Objective: To explore the relationship between sleep quality and medical treatment in patients with PD.

Background: Disturbances, autonomic dysfunction and depression are common non-motor symptoms even in early Parkinson’s disease (PD), markedly affecting their quality of life. Symptomatic relief is often provided by medications that can affect multiple non-motor domains. The interplay between symptomatic medications and sleep interruptions in early stages of the disease is not clear.

Method: Sleep interruptions were assessed using a tri-axial accelerometer worn on the lower back for seven consecutive nights. Sleep interruptions were classified as getting up or out of bed during the night based on the change in the vertical axis. Patients were classified as having sleep interruptions if they presented more than one standard deviation from the median percent wake time of age matched healthy adults (i.e., >1.4 percent wake time per night). Non-motor symptoms were assessed using the Non-Motor Symptoms Questionnaire (NMSQ). Levodopa Equivalent Daily Dose (LEDD) was calculated and concomitant medication were assessed as well. Statistical analysis was adjusted for age, gender, LEDD and disease duration.

Results: 149 patients with PD were included (mean age: 65.7±9.8; 70% male, MDS-UPDRS-III: 19.9±11.1, disease duration: 3.3±2.2; LEDD: 399.4±339.1). Percent wake time at night was highly variable (0-16%) with 40 patients (27%) classified as suffering from sleep interruptions. Patients with sleep interruptions had significantly worse NMS (10.9±5.1 vs. 6.6±3.9; p<0.001 with 85% reporting nocturnal urination p<0.001). Sleep interruptions were significantly correlated with LEDD (r=0.203, p=0.025) and anti-hypertensive medications (r=0.422; p=0.008), potentially explaining nighttime urination. Of the 9.4% of patients receiving sleep medication, 76.9% did not have sleep interruptions.

Conclusion: Sleep interruptions are common even in early stages of PD and are highly associated with nocturnal urination and hypertension. Sleep medications might be effective in reducing sleep interruptions in early stage PD.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/relationship-between-non-motor-symptoms-medications-and-sleep-interruptions-in-patients-with-parkinsons-disease/