Sleep in Parkinson's disease: an examination of clinical correlates and cognition using actigraphy
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Sleep-related deficits are common in Parkinson's disease (PD) and significantly affect quality of life. The etiology of sleep problems is not well understood as they may arise from disease-related pathology or from factors such as motor dysfunction or medications. They may also affect the integrity of cognitive processes. In other disorders, actigraphy has emerged as an alternative to polysomnography to measure sleep, raising the question of its ability to capture sleep quality in PD. Study #1 evaluated the validity of actigraphy by examining its association with self-report in 30 patients with PD and 14 normal control participants (NC). For NC, actigraphic sleep variables were not related to any self-reported measures of sleep, a finding consistent with previous reports of over-reporting of sleep problems in older adults. In PD patients these correlations were significant, suggesting that actigraphy is an appropriate method of measuring sleep quality in PD. Study #2 investigated factors associated with sleep disturbance using actigraphy and questionnaire measures in 35 PD patients. Motor symptom severity and dopaminergic medication dosages were significantly related to sleep quality. Other factors affecting sleep were disease subtypes, with non-tremor onset patients reporting worse sleep quality than tremor-onset patients, and gender, with men having worse sleep quality and more excessive daytime sleepiness than women. Actigraphy identified individuals with possible REM behavior disorder, a sleep disorder that is implicated in early detection of PD. Study #3 investigated the association between actigraphic sleep measures and cognition in 36 PD patients and 18 NC participants. Executive dysfunction was predicted by sleep efficiency and not by motor symptom severity, medication dosage or disease duration. For memory, by contrast, motor symptom severity and disease duration but not sleep quality predicted performance. For psychomotor function, none of the variables significantly predicted performance. The relation of sleep and cognition in PD varied with gender and motor symptom subtypes. Taken together, these studies show actigraphy to be a valid method of assessing sleep quality in non-demented PD patients, indicate the relation of sleep to motor symptom severity, medication, gender, and disease subtypes, and demonstrate that sleep disturbances in PD significantly predict cognitive functioning.
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