Current Sleep Medicine Reports

, Volume 4, Issue 2, pp 118–124 | Cite as

Obstructive Sleep Apnea in Parkinson’s Disease—a Mini-Review

  • Ariel B. Neikrug
Sleep and Neurological Disorders (JL DeWolfe, Section Editor)
Part of the following topical collections:
  1. Topical Collection on Sleep and Neurological Disorders


Purpose of Review

Sleep disturbances in Parkinson’s disease (PD) are very common and debilitating. In fact, obstructive sleep apnea (OSA) shares core symptomology with PD including cognitive disturbances and excessive daytime sleepiness. This narrative review aims to summarize the available research evaluating OSA in PD and provide treatment considerations based on available data.

Recent Findings

Pathophysiological evidence suggests a possible increased risk for OSA in PD, yet rates of OSA in PD appear to be similar to that seen in the general older adult population. The relationship between OSA and cognitive disturbances as well as excessive daytime sleepiness in PD has been evaluated and there is some evidence improvement in sleep and sleepiness with OSA treatment.


Discrepant results have led to a debate on the relevance of OSA in PD and there is little agreement in current research and firm clinical conclusions are hard to ascertain. Nonetheless, research suggests that treatment of OSA can be tolerated by patients with PD and treatment results in sleep improvements.


Parkinson’s disease Sleep Obstructive sleep apnea Sleepiness Cognition 


Compliance with Ethical Standards

Conflict of Interest

Ariel B. Neikrug declares no conflicts of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.


Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. 1.
    De Lau LM, Breteler MM. Epidemiology of Parkinson’s disease. Lancet Neurol. 2006;5(6):525–35.CrossRefPubMedGoogle Scholar
  2. 2.
    Aarsland D, Larsen JP, Tandberg E, Laake K. Predictors of nursing home placement in Parkinson’s disease: a population‐based, prospective study. J Am Geriatr Soc. 2000;48(8):938–42.CrossRefPubMedGoogle Scholar
  3. 3.
    Barone P, Antonini A, Colosimo C, Marconi R, Morgante L, Avarello TP, et al. The PRIAMO study: a multicenter assessment of nonmotor symptoms and their impact on quality of life in Parkinson’s disease. Mov Disord. 2009;24(11):1641–9.CrossRefPubMedGoogle Scholar
  4. 4.
    Hely MA, Reid WG, Adena MA, Halliday GM, Morris JG. The Sydney multicenter study of Parkinson’s disease: the inevitability of dementia at 20 years. Mov Disord. 2008;23(6):837–44.CrossRefPubMedGoogle Scholar
  5. 5.
    Boeve BF, Silber M, Saper C, Ferman TJ, Dickson DW, Parisi JE, et al. Pathophysiology of REM sleep behaviour disorder and relevance to neurodegenerative disease. Brain. 2007;130(11):2770–88.CrossRefPubMedGoogle Scholar
  6. 6.
    Iranzo A, Molinuevo JL, Santamaría J, Serradell M, Martí MJ, Valldeoriola F, et al. Rapid-eye-movement sleep behaviour disorder as an early marker for a neurodegenerative disorder: a descriptive study. Lancet Neurol. 2006;5(7):572–7.CrossRefPubMedGoogle Scholar
  7. 7.
    Schenck CH, Bundlie SR, Mahowald MW. Delayed emergence of a parkinsonian disorder in 38% of 29 older men initially diagnosed with idiopathic rapid eye movement sleep behavior disorder. Neurology. 1996;46(2):388–93.CrossRefPubMedGoogle Scholar
  8. 8.
    Chaudhuri KR, Martinez‐Martin P, Schapira AH, Stocchi F, Sethi K, Odin P, et al. International multicenter pilot study of the first comprehensive self‐completed nonmotor symptoms questionnaire for Parkinson’s disease: the NMSQuest study. Mov Disord. 2006;21(7):916–23.CrossRefPubMedGoogle Scholar
  9. 9.
    Gjerstad M, Wentzel-Larsen T, Aarsland D, Larsen J. Insomnia in Parkinson’s disease: frequency and progression over time. J Neurol Neurosurg Psychiatry. 2007;78(5):476–9.CrossRefPubMedGoogle Scholar
  10. 10.
    Lees AJ, Blackburn NA, Campbell VL. The nighttime problems of Parkinson’s disease. Clin Neuropharmacol. 1988;11(6):512–9.CrossRefPubMedGoogle Scholar
  11. 11.
    Chaudhuri KR, Healy DG, Schapira AH. Non-motor symptoms of Parkinson’s disease: diagnosis and management. Lancet Neurol. 2006;5(3):235–45.CrossRefPubMedGoogle Scholar
  12. 12.
    Martinez‐Martin P, Rodriguez‐Blazquez C, Kurtis MM, Chaudhuri K. The impact of non‐motor symptoms on health‐related quality of life of patients with Parkinson’s disease. Mov Disord. 2011;26(3):399–406.CrossRefPubMedGoogle Scholar
  13. 13.
    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.CrossRefPubMedPubMedCentralGoogle Scholar
  14. 14.
    Neikrug AB, Maglione JE, Liu L, Natarajan L, Avanzino JA, Corey-Bloom J, et al. Effects of sleep disorders on the non-motor symptoms of Parkinson disease. J Clin Sleep Med. 2013;9(11):1119–29.PubMedPubMedCentralGoogle Scholar
  15. 15.
    de Bruin PFC, de Bruin VMS, Lees AJ, Pride N. Effects of treatment on airway dynamics and respiratory muscle strength in Parkinson’s disease. Am Rev Respir Dis. 1993;148:1576–80.CrossRefPubMedGoogle Scholar
  16. 16.
    Hovestadt A, Bogaard J, Meerwaldt J, van Der Meche F, Stigt J. Pulmonary function in Parkinson’s disease. J Neurol Neurosurg Psychiatry. 1989;52(3):329–33.CrossRefPubMedPubMedCentralGoogle Scholar
  17. 17.
    Obenour WH, Stevens PM, Cohen AA, McCutchen JJ. The causes of abnormal pulmonary function in Parkinson’s disease 1, 2. Am Rev Respir Dis. 1972;105(3):382–7.PubMedGoogle Scholar
  18. 18.
    H Shill, M Stacy, editors. Respiratory complications of Parkinson’s disease. Seminars in respiratory and critical care medicine; 2002: Copyright© 2002 by Thieme Medical Publishers, Inc., New York.Google Scholar
  19. 19.
    Vincken WG, Gauthier SG, Dollfuss RE, Hanson RE, Darauay CM, Cosio MG. Involvement of upper-airway muscles in extrapyramidal disorders: a cause of airflow limitation. N Engl J Med. 1984;311(7):438–42.CrossRefPubMedGoogle Scholar
  20. 20.
    Sabaté M, González I, Ruperez F, Rodríguez M. Obstructive and restrictive pulmonary dysfunctions in Parkinson’s disease. J Neurol Sci. 1996;138(1):114–9.CrossRefPubMedGoogle Scholar
  21. 21.
    Seccombe LM, Giddings HL, Rogers PG, Corbett AJ, Hayes MW, Peters MJ, et al. Abnormal ventilatory control in Parkinson’s disease—further evidence for non-motor dysfunction. Respir Physiol Neurobiol. 2011;179(2):300–4.CrossRefPubMedGoogle Scholar
  22. 22.
    Trotti LM, Bliwise DL. No increased risk of obstructive sleep apnea in Parkinson’s disease. Mov Disord. 2010;25(13):2246–9.CrossRefPubMedPubMedCentralGoogle Scholar
  23. 23.
    • Zeng J, Wei M, Li T, Chen W, Feng Y, Shi R, et al. Risk of obstructive sleep apnea in Parkinson’s disease: a meta-analysis. PLoS One. 2013;8(12):e82091. This is a meta-analysis evaluating the association between PD and OSA Prevalence. CrossRefPubMedPubMedCentralGoogle Scholar
  24. 24.
    •• LM Chahine, AW Amara, A Videnovic. A systematic review of the literature on disorders of sleep and wakefulness in Parkinson’s disease from 2005 to 2015. Sleep Med Rev. 2017;35:33–50. This is a recent systematic review of the epidemiology, etiology, assessment, and management sleep disorders in Parkinson’s disease. Google Scholar
  25. 25.
    Arnulf I, Konofal E, Merino-Andreu M, Houeto J, Mesnage V, Welter M, et al. Parkinson’s disease and sleepiness an integral part of PD. Neurology. 2002;58(7):1019–24.CrossRefPubMedGoogle Scholar
  26. 26.
    Maria B, Sophia S, Michalis M, Charalampos L, Andreas P, John ME, et al. Sleep breathing disorders in patients with idiopathic Parkinson’s disease. Respir Med. 2003;97(10):1151–7.CrossRefPubMedGoogle Scholar
  27. 27.
    Norlinah M, Afidah KN, Noradina A, Shamsul A, Hamidon B, Sahathevan R, et al. Sleep disturbances in Malaysian patients with Parkinson’s disease using polysomnography and PDSS. Parkinsonism Relat Disord. 2009;15(9):670–4.CrossRefPubMedGoogle Scholar
  28. 28.
    Zoccolella S, Savarese M, Lamberti P, Manni R, Pacchetti C, Logroscino G. Sleep disorders and the natural history of Parkinson’s disease: the contribution of epidemiological studies. Sleep Med Rev. 2011;15(1):41–50.CrossRefPubMedGoogle Scholar
  29. 29.
    De Cock VC, Abouda M, Leu S, Oudiette D, Roze E, Vidailhet M, et al. Is obstructive sleep apnea a problem in Parkinson’s disease? Sleep Med. 2010;11(3):247–52.CrossRefGoogle Scholar
  30. 30.
    Diaz K, Faverio P, Hospenthal A, Restrepo MI, Amuan ME, Pugh MJV. Obstructive sleep apnea is associated with higher healthcare utilization in elderly patients. Ann Thorac Med. 2014;9(2):92–8.CrossRefPubMedPubMedCentralGoogle Scholar
  31. 31.
    Smith R, Ronald J, Delaive K, Walld R, Manfreda J, Kryger MH. What are obstructive sleep apnea patients being treated for prior to this diagnosis? Chest J. 2002;121(1):164–72.CrossRefGoogle Scholar
  32. 32.
    • Nomura T, Inoue Y, Kobayashi M, Namba K, Nakashima K. Characteristics of obstructive sleep apnea in patients with Parkinson’s disease. J Neurol Sci. 2013;327(1):22–4. This study compared clinical variables and polysomnographic sleep findings in PD with and without OSA, as well as between PD patients with OSA vs OSA patients without PD. CrossRefPubMedGoogle Scholar
  33. 33.
    Valko PO, Hauser S, Werth E, Waldvogel D, Baumann CR. Heart rate variability in patients with idiopathic Parkinson’s disease with and without obstructive sleep apnea syndrome. Parkinsonism Relat Disord. 2012;18(5):525–31.CrossRefPubMedGoogle Scholar
  34. 34.
    Aarsland D, Andersen K, Larsen JP, Lolk A. Prevalence and characteristics of dementia in Parkinson disease: an 8-year prospective study. Arch Neurol. 2003;60(3):387–92.CrossRefPubMedGoogle Scholar
  35. 35.
    Aarsland D, Zaccai J, Brayne C. A systematic review of prevalence studies of dementia in Parkinson’s disease. Mov Disord. 2005;20(10):1255–63.CrossRefPubMedGoogle Scholar
  36. 36.
    Schulz-Schaeffer WJ. The synaptic pathology of α-synuclein aggregation in dementia with Lewy bodies, Parkinson’s disease and Parkinson’s disease dementia. Acta Neuropathol. 2010;120(2):131–43.CrossRefPubMedPubMedCentralGoogle Scholar
  37. 37.
    Pillon B, Czernecki V, Dubois B. Dopamine and cognitive function. Curr Opin Neurol. 2003;16:S17–22.CrossRefPubMedGoogle Scholar
  38. 38.
    Bohnen NI, Kaufer DI, Hendrickson R, Ivanco LS, Lopresti BJ, Constantine GM, et al. Cognitive correlates of cortical cholinergic denervation in Parkinson’s disease and parkinsonian dementia. J Neurol. 2006;253(2):242–7.CrossRefPubMedGoogle Scholar
  39. 39.
    Calabresi P, Picconi B, Parnetti L, Di Filippo M. A convergent model for cognitive dysfunctions in Parkinson’s disease: the critical dopamine–acetylcholine synaptic balance. Lancet Neurol. 2006;5(11):974–83.CrossRefPubMedGoogle Scholar
  40. 40.
    Kehagia AA, Barker RA, Robbins TW. Neuropsychological and clinical heterogeneity of cognitive impairment and dementia in patients with Parkinson’s disease. Lancet Neurol. 2010;9(12):1200–13.CrossRefPubMedGoogle Scholar
  41. 41.
    Pilcher JJ, Huffcutt AI. Effects of sleep deprivation on performance: a meta-analysis. Sleep. 1996;19(4):318–26.CrossRefPubMedGoogle Scholar
  42. 42.
    Bucks RS, Olaithe M, Eastwood P. Neurocognitive function in obstructive sleep apnoea: a meta‐review. Respirology. 2013;18(1):61–70.CrossRefPubMedGoogle Scholar
  43. 43.
    Cheshire K, Engleman H, Deary I, Shapiro C, Douglas NJ. Factors impairing daytime performance in patients with sleep apnea/hypopnea syndrome. Arch Intern Med. 1992;152(3):538–41.CrossRefPubMedGoogle Scholar
  44. 44.
    Findley LJ, Barth JT, Powers DC, Wilhoit SC, Boyd DG, Suratt PM. Cognitive impairment in patients with obstructive sleep apnea and associated hypoxemia. Chest. 1986;90(5):686–90.CrossRefPubMedGoogle Scholar
  45. 45.
    Greenberg GD, Watson RK, Deptula D. Neuropsychological dysfunction in sleep apnea. Sleep. 1987;10(3):254–62.CrossRefPubMedGoogle Scholar
  46. 46.
    Blackwell T, Yaffe K, Ancoli‐Israel S, Redline S, Ensrud KE, Stefanick ML, et al. Associations between sleep architecture and sleep‐disordered breathing and cognition in older community‐dwelling men: the osteoporotic fractures in men sleep study. J Am Geriatr Soc. 2011;59(12):2217–25.CrossRefPubMedPubMedCentralGoogle Scholar
  47. 47.
    Blackwell T, Yaffe K, Laffan A, Redline S, Ancoli‐Israel S, Ensrud KE, et al. Associations between sleep‐disordered breathing, nocturnal hypoxemia, and subsequent cognitive decline in older community‐dwelling men: the osteoporotic fractures in men sleep study. J Am Geriatr Soc. 2015;63(3):453–61.CrossRefPubMedPubMedCentralGoogle Scholar
  48. 48.
    Yaffe K, Laffan AM, Harrison SL, Redline S, Spira AP, Ensrud KE, et al. Sleep-disordered breathing, hypoxia, and risk of mild cognitive impairment and dementia in older women. JAMA. 2011;306(6):613–9.CrossRefPubMedPubMedCentralGoogle Scholar
  49. 49.
    Muslimović D, Schmand B, Speelman JD, De Haan RJ. Course of cognitive decline in Parkinson’s disease: a meta-analysis. J Int Neuropsychol Soc. 2007;13(6):920–32.PubMedGoogle Scholar
  50. 50.
    Noe E, Marder K, Bell KL, Jacobs DM, Manly JJ, Stern Y. Comparison of dementia with Lewy bodies to Alzheimer’s disease and Parkinson’s disease with dementia. Mov Disord. 2004;19(1):60–7.CrossRefPubMedGoogle Scholar
  51. 51.
    Reid W, Hely M, Morris J, Loy C, Halliday G. Dementia in Parkinson’s disease: a 20-year neuropsychological study (Sydney multicentre study). J Neurol Neurosurg Psychiatry. 2011;82:1033–7. Scholar
  52. 52.
    Schwalen S, Lorenz S, Reuter K, Boucsein W, Jörg J. Memory performance of Parkinson patients with and without sleep apnea syndrome. Wien Med Wochenschr. 1995;146(13–14):294–5.Google Scholar
  53. 53.
    • Harmell AL, Neikrug AB, Palmer BW, Avanzino JA, Liu L, Maglione JE, et al. Obstructive sleep apnea and cognition in Parkinson’s disease. Sleep Med. 2016;21:28–34. This is the only pacebo-controlled study evauating the effect of OSA treatment on cognitive performance in PD. CrossRefPubMedPubMedCentralGoogle Scholar
  54. 54.
    • Terzaghi M, Spelta L, Minafra B, Rustioni V, Zangaglia R, Pacchetti C, et al. Treating sleep apnea in Parkinson’s disease with C-PAP: feasibility concerns and effects on cognition and alertness. Sleep Med. 2017;33:114–8. This study evaluated the long-term (3 months) impact of OSA treatment on sleep, cognitive performance, and daytime sleepiness in PD. CrossRefPubMedGoogle Scholar
  55. 55.
    Ancoli‐Israel S, Palmer BW, Cooke JR, Corey‐Bloom J, Fiorentino L, Natarajan L, et al. Cognitive effects of treating obstructive sleep apnea in Alzheimer’s disease: a randomized controlled study. J Am Geriatr Soc. 2008;56(11):2076–81.CrossRefPubMedPubMedCentralGoogle Scholar
  56. 56.
    Kushida CA, Nichols DA, Holmes TH, Quan SF, Walsh JK, Gottlieb DJ, et al. Effects of continuous positive airway pressure on neurocognitive function in obstructive sleep apnea patients: the Apnea Positive Pressure Long-term Efficacy Study (APPLES). Sleep. 2012;35(12):1593–602.CrossRefPubMedPubMedCentralGoogle Scholar
  57. 57.
    Rye DB, Bliwise DL, Dihenia B, Gurecki P. Daytime sleepiness in Parkinson’s disease. J Sleep Res. 2000;9(1):63–9.CrossRefPubMedGoogle Scholar
  58. 58.
    Tandberg E, Larsen JP, Karlsen K. A community‐based study of sleep disorders in patients with Parkinson’s disease. Mov Disord. 1998;13(6):895–9.CrossRefPubMedGoogle Scholar
  59. 59.
    Valko P, Waldvogel D, Weller M, Bassetti C, Held U, Baumann C. Fatigue and excessive daytime sleepiness in idiopathic Parkinson’s disease differently correlate with motor symptoms, depression and dopaminergic treatment. Eur J Neurol. 2010;17(12):1428–36.CrossRefPubMedGoogle Scholar
  60. 60.
    Yong M-H, Fook-Chong S, Pavanni R, Lim L-L, Tan E-K. Case control polysomnographic studies of sleep disorders in Parkinson’s disease. PLoS One. 2011;6(7):e22511.CrossRefPubMedPubMedCentralGoogle Scholar
  61. 61.
    Stevens S, Comella CL, Stepanski EJ. Daytime sleepiness and alertness in patients with Parkinson disease. Sleep. 2004;27(5):967–72.CrossRefPubMedGoogle Scholar
  62. 62.
    Tandberg E, Larsen JP, Karlsen K. Excessive daytime sleepiness and sleep benefit in Parkinson’s disease: a community‐based study. Mov Disord. 1999;14(6):922–7.CrossRefPubMedGoogle Scholar
  63. 63.
    Meindorfner C, Körner Y, Möller JC, Stiasny‐Kolster K, Oertel WH, Krüger HP. Driving in Parkinson’s disease: mobility, accidents, and sudden onset of sleep at the wheel. Mov Disord. 2005;20(7):832–42.CrossRefPubMedGoogle Scholar
  64. 64.
    Frucht S, Rogers J, Greene P, Gordon M, Fahn S. Falling asleep at the wheel: motor vehicle mishaps in persons taking pramipexole and ropinirole. Neurology. 1999;52(9):1908–10.CrossRefPubMedGoogle Scholar
  65. 65.
    Gjerstad M, Alves G, Wentzel-Larsen T, Aarsland D, Larsen J. Excessive daytime sleepiness in Parkinson disease: is it the drugs or the disease? Neurology. 2006;67(5):853–8.CrossRefPubMedGoogle Scholar
  66. 66.
    Carrier J, Paquet J, Morettini J, Touchette É. Phase advance of sleep and temperature circadian rhythms in the middle years of life in humans. Neurosci Lett. 2002;320(1):1–4.CrossRefPubMedGoogle Scholar
  67. 67.
    Ferreira J, Desboeuf K, Galitzky M, Thalamas C, Brefel‐Courbon C, Fabre N, et al. Sleep disruption, daytime somnolence and ‘sleep attacks’ in Parkinson’s disease: a clinical survey in PD patients and age‐matched healthy volunteers. Eur J Neurol. 2006;13(3):209–14.CrossRefPubMedGoogle Scholar
  68. 68.
    Ferreira JJ, Galitzky M, Montastruc J, Rascol O. Sleep attacks and Parkinson’s disease treatment. Lancet. 2000;355(9212):1333–4.CrossRefPubMedGoogle Scholar
  69. 69.
    Hauser RA, Gauger L, Anderson W, Zesiewicz TA. Pramipexole-induced somnolence and episodes of daytime sleep. Mov Disord. 2000;15(4):658–63.CrossRefPubMedGoogle Scholar
  70. 70.
    Kaynak D, Kiziltan G, Kaynak H, Benbir G, Uysal O. Sleep and sleepiness in patients with Parkinson’s disease before and after dopaminergic treatment. Eur J Neurol. 2005;12(3):199–207.CrossRefPubMedGoogle Scholar
  71. 71.
    Barraud Q, Obeid I, Aubert I, Barrière G, Contamin H, McGuire S, et al. Neuroanatomical study of the A11 diencephalospinal pathway in the non-human primate. PLoS One. 2010;5(10):e13306.CrossRefPubMedPubMedCentralGoogle Scholar
  72. 72.
    Ondo W, Vuong KD, Khan H, Atassi F, Kwak C, Jankovic J. Daytime sleepiness and other sleep disorders in Parkinson’s disease. Neurology. 2001;57(8):1392–6.CrossRefPubMedGoogle Scholar
  73. 73.
    Braga-Neto P, da Silva-Júnior FP, Monte FS, de Bruin PF, de Bruin VM. Snoring and excessive daytime sleepiness in Parkinson’s disease. J Neurol Sci. 2004;217(1):41–5.CrossRefPubMedGoogle Scholar
  74. 74.
    Shpirer I, Miniovitz A, Klein C, Goldstein R, Prokhorov T, Theitler J, et al. Excessive daytime sleepiness in patients with Parkinson’s disease: a polysomnography study. Mov Disord. 2006;21(9):1432–8.CrossRefPubMedGoogle Scholar
  75. 75.
    De Cock VC, Bayard S, Jaussent I, Charif M, Grini M, Langenier MC, et al. Daytime sleepiness in Parkinson’s disease: a reappraisal. PLoS One. 2014;9(9):e107278.CrossRefGoogle Scholar
  76. 76.
    Lelieveld IM, Müller ML, Bohnen NI, Koeppe RA, Chervin RD, Frey KA, et al. The role of serotonin in sleep disordered breathing associated with Parkinson disease: a correlative [11C] DASB PET imaging study. PLoS One. 2012;7(7):e40166.CrossRefPubMedPubMedCentralGoogle Scholar
  77. 77.
    De Cock VC, Bayard S, Jaussent I, Charif M, Grini M, Yu H, et al. Daytime sleepiness in Parkinson’s disease. Sleep Med. 2015;16:S187–S8.CrossRefGoogle Scholar
  78. 78.
    •• Neikrug AB, Liu L, Avanzino JA, Maglione JE, Natarajan L, Bradley L, et al. Continuous positive airway pressure improves sleep and daytime sleepiness in patients with Parkinson disease and sleep apnea. Sleep. 2014;37(1):177–85. This is the only placebo-controlled study evauating the effect of OSA treatment on sleep and sleepiness in PD. CrossRefPubMedPubMedCentralGoogle Scholar

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© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of Psychiatry and Human BehaviorUniversity of California, IrvineOrangeUSA

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