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Journal of Neurology

Erschienen in:

01.05.2011

When Parkinson’s disease patients go to sleep: specific sleep disturbances related to Parkinson’s disease

verfasst von: Eva C. Schulte, Juliane Winkelmann

Erschienen in: Journal of Neurology | Sonderheft 2/2011

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Abstract

Nonmotor symptoms of Parkinson’s disease can be as disabling as the much better studied motor symptoms. Among the nonmotor manifestations are numerous forms of alterations of physiologic sleep patterns that may present at different stages during the course of disease. These include changes believed to be primarily related to the underlying neurodegenerative process of the disease as well as those brought about secondarily, for example, by pharmacologic treatment. Also, sleep disturbances seen in Parkinson’s disease can range from temporarily increased daytime sleepiness after introduction of a dopamine agonist to the therapeutic regime to specific sleep-related diagnoses such as restless legs syndrome, rapid eye movement sleep behavior disorder, periodic limb movements in sleep, and sleep-related breathing disorders such as obstructive sleep apnea. In this review, we discuss the different specific sleep disturbances that arise in the context of Parkinson’s disease with a special emphasis on epidemiology, pathophysiology, and diagnosis.

Allen RP, Picchietti D, Hening WA, Trenkwalder C, Walters AS, Montplaisir J, on behalf of the Restless Legs Syndrome Diagnosis and Epidemiology workshop at the National Institutes of Health and the International Restless Legs Syndrome Study Group (2003) Restless legs syndrome: diagnostic criteria, special considerations, and epidemiology. Sleep Med 4:101–119PubMedCrossRef

Arnulf I, Bonnet AM, Damier P, Bejjani BP, Seilhean D, Derenne J, Agid Y (2000) Hallucinations, REM sleep, and Parkinson’s disease: a medical hypothesis. Neurology 55:281–288PubMed

Arnulf I, Konofal E, Merino-Andreu M, Houeto JL, Mesnage V, Welter ML, Lacomblez L, Golmard JL, Derenne JP, Agid Y (2002) Parkinson’s disease and sleepiness: an integral part of PD. Neurology 58:1019–1024PubMed

Askenasy JJ, Yahr MD (1990) Different laws govern motor activity in sleep than in wakefulness. J Neural Transm Gen Sect 79:103–111PubMedCrossRef

Boeve BF, Silber MH, Parisi JE, Dickson DW, Ferman TJ, Benarroch EE, Schmeichel AM, Smith GE, Petersen RC, Ahlskog JE, Matsumoto JY, Kopman DS, Schenck CH, Mahowald MW (2003) Synucleinopathy pathology and REM sleep behavior disorder plus dementia or parkinsonism. Neurology 61:40–45PubMed

Boeve BF, Silber MH, Saper CB, Ferman TJ, Dickson DW, Parisi JE, Benarroch EE, Ahlskog JE, Smith GE, Caselli RC, Tippman-Peikert M, Olson EJ, Lin SC, Young T, Wszolek Z, Schenck CH, Mahowald MW, Castillo PR, Del Tredici K, Braak H (2007) Pathophysiology of REM sleep behaviour disorder and relevance to neurodegenerative disease. Brain 130:2770–2788PubMedCrossRef

Boeve BF (2010) Predicting the future in idiopathic rapid-eye movement sleep behaviour disorder. Lancet Neurol 9:1040–1042PubMedCrossRef

Burn DJ (2002) Beyond the iron mask: towards better recognition and treatment of depression associated with Parkinson’s disease. Mov Disord 17:445–454PubMedCrossRef

Chaudhuri KR, Pal S, DiMarco A, Whately-Smith C, Bridgman K, Mathew R, Pezzela FR, Forbes A, Högl B, Trenkwalder C (2002) The Parkinson’s disease sleep scale: a new instrument for assessing sleep and nocturnal disability in Parkinson’s disease. J Neurol Neurosurg Psychiatry 73:629–635PubMedCrossRef

10.

Chaudhuri KR, Schapira AHV (2009) Non-motor symptoms of Parkinson’s disease: dopaminergic pathophysiology and treatment. Lancet Neurol 8:464–474PubMedCrossRef

11.

Claassen DO, Josephs KA, Ahlskog JE, Silber MH, Tippmann-Peikert M, Boeve BF (2010) REM sleep behavior disorder preceding other aspects of synucleinopathies by up to half a century. Neurology 75:494–499PubMedCrossRef

12.

Cochen de Cock V, Abouda M, Leu S, Qudiette D, Roze E, Vidailhet M, Similowski T, Arnulf I (2010) Is obstructive sleep apnea a problem in Parkinson’s disease ? Sleep Med 11:247–252PubMedCrossRef

13.

Comella CL, Goetz CG (1994) Akathisia in Parkinson’s disease. Mov Disord 9:545–549PubMedCrossRef

14.

Comella CL (2007) Sleep disorders in Parkinson’s disease: an overview. Mov Disord 22:S367–S373PubMedCrossRef

15.

De Maindreville AD, Fenelon G, Mahieux (2005) Hallucinations in Parkinson’s disease. Mov Disord 20:212–217PubMedCrossRef

16.

Dhawan V, Healy DG, Pal S, Chaudhuri KR (2006) Sleep-related problems of Parkinson’s disease. Age Ageing 35:220–228PubMedCrossRef

17.

Diederich NJ, Vaillant M, Leischen M, Mancuso G, Golinval S, Nati R, Schlesser M (2005) Sleep apnea syndrome in Parkinson’s disease. A case-control study in 49 patients. Mov Disord 20:1413–1418PubMedCrossRef

18.

Fenelon G, Mahieux F, Huon R, Ziegler M (2000) Hallucinations in Parkinson’s disease: prevalence, phenomenology and risk factors. Brain 123:733–745PubMedCrossRef

19.

Gama RL, Tavora DG, Bomfim RC, Silva CE, de Bruin VM, de Bruin PF (2010) Sleep disturbances and brain MRI morphometry in Parkinson’s disease, multiple system atrophy and progressive supranuclear palsy—a comparative study. Parkinsonism Relat Disord 16:275–279PubMedCrossRef

20.

Garcia-Borreguero D, Odin P, Serrano C (2005) Restless legs syndrome and PD. Neurology 61:S49–S55

21.

Gasser T (2009) Medelian forms of Parkinson’s disease. Biochim Biophys Acta 1792:587–596PubMed

22.

Ghorayeb I, Loundou A, Auquier P, Dauvilliers Y, Bioulac B, Tison F (2007) A nationwide survey of excessive daytime sleepiness in Parkinson’s disease in France. Mov Disord 22:1567–1572PubMedCrossRef

23.

Global Parkinson`s Disease Survey Steering Committee (2002) Factors impacting on quality of life in Parkinson’s disease: results from an international survey. Mov Disord 17:60–67CrossRef

24.

Goulart FO, Godke BA, Borges V, Azevedo-Silva SMC, Mendes MF, Cendoroglo MS, Ferraz HB (2009) Fatigue in a cohort of geriatric patients with and without Parkinson’s disease. Braz J Med Biol Res 42:771–775PubMedCrossRef

25.

Happe S, Pirker W, Kölsch G, Sauter C, Zeitlhofer J (2003) Periodic leg movements in patients with Parkinson’s disease are associated with reduced striatal dopamine transporter binding. J Neurol 250:83–86PubMedCrossRef

26.

Hampp G, Ripperger JA, Houben T, Schmutz I, Blex C, Perreau-Lenz S, Brunk I, Spanagel R, Ahnert-Hilger G, Meijer JH, Albrecht U (2008) Regulation of monoamine oxidase A by circadian-clock components implies clock influence on mood. Curr Biol 18:678–683PubMedCrossRef

27.

Healy DG, Falchi M, O`Sullivan SS, Bonifati V, Durre A, Bressman S, Brice A, Aaslyi J, Zabetian CP, Goldwurm S, Ferreira JJ, Tolos D, Kay DM, Klein C, Williams DR, Marras C, Lang AE, Wszolek ZK, Bercianos J, Schapira AHV, Lynch R, Bhatia KP, Gasser T, Lees SJ, Wood NW, on behalf of the International LRRK2 Consortium (2008) Phenotype, genotype, and worldwide genetic pentrance of LRRK2-associated Parkinson’s disease: a case-control study. Lancet Neurol 7:583–590PubMedCrossRef

28.

Högl B, Rothdach A, Wetter TC, Trenkwalder C (2003) The effect of cabergoline on sleep, periodic leg movements in sleep, and early morning motor function in patients with Parkinson’s disease. Neuropsychopharmacology 28:1866–1870PubMedCrossRef

29.

Högl B, Seppi K, Brandauer E, Glatzl S, Frauscher B, Niedermüller U, Wenning G, Poewe W (2003) Increased daytime sleepiness in Parkinson’s disease: a questionnaire survey. Mov Disord 18:319–323PubMedCrossRef

30.

Högl B, Arnulf I, Comella C, Ferreira J, Iranzo A, Tilley B, Trenkwalder C, Poewe W, Rascol O, Sampaio C, Stebbins GT, Schrag A, Goetz CG (2010) Scales to assess sleep impairment in Parkinson’s disease: critique and recommendations. Mov Disord (in press). (doi:10.1002/mds.23190)

31.

Hood S, Cassidy P, Cossette MP, Weigl Y, Verwey M, Robinson B, Stewart J, Amir S (2010) Endogenous dopamine regulates the rhythm of expression of the clock protein PER2 in the rat dorsal striatum via daily activation of D₂ dopamine receptors. J Neurosci 30:14046–14058PubMedCrossRef

32.

Iranzo A, Omena F, Stockner H, Valldeoriola F, Vilaseca I, Salamero M, Molinuevo JL, Serradell M, Duch J, Pavia J, Gallego J, Seppi K, Högl B, Tolosa E, Poewe W, Sanatamaria J, for the Sleep Innsbruck Barcelona (SINBAR) group (2010) Decreased striatal dopamine transporter uptake and substantia nigra hyperechogenicity as risk markers of synucleinopathy in patients with idiopathic rapid-eye-movement sleep behaviour disorder: a prospective study. Lancet Neurol 9:1070–1077PubMedCrossRef

33.

Lee JE, Shin HW, Kim KS, Sohn YH (2009) Factors contributing to the development of restless legs syndrome in patients with Parkinson’s disease. Mov Disord 24:579–582PubMedCrossRef

34.

Löhle M, Storch A, Reichmann H (2009) Beyond tremor and rigidity: non-motor features of Parkinson’s disease. J Neural Transm 116:1483–1492PubMedCrossRef

35.

Lu BS, Zee PC (2010) Neurobiology of Sleep. Clin Chest Med 31:309–318PubMedCrossRef

36.

Mahowald MW, Schenck CH (2005) Insights from studying human sleep disorders. Nature 437:1279–1285PubMedCrossRef

37.

Manni R, Pacchetti C, Terzaghi M, Sartori I, Mancini F, Nappi G (2002) Hallucinations and sleep-wake cycle in PD: a 24-hour continuous polysomnographic study. Neurology 59:1979–1981PubMed

38.

Maria B, Sophia S, Michalis M, Charalampos L, Andreas P, John ME, Nikolaos SM (2003) Sleep breathing disorders in patients with idiopathic Parkinson’s disease. Respir Med 97:1151–1157PubMedCrossRef

39.

Martinez-Martin P, Schapira AHV, Stocchi F, Sethi K, Odin P, MacPhee G, Brown RG, Naidu Y, Clayton L, Abe K, Tsuboi Y, MacMahon D, Barone P, Rabey M, Bonuccelli U, Forbes A, Breen K, Tluk S, Olanow CW, Thomas S, Rye D, Hand A, Williams AJ, Ondo W, Chaudhuri KR (2007) Prevalence of nonmotor symptoms in Parkinson’s disease in an international setting: study using nonmotor symptoms questionnaire in 545 patients. Mov Disord 22:1623–1629PubMedCrossRef

40.

Möller JC, Unger M, Stiasny-Kolster K, Oertel WH (2009) Restless legs syndrome and Parkinson’s disease—Related disorders or different entities? J Neurol Sci 289:135–137PubMedCrossRef

41.

Ng KY, Chase TN, Colburn RW, Kopin IJ (1971) Dopamine stimulation induced release from central neurons. Science 1172:487–489CrossRef

42.

Noradina AT, Karim NA, Hmidon BB, Norlinah I, Raymond AA (2010) Sleep-disordered breathing in patients with Parkinson’s disease. Singapore Med J 51:60–64PubMed

43.

Ondo WG, Dat Vuong K, Khan H, Atassi F, Kwak C, Jankovic J (2001) Daytime sleepiness and other sleep disorders in Parkinson’s disease. Neurology 57:1392–1396PubMed

44.

Onofrj M, Thomas A, D`Andreamatteo G, Iacono D, Luciano AL, Di Rollo A, Di Mascio R, Ballone E, Di Iorio A (2002) Incidence of RBD and hallucination in patients affected by Parkinson’s disease: 8-year follow-up. Neurol Sci 23:S91–S94PubMedCrossRef

45.

O`Sullivan SS, Williams DR, Gallagher DA, Massey LA, Silveira-Moriyama L, Lees AJ (2008) Non motor symptoms as presenting complaints in Parkinson’s disease: a clinicopathological study. Mov Disord 23:101–106CrossRef

46.

Pacchetti C, Manni R, Zangaglia R, Mancini F, Marchioni E, Tassorelli C, Terzaghi M, Ossola M, Martignoni E, Moglia A, Nappi G (2005) Mov Disord 20:1439–1448PubMedCrossRef

47.

Pahwa R, Stacy MA, Factor SA, Lyons KE, Stocchi F, Hersh BP, Elmer LW, Truong DD, Earl NL, on behalf of the EASE-PD Adjunct Study Investigators (2007) Ropinirole 24-hour prolonged release: randomized, controlled study in advanced Parkinson disease. Neurology 68:1108–1115PubMedCrossRef

48.

Paus S, Brecht HM, Koster J, Seeger G, Klockgether T, Wullner U (2003) Sleep attacks, daytime sleepiness, and dopamine agonists in Parkinson’s disease. Mov Disord 18:659–667PubMedCrossRef

49.

Peralta CM, Frauscher B, Seppi K, Wolf E, Wenning GK, Högl B, Poewe W (2009) Restless legs syndrome in Parkinson’s disease. Mov Disord 24:2076–2080PubMedCrossRef

50.

Pichler I, Marroni F, Pattaro C, Lohmann K, De Grandi A, Klein C, Hicks AA, Pramstaller PP (2009) Parkin gene modifies the effect of RLS4 on the age at onset of restless legs syndrome. Am J Med Genet 153B:350–355

51.

Poewe W, Rascol O, Quinn N, Tolosa E, Oertel WH, Martignoni E, Rupp M, Boroojerdi B, on behalf of the SP 515 Investigators (2007) Efficacy of pramipexole and transdermal rotigotine in advanced Parkinson’s disease: a double-blind, double-dummy randomized controlled trial. Lancet Neurol 6:513–520PubMedCrossRef

52.

Poryazova R, Benninger D, Waldvogel D, Bassetti CL (2010) Excessive daytime sleepiness in Parkinson’s disease: characteristics and determinants. Eur Neurol 63:129–135PubMedCrossRef

53.

Postuma RB, Gagnon JF, Vendette M, Fantini ML, Massicotte-Marquez J, Montplaisir J (2009) Quantifying the risk of neurodegenerative disease in idiopathic REM sleep behaviour disorder. Neurology 72:1296–1300PubMed

54.

Razamy A, Lang AE, Shapiro CM (2004) Predictors of impaired daytime sleep and wakefulness in patients with Parkinson disease treated with older (ergot) vs newer (nonergot) dopamine agonists. Arch Neurol 61:97–102CrossRef

55.

Reichmann H, Brecht MH, Koster J, Kraus PH, Lemke MR (2003) Pramipexole in routine clinical practice: a prospective observational trial in Parkinson’s disease. CNS Drugs 17:965–973PubMedCrossRef

56.

Remy P, Doder M, Lees A, Turjanski N, Brooks D (2005) Depression in Parkinson’s disease. Loss of dopamine and noradrenaline innervations in the limbic system. Brain 12:1314–1322CrossRef

57.

Rye DB, Jankovic J (2002) Emerging views of dopamine in modulating sleep/wake state from an unlikely source: PD. Neurology 58:341–346PubMed

58.

Satake W, Nakabayashi Y, Mizuta I, Hirota Y, Ito C, Kubo M, Kawaguchi T, Tsunoda T, Watanabe M, Takeda A, Tomiyama H, Nakashima K, Hasegawa K, Obata F, Yoshikawa T, Kawakami H, Sakoda S, Yamamoto M, Hattori N, Murata M, Nakamura Y, Toda T (2009) Genome-wide association study identifies common variants at four loci as genetic risk factors for Parkinson’s disease. Nat Genet 41:1303–1307PubMedCrossRef

59.

Schormair B, Kemlink D, Roeske D, Eckstein G, Xiong L, Lichtner P, Ripke S, Trenkwalder C, Zimprich A, Stiasny-Kolster K, Oertel W, Bachmann CG, Paulus W, Högl B, Frauscher B, Gschliesser V, Poewe W, Peglau I, Vodicka P, Vavrova J, Sonka K, Nevsimalova S, Montplaisir J, Turecki G, Rouleau G, Gieger C, Illig T, Wichmann HE, Holsboer F, Müller-Myhsok B, Meitinger T, Winkelmann J (2008) PTPRD (protein tyrosin phosphatase receptor type delta) is associated with restless legs syndrome. Nat Genet 40:946–948PubMedCrossRef

60.

Shpirer I, Miniovitz A, Klein C, Goldstein R, Prokohorov T, Theitler J, Rabey JM (2006) Excessive daytime sleepiness in patients with Parkinson’s disease: a polysomnography study. Mov Disord 21:1432–1438PubMedCrossRef

61.

Simon-Sanchez J, Schulte C, Bras JM, Sharma M, Gibbs JR, Berg D, Paison-Ruiz C, Lichtner P, Scholz SW, Hernandez DG, Krüger R, Federoff M, Klein C, Goate A, Perlmutter J, Bonin M, Nalls MA, Illig T, Gieger C, Houlden H, Steffens M, Okun MS, Racette BA, Cookson MR, Foote KD, Fernandez HH, Traynor BJ, Schreiber S, Arepalli S, Zonozi R, Gwinn K, van der Brug M, Lopez G, Chanock SJ, Schatzkin A, Park Y, Hollenbeck A, Gao J, Huang X, Wood NW, Lorenz D, Deuschl G, Chen H, Riess O, Hardy JA, Singleton AB, Gasser T (2009) Genome-wide association study reveals genetic risk underlying Parkinson’s disease. Nat Genet 41:1308–1312PubMedCrossRef

62.

Stefansson H, Rye DB, Hicks A, Petursson H, Ingason A, Thorgeirsson TE, Palsson S, Sigmundsson T, Sigurdsson AP, Eiriksdottir I, Soebech E, Bliwise D, Beck JM, Rosen A, Waddy S, Trotti LM, Iranzo A, Thambisetty M, Hardarson GA, Kristjansson K, Gudmundsson LJ, Thorseinsdottir U, Kong A, Gulcher JR, Gudbjartsson D, Stefansson K (2007) N Engl J Med 357:639–647PubMedCrossRef

63.

Stevens S, Cormella CL, Stepanski EJ (2004) Daytime sleepiness and alertness in patients with Parkinson disease. Sleep 27:967–972PubMed

64.

Tan EK, Lum SY, Fook-Chong SM, Teoh ML, Yih Y, Tan L, Tan A, Wong MC (2002) Evaluation of somnolence in Parkinson’s disease: comparison with age-and sex-matched controls. Neurology 58:465–468PubMed

65.

Tandberg E, Larsen JP, Karlsen K (1998) A community-based study of sleep disorders in patients with Parkinson’s disease. Mov Disord 13:895–899PubMedCrossRef

66.

Trenkwalder C, Kohnen R, Högl B, Metta V, Sixel-Döring F, Frauscher B, Hülsmann J, Martinez-Martin P, Chaudhuri KR (2010) Parkinson’s disease sleep scale—validation of the revised version PDSS-2. Mov Disord (in press)

67.

Vilarino-Güell C, Soto AI, Young JE, Lin SC, Uitti RJ, Wszolek ZK, Farrer MJ (2008) Susceptibility genes for restless legs syndrome are not aassociated with Parkinson disease. Neurology 71:222–223PubMedCrossRef

68.

Wetter TC, Collado-Seidel V, Pollmächer T, Yassouridis A, Trenkwalder C (2000) Sleep and periodic leg movement patterns in drug-free patients with Parkinson’s disease and multiple system atrophy. Sleep 23:361–367PubMed

69.

Wetter TC, Brunner H, Högl B, Yassouridis A, Trenkwalder C, Friess E (2001) Increased alpha activity in REM sleep in de novo patients with Parkinson’s disease. Mov Disord 16:928–933PubMedCrossRef

70.

Winkelmann J, Schormair B, Lichtner P, Ripke S, Xiong L, Jalizadeh S, Fulda S, Pütz B, Eckstein G, Hauk S, Trenkwalder C, Zimprich A, Stiasny-Kolster K, Oertel W, Bachmann CG, Paulus W, Peglau I, Eisensehr I, Montplaisir J, Turecki G, Rouleau G, Gieger C, Illig T, Wichmann HE, Holsboer F, Müller-Myhsok B, Meitinger T (2007) Genome-wide association study of restless legs syndrome identifies common variants in three genomic regions. Nat Genet 39:1000–1006PubMedCrossRef

71.

Winkelmann J, Polo O, Provini F, Nevsimalova S, Kemlink D, Sonka K, Högl B, Poewe W, Stiasny-Kolster K, Oertel W, de Weerd A, Ferini-Strambi L, Zucconi M, Pramstaller PP, Arnulf I, Trenkwalder C, Klein C, Hadjigeorgiou GM, Happe S, Rye D, Montagna P (2007) Genetics of restless legs syndrome (RLS): state-of-the-art and future directions. Mov Disord 22:S449–S458PubMedCrossRef

Titel: When Parkinson’s disease patients go to sleep: specific sleep disturbances related to Parkinson’s disease
verfasst von: Eva C. Schulte
Juliane Winkelmann
Publikationsdatum: 01.05.2011
Verlag: Springer-Verlag
Erschienen in: Journal of Neurology / Ausgabe Sonderheft 2/2011
Print ISSN: 0340-5354
Elektronische ISSN: 1432-1459
DOI: https://doi.org/10.1007/s00415-011-5933-0

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