Objective: To assess which (non-)motor symptoms are associated with the longitudinal development of sleep disturbances, one of the major non-motor symptoms (NMS) in Parkinson’s disease (PD) patients.

Background: Although the role of depression and cognition in sleep problems in PD is well-established, whether other NMS are associated with the development of sleep problems remains understudied.

Method: A longitudinal analysis of 209 participants enrolled in the global Non-motor Longitudinal International Study (NILS; UKCRN No: 10084, database held at King’s College Hospital (London UK)). Patients were stratified (good sleep (n=160) and poor sleep (n=49)) based on PD Sleep Scale (PDSS) scores at follow-up, where scores < 82 were considered as poor sleep [1]. We used the Non-Motor Symptom (NMSS), Hospital Anxiety and Depression (HADS), and Epworth Sleepiness scales (ESS), Mini Mental State Examination (MMSE), and Scales for Outcomes in Parkinson's disease (SCOPA) as predictors. Group differences were assessed with the Mann-Whitney-U-test, and baseline to follow-up differences with the Wilcoxon signed rank test, with correction for multiple testing.

Results: Average disease duration was 6.2±6.9 years at baseline and 9.2±7.0 years at follow-up. At baseline, no differences were observed between groups for age, sex, disease duration, Hoehn and Yahr, and levodopa equivalent dose (p≥0.19). Those with poor sleep at follow-up, had higher NMSS total scores, NMSS mood/cognition, urinary, and miscellaneous scores, SCOPA motor and disability scores, and HADS (anxiety and depression) scores at baseline (p≤0.003). Over the follow-up period the only NMS to change was the NMSS perceptual domain scores, which worsened (p=0.002). There were no differences in baseline dopamine transporter scan ratios (for striatum, putamen and caudate) between groups (p≥0.22).

Conclusion: In this cohort of moderately advanced to advanced PD patients, poor sleep after three years was associated with differences in NMSS total scores, mood/cognition, urinary problems, the NMSS miscellaneous domain, and worse SCOPA motor and disability scores at baseline. These symptoms should alert health care professionals to the development of poor sleep in PD patients.

References: 1. Martinez-Martin P, Visser M, Rodriguez-Blazquez C, Marinus J, Chaudhuri KR, van Hilten JJ; SCOPA-Propark Group; ELEP Group. SCOPA-sleep and PDSS: two scales for assessment of sleep disorder in Parkinson’s disease. Mov Disord. 2008;23(12):1681-8. doi: 10.1002/mds.22110.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/motor-and-non-motor-symptoms-related-to-sleep-disturbances-in-parkinsons-disease/