Objective Measures of the Sleep–Wake Cycle in Parkinson’s Disease

  • Valérie Cochen De CockEmail author


Complaints about sleep–wake cycle are frequent in patients with Parkinson’s disease (PD). Nocturnal sleep in PD may be impaired by several factors: motor phenomena related to the disease such as nocturnal bradykinesia/akinesia, rigidity, tremor or nocturia, and comorbid sleep disorders such as insomnia, restless legs syndrome (RLS), periodic limb movements (PLMs), circadian rhythm alteration, sleep disordered breathing, and rapid-eye-movement (REM) sleep behavior disorder (RBD). Moreover, daytime sleepiness and sleep attacks are frequently reported in patients with PD. Numerous studies evaluating sleep in PD have pressed that not only the illness but also dopaminergic treatments may play an important role in these sleep disorders.

Questionnaires have been developed to identify sleep disorders in the context of PD, but objective measures are needed to confirm diagnoses and inform treatments to the patients.

Videopolysomnographic recording is the gold standard to explore sleep and to diagnose PLMs, sleep disordered breathing, and RBD. Suggested immobilization test is a useful measure to explore RLS especially in patients with PD. Excessive daytime sleepiness is usually explored as in central hypersomnia by multiple sleep latency test (MSLT) but actigraphy or 24-h ambulatory polysomnography could be interesting tools to evaluate sleepiness at home, in a more naturalistic way. Maintenance of wakefulness test (MWT) is interesting to evaluate vigilance and though the efficacy of the different treatments used to improve sleepiness.


Obstructive Sleep Apnea Apnea Hypopnea Index Excessive Daytime Sleepiness Multiple Sleep Latency Test Circadian Rhythm Alteration 
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  1. 1.
    De Cock VC, Vidailhet M, Arnulf I. Sleep disturbances in patients with parkinsonism. Nat Clin Pract Neurol. 2008;4:254–66.CrossRefPubMedGoogle Scholar
  2. 2.
    Arnulf I, Leu S, Oudiette D. Abnormal sleep and sleepiness in Parkinson’s disease. Curr Opin Neurol. 2008;21:472–7.CrossRefPubMedGoogle Scholar
  3. 3.
    Louter M, Aarden WC, Lion J, Bloem BR, Overeem S. Recognition and diagnosis of sleep disorders in Parkinson’s disease. J Neurol. 2012;259:2031–40.CrossRefPubMedCentralPubMedGoogle Scholar
  4. 4.
    Iber C, Ancoli-Israel S, Chesson AL, Quan SF, American Academy of Sleep Medicine. The AASM manual for the scoring of sleep and associated events: rules, terminology, and technical specifications. Westchester: American Academy of Sleep Medicine; 2007.Google Scholar
  5. 5.
    Peeraully T, Yong MH, Chokroverty S, Tan EK. Sleep and Parkinson’s disease: a review of case-control polysomnography studies. Mov Disord. 2012;27:1729–37.CrossRefPubMedGoogle Scholar
  6. 6.
    Wetter TC, Collado-Seidel V, Pollmacher T, Yassouridis A, Trenkwalder C. Sleep and periodic leg movement patterns in drug-free patients with Parkinson’s disease and multiple system atrophy. Sleep. 2000;23:361–7.PubMedGoogle Scholar
  7. 7.
    Pollmächer T, Schulz H. Periodic leg movements (PLM): their relationship to sleep stages. Sleep. 1993;16:572–7.PubMedGoogle Scholar
  8. 8.
    Young T, Shahar E, Nieto FJ, Redline S, Newman AB, Gottieb DJ, et al. Predictors of sleep-disordered breathing in community-dwelling adults: the Sleep Heart Health Study. Arch Intern Med. 2002;162:893–900.CrossRefPubMedGoogle Scholar
  9. 9.
    Cochen De Cock V, Abouda M, Leu S, et al. Is obstructive sleep apnea a problem in Parkinson’s disease? Sleep Med. 2010;11:247–52.CrossRefPubMedGoogle Scholar
  10. 10.
    Diederich N, Vaillant M, Leischen M, Mancuso G, Golinval S, Nati R, et al. Sleep apnea syndrome in Parkinson’s disease. A case–control study in 49 patients. Mov Disord. 2005;20:1413–8.CrossRefPubMedGoogle Scholar
  11. 11.
    Trotti LM, Bliwise DL. No increased risk of obstructive sleep apnea in Parkinson’s disease. Mov Disord. 2010;25:2246–9.CrossRefPubMedCentralPubMedGoogle Scholar
  12. 12.
    Takashi N, Inoue Y, Kobayashi M, Namba K, Nakashima K. Characteristics of obstructive sleep apnea in patients with Parkinson’s disease. J Neurol Sci. 2013;327:22–4.CrossRefGoogle Scholar
  13. 13.
    Fagbami OY, Donato AA. Stridor and dysphagia associated with subthalamic nucleus stimulation in Parkinson disease. J Neurosurg. 2011;115:1005–6.CrossRefPubMedGoogle Scholar
  14. 14.
    Schenck CH, Hurwitz TD, Mahowald MW. Symposium: normal and abnormal REM sleep regulation: REM sleep behaviour disorder: an update on a series of 96 patients and a review of the world literature. J Sleep Res. 1993;2:224–31.CrossRefPubMedGoogle Scholar
  15. 15.
    Schenck CH, Mahowald MW. REM sleep behavior disorder: clinical, developmental, and neuroscience perspectives 16 years after its formal identification in SLEEP. Sleep. 2002;25:120–38.PubMedGoogle Scholar
  16. 16.
    Oudiette D, De Cock VC, Lavault S, Leu S, Vidailhet M, Arnulf I. Nonviolent elaborate behaviors may also occur in REM sleep behavior disorder. Neurology. 2009;72:551–7.CrossRefPubMedGoogle Scholar
  17. 17.
    Montplaisir J, Gagnon JF, Fantini ML, Postuma RB, Dauvilliers Y, Desautels A, et al. Polysomnographic diagnosis of idiopathic REM sleep behavior disorder. Mov Disord. 2010;25:2044–51.CrossRefPubMedGoogle Scholar
  18. 18.
    Iranzo A, Santamaria J. Severe obstructive sleep apnea/hypopnea mimicking REM sleep behavior disorder. Sleep. 2005;28:203–6.PubMedGoogle Scholar
  19. 19.
    Frauscher B, Iranzo A, Högl B, Casanova-Molla J, Salamero M, Gschliesser V, Tolosa E, Poewe W, Santamaria J. Quantification of electromyographic activity during REM sleep in multiple muscles in REM sleep behavior disorder. Sleep. 2008;31:724–31.PubMedCentralPubMedGoogle Scholar
  20. 20.
    De Cock VC, Vidailhet M, Leu S, et al. Restoration of normal motor control in Parkinson’s disease during REM sleep. Brain. 2007;130:450–6.CrossRefPubMedGoogle Scholar
  21. 21.
    Sixel-Doring F, Trautmann E, Mollenhauer B, Trenkwalder C. Associated factors for REM sleep behavior disorder in Parkinson disease. Neurology. 2011;77:1048–54.CrossRefPubMedGoogle Scholar
  22. 22.
    Abe S, Gagnon JF, Montplaisir JY, Postuma RB, Rompré PH, Huynh NT, Kato T, Kawano F, Lavigne GJ. Sleep bruxism and oromandibular myoclonus in rapid eye movement sleep behavior disorder: a preliminary report. Sleep Med. 2013;14:1024–30.CrossRefPubMedGoogle Scholar
  23. 23.
    Michaud M, Lavigne G, Desautels A, Poirier G, Montplaisir J. Effects of immobility on sensory and motor symptoms of restless legs syndrome. Mov Disord. 2002;17:112–5.CrossRefPubMedGoogle Scholar
  24. 24.
    Allen RP, Picchietti D, Hening WA, Trenkwalder C, Walters AS, Montplaisi J. Restless legs syndrome: diagnostic criteria, special considerations, and epidemiology. A report from the restless legs syndrome diagnosis and epidemiology workshop at the National Institutes of Health. Sleep Med. 2003;4:101–19.CrossRefPubMedGoogle Scholar
  25. 25.
    Garcia-Borreguero D, Odin P, Serrano C. Restless legs syndrome and PD: a review of the evidence for a possible association. Neurology. 2003;61:S49–55.CrossRefPubMedGoogle Scholar
  26. 26.
    Michaud M, Poirier G, Lavigne G, Montplaisir J. Restless Legs Syndrome: scoring criteria for leg movements recorded during the suggested immobilization test. Sleep Med. 2001;2:317–21.CrossRefPubMedGoogle Scholar
  27. 27.
    De Cock VC, Bayard S, Yu H, Grini M, Carlander B, Postuma R, Charif M, Dauvilliers Y. Suggested immobilization test for diagnosis of restless legs syndrome in Parkinson’s disease. Mov Disord. 2012;27:743–9.CrossRefPubMedGoogle Scholar
  28. 28.
    Frucht S, Rogers JD, Greene PE, Gordon MF, Fahn S. Falling asleep at the wheel: motor vehicle mishaps in persons taking pramipexole and ropinirole. Neurology. 1999;52:1908–10.CrossRefPubMedGoogle Scholar
  29. 29.
    Littner MR, Kushida C, Wise M, Standards of Practice Committee of the American Academy of Sleep Medicine, et al. Practice parameters for clinical use of the multiple sleep latency test and the maintenance of wakefulness test. Sleep. 2005;28:113–21.PubMedGoogle Scholar
  30. 30.
    Rye DB, Bliwise DL, Dihenia B, Gurecki P. FAST TRACK: daytime sleepiness in Parkinson’s disease. J Sleep Res. 2000;9:63–9.CrossRefPubMedGoogle Scholar
  31. 31.
    Arnulf I, Konofal E, Merino-Andreu M, et al. Parkinson’s disease and sleepiness: an integral part of PD. Neurology. 2002;58:1019–26.CrossRefPubMedGoogle Scholar
  32. 32.
    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;21:1432–8.CrossRefPubMedGoogle Scholar
  33. 33.
    Yong MH, Fook-Chong S, Pavanni R, Lim LL, Tan EK. Case control polysomnographic studies of sleep disorders in Parkinson’s disease. PLoS One. 2011;6:e22511.CrossRefPubMedCentralPubMedGoogle Scholar
  34. 34.
    Arnulf I, Bonnet AM, Damier P, Bejjani BP, Seilhean D, Derenne JP, Agid Y. Hallucinations, REM sleep, and Parkinson’s disease: a medical hypothesis. Neurology. 2000;55:281–8.CrossRefPubMedGoogle Scholar
  35. 35.
    Doghramji K, Mitler MM, Sangal RB, et al. A normative study of the maintenance of wakefulness test (MWT). Electroencephalogr Clin Neurophysiol. 1997;103:554–62.CrossRefPubMedCentralPubMedGoogle Scholar
  36. 36.
    Sangal RB, Thomas L, Mitler MM. Maintenance of wakefuness test and multiple sleep latency test. Measurement of different abilities in patients with sleep disorders. Chest. 1992;101:898–902.CrossRefPubMedGoogle Scholar
  37. 37.
    Bliwise DL, Shpirer I, Miniovitz A, Klein C, Goldstein R, Prokhorov T, Theitler J, et al. Daytime alertness in Parkinson’s disease: potentially dose-dependent, divergent effects by drug class. Mov Disord. 2012;27:1118–24.CrossRefPubMedCentralPubMedGoogle Scholar
  38. 38.
    Manni R, Terzaghi M, Sartori I, Mancini F, Pacchetti C. Dopamine agonists and sleepiness in PD: review of the literature and personal findings. Sleep Med. 2004;5:189–93.CrossRefPubMedGoogle Scholar
  39. 39.
    Stavitsky JL, Saurman P, McNamara A, Cronin-Golomb A. Sleep in Parkinson’s disease: a comparison of actigraphy and subjective measures. Parkinsonism Relat Disord. 2010;16:280–3.CrossRefPubMedGoogle Scholar
  40. 40.
    Kotschet K, Johnson W, McGregor S, Kettlewell J, Kyoong A, O’Driscoll DM, Turton AR, Griffiths RI, Horne MK. Daytime sleep in Parkinson’s disease measured by episodes of immobility. Parkinsonism Relat Disord. 2014;20:578–83.CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag Wien 2015

Authors and Affiliations

  1. 1.Service des pathologies du sommeilClinique Beau SoleilMontpellierFrance

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