Journal of Parkinson’s Disease. IOS Press; 2019. p. 603–14.
6. Fu YT, Mao CJ, Ma LJ, Zhang HJ, Wang Y, Li J, et al. Pain Correlates with Sleep Disturbances in Parkinson’s Disease Patients. Pain Practice. 2018 Jan 1;18(1):29–37.
7. Neu D, Cagnie B, Nijs J, Mairesse O, Neu D, Leysen L, et al. Perspective Sleep Disturbances in Chronic Pain: Neurobiology, Assessment, and Treatment in Physical Therapist Practice [Internet]. Vol. 98, Physical Therapy  325 J. Nijs. 2018. Available from: https://academic.oup.com/ptj/article-abstract/98/5/325/4841863
8. Haack M, Simpson N, Sethna N, Kaur S, Mullington J. Sleep deficiency and chronic pain: potential underlying mechanisms and clinical implications. Vol. 45, Neuropsychopharmacology. Springer Nature; 2020. p. 205–16.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/sleep-disorders-and-their-relationship-to-non-motor-symptoms-in-mexican-parkinsons-disease-patients/