Sleep Disordered Breathing in Parkinson’s Disease

  • Michael K. ScullinEmail author
  • Lynn Marie Trotti
  • Donald L. Bliwise


Sleep disordered breathing (SDB) is a serious medical condition in which there are repeated reductions or cessations of breathing during sleep. Early research suggested that because Parkinson’s disease (PD) patients have pulmonary abnormalities while they are awake they may be at increased risk for developing sleep disordered breathing. A large literature now demonstrates that sleep disordered breathing is common in Parkinson’s disease patients, but no different than age-matched controls from the general population. In the general population, sleep disordered breathing often correlates with excessive daytime sleepiness, but this correlation is not typically observed within Parkinson’s disease patients. However, sleep disordered breathing in Parkinson’s disease has been preliminarily linked to impaired sleep-dependent memory consolidation, blunted sympathetic responses, and worsening motor function Unified Parkinson’s Disease Rating Scale (UPDRS). Parkinson’s disease patients who have sleep disordered breathing may benefit from positive airway pressure or mandibular advancement treatments, and an exciting avenue for future research is determining whether such treatment also positively affects disease progression and quality of life.


Obstructive Sleep Apnea Obstructive Sleep Apnea Syndrome Sleep Disorder Breathing Excessive Daytime Sleepiness Berlin Questionnaire 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.



Preparation of this chapter was supported by funding from the National Institute on Health (grant numbers 1P50NS071669 and F32AG041543). M.K.S. was partially supported by an Emory University School of Medicine Cottrell Fellowship.


  1. 1.
    Young T, Palta M, Dempsey J, et al. The occurrence of sleep-disordered breathing among middle-aged adults. N Engl J Med. 1993;328:1230–5.CrossRefPubMedGoogle Scholar
  2. 2.
    Young T, Evans L, Finn L, et al. Estimation of the clinically diagnosed proportion of sleep apnea syndrome in middle-aged men and women. Sleep. 1997;20:705–6.PubMedGoogle Scholar
  3. 3.
    White DP. Pathogenesis of obstructive and central sleep apnea. Am J Respir Crit Care Med. 2005;172:1363–70.CrossRefPubMedGoogle Scholar
  4. 4.
    Netzer NC, Stoohs RA, Netzer CM. Using the Berlin Questionnaire to identify patients at risk for the sleep apnea syndrome. Ann Intern Med. 1999;131:485–91.CrossRefPubMedGoogle Scholar
  5. 5.
    Chung F, Yegneswaran B, Liao P, et al. STOP Questionnaire: a tool to screen patients for obstructive sleep apnea. Anesthesiology. 2008;108:812–21.CrossRefPubMedGoogle Scholar
  6. 6.
    Strobel RJ, Rosen RC. Obesity and weight loss in obstructive sleep apnea: a critical review. Sleep. 1996;19:104–15.PubMedGoogle Scholar
  7. 7.
    Ferguson KA, Ono T, Lowe AA, et al. The relationship between obesity and craniofacial structure in obstructive sleep apnea. Chest. 1995;108:375–81.CrossRefPubMedGoogle Scholar
  8. 8.
    Iber C, Ancoli-Israel S, Chesson AL, et al. 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
  9. 9.
    Young T, Shahar E, Nieto FJ, 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
  10. 10.
    Teran-Santos J, Jimenez-Gomez A, Cordero-Guevara J. The association between sleep apnea and the risk of traffic accidents. N Engl J Med. 1999;340:847–51.CrossRefPubMedGoogle Scholar
  11. 11.
    Kushida CA, Nichols DA, Holmes TH, 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;35:1593–602.PubMedCentralPubMedGoogle Scholar
  12. 12.
    Yaffe K, Laffan AM, Harrison SL, et al. Sleep-disordered breathing, hypoxia, and risk of mild cognitive impairment and dementia in older women. JAMA. 2011;306:613–9.PubMedCentralPubMedGoogle Scholar
  13. 13.
    Nieto FJ, Young TB, Lind BK, et al. Association of sleep-disordered breathing, sleep apnea, and hypertension in a large community- based study. Sleep Heart Health Study. JAMA. 2000;283:1829–36.CrossRefPubMedGoogle Scholar
  14. 14.
    Shamsuzzaman AS, Gersh BJ, Somers VK. Obstructive sleep apnea: implications for cardiac and vascular disease. JAMA. 2003;290:1906–14.CrossRefPubMedGoogle Scholar
  15. 15.
    Zhu Y, Fenik P, Zhan G, et al. Selective loss of catecholaminergic wake–active neurons in a murine sleep apnea model. J Neurosci. 2007;27:10060–71.CrossRefPubMedGoogle Scholar
  16. 16.
    Decker MJ, Jones KA, Solomon IG, et al. Reduced extracellular dopamine and increased responsiveness to novelty: neurochemical and behavioral sequelae of intermittent hypoxia. Sleep. 2005;28:169–76.PubMedGoogle Scholar
  17. 17.
    Riederer P, Wuketich S. Time course of nigrostriatal degeneration in Parkinson’s disease: a detailed study of influential factors in human brain amine analysis. J Neural Transm. 1976;38:277–301.CrossRefPubMedGoogle Scholar
  18. 18.
    Hardie RJ, Efthimiou J, Stern GM. Respiration and sleep in Parkinson’s disease. J Neurol Neurosurg Psychiatry. 1986;49:1326.CrossRefPubMedCentralPubMedGoogle Scholar
  19. 19.
    Braak H, Rüb U, Sandmann-Keil D, et al. Parkinson’s disease: affection of brain stem nuclei controlling premotor and motor neurons of the somatomotor system. Acta Neuropathol. 2000;99:489–95.CrossRefPubMedGoogle Scholar
  20. 20.
    Braak H, Tredici KD, Rüb U, et al. Staging of brain pathology related to sporadic Parkinson’s disease. Neurobiol Aging. 2003;24:197–211.CrossRefPubMedGoogle Scholar
  21. 21.
    Probst A, Bloch A, Tolnay M. New insights into the pathology of Parkinson’s disease: does the peripheral autonomic system become central? Eur J Neurol. 2008;15 Suppl 1:1–4.CrossRefPubMedGoogle Scholar
  22. 22.
    Hovestadt A, Bogaard JM, Meerwaldt JD, et al. Pulmonary function in Parkinson’s disease. J Neurol Neurosurg Psychiatry. 1989;52:329–33.CrossRefPubMedCentralPubMedGoogle Scholar
  23. 23.
    Shill H, Stacy M. Respiratory complications of Parkinson’s disease. Semin Respir Crit Care Med. 2002;23:261–5.CrossRefPubMedGoogle Scholar
  24. 24.
    Canning CG, Alison JA, Allen NE, et al. Parkinson’s disease: an investigation of exercise capacity, respiratory function, and gait. Arch Phys Med Rehabil. 1997;78:199–207.CrossRefPubMedGoogle Scholar
  25. 25.
    Herer B, Arnulf I, Housset B. Effects of levodopa on pulmonary function in Parkinson’s disease. Chest. 2001;119:387–93.CrossRefPubMedGoogle Scholar
  26. 26.
    Sabate M, Gonzalez I, Ruperez F, et al. Obstructive and restrictive pulmonary dysfunctions in Parkinson’s disease. J Neurol Sci. 1996;138:114–9.CrossRefPubMedGoogle Scholar
  27. 27.
    Hobson DE, Lang AE, Martin WW, et al. Excessive daytime sleepiness and sudden-onset sleep in Parkinson disease. JAMA. 2002;287:455–63.CrossRefPubMedGoogle Scholar
  28. 28.
    Ferreira JJ, Galitzky M, Montastruc JL, et al. Sleep attacks and Parkinson’s disease treatment. Lancet. 2000;355:1333–4.CrossRefPubMedGoogle Scholar
  29. 29.
    Bliwise DL, Trotti LM, Wilson AG, et al. Daytime alertness in Parkinson's disease: potentially dose‐dependent, divergent effects by drug class. Mov Disord. 2012;27:1118–24.CrossRefPubMedCentralPubMedGoogle Scholar
  30. 30.
    Arnulf I, Konofal E, Merino-Andreu M, et al. Parkinson’s disease and sleepiness: an integral part of PD. Neurology. 2002;58:1019–24.CrossRefPubMedGoogle Scholar
  31. 31.
    Rye DB, Bliwise DL, Dihenia B, et al. Daytime sleepiness in Parkinson’s disease. J Sleep Res. 2000;9:63–9.CrossRefPubMedGoogle Scholar
  32. 32.
    Chotinaiwattarakul W, Dayalu P, Chervin RD, et al. Risk of sleep-disordered breathing in Parkinson’s disease. Sleep Breath. 2011;15:471–8.CrossRefPubMedCentralPubMedGoogle Scholar
  33. 33.
    Rongve A, Boeve BF, Aarsland D. Frequency and correlates of caregiver‐reported sleep disturbances in a sample of persons with early dementia. J Am Geriatr Soc. 2010;58:480–6.CrossRefPubMedGoogle Scholar
  34. 34.
    Douglass AB, Bornstein R, Nino-Murcia G, et al. The sleep disorders questionnaire I: creation and multivariate structure of SDQ. Sleep. 1994;17:160–7.PubMedGoogle Scholar
  35. 35.
    Happe S, Schrödl B, Faltl M, et al. Sleep disorders and depression in patients with Parkinson’s disease. Acta Neurol Scand. 2001;104:275–80.CrossRefPubMedGoogle Scholar
  36. 36.
    Maria B, Sophia S, Michalis M, et al. Sleep breathing disorders in patients with idiopathic Parkinson’s disease. Respir Med. 2003;97:1151–7.CrossRefPubMedGoogle Scholar
  37. 37.
    Baumann C, Ferini-Strambi L, Waldvogel D, et al. Parkinsonism with excessive daytime sleepiness—a narcolepsy-like disorder? J Neurol. 2005;252:139–45.CrossRefPubMedGoogle Scholar
  38. 38.
    Diederich NJ, Vaillant M, Leischen M, et al. Sleep apnea syndrome in Parkinson’s disease. A case–control study in 49 patients. Mov Disord. 2005;20:1413–8.CrossRefPubMedGoogle Scholar
  39. 39.
    Shpirer I, Miniovitz A, Klein C, et al. Excessive daytime sleepiness in patients with Parkinson’s disease: a polysomnography study. Mov Disord. 2006;21:1432–8.CrossRefPubMedGoogle Scholar
  40. 40.
    Monaca C, Duhamel A, Jacquesson JM, et al. Vigilance troubles in Parkinson’s disease: a subjective and objective polysomnographic study. Sleep Med. 2006;7:448–53.CrossRefPubMedGoogle Scholar
  41. 41.
    Sixel-Döring F, Schweitzer M, Mollenhauer B, et al. Polysomnographic findings, video-based sleep analysis and sleep perception in progressive supranuclear palsy. Sleep Med. 2009;10:407–15.CrossRefPubMedGoogle Scholar
  42. 42.
    Norlinah MI, Afidah KN, Noradina AT, et al. Sleep disturbances in Malaysian patients with Parkinson’s disease using polysomnography and PDSS. Parkinsonism Relat Disord. 2009;15:670–4.CrossRefPubMedGoogle Scholar
  43. 43.
    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
  44. 44.
    Trotti LM, Bliwise DL. No increased risk of obstructive sleep apnea in Parkinson’s disease. Mov Disord. 2010;25:2246–9.CrossRefPubMedCentralPubMedGoogle Scholar
  45. 45.
    Yong MH, Fook-Chong S, Pavanni R, et al. Case control polysomnographic studies of sleep disorders in Parkinson’s disease. PLoS One. 2011;6:e22511.CrossRefPubMedCentralPubMedGoogle Scholar
  46. 46.
    Nomura T, Inoue Y, Kobayashi M, et al. Characteristics of obstructive sleep apnea in patients with Parkinson’s disease. J Neurol Sci. 2013.Google Scholar
  47. 47.
    Efthimiou J, Ellis SJ, Hardie RJ, et al. Sleep apnea in idiopathic and postencephalitic parkinsonism. Adv Neurol. 1987;45:275–6.PubMedGoogle Scholar
  48. 48.
    Apps MC, Sheaff PC, Ingram DA, et al. Respiration and sleep in Parkinson’s disease. J Neurol Neurosurg Psychiatry. 1985;48:1240–5.CrossRefPubMedCentralPubMedGoogle Scholar
  49. 49.
    Peeraully T, Yong MH, Chokroverty S, et al. Sleep and Parkinson’s disease: a review of case‐control polysomnography studies. Mov Disord. 2012;27:1729–37.CrossRefPubMedGoogle Scholar
  50. 50.
    Chaudhuri K, Martinez-Martin P, Schapira A, 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;21:916–23.CrossRefPubMedGoogle Scholar
  51. 51.
    Johns MW. A new method for measuring daytime sleepiness: the Epworth sleepiness scale. Sleep. 1991;14:540–5.PubMedGoogle Scholar
  52. 52.
    Gama RL, Távora DG, Bomfim RC, et al. Sleep disturbances and brain MRI morphometry in Parkinson’s disease, multiple system atrophy and progressive supranuclear palsy–a comparative study. Parkinsonism Relat Disord. 2010;16:275–9.CrossRefPubMedGoogle Scholar
  53. 53.
    Poryazova R, Benninger D, Waldvogel D, et al. Excessive daytime sleepiness in Parkinson’s disease: characteristics and determinants. Eur Neurol. 2010;63:129–35.CrossRefPubMedGoogle Scholar
  54. 54.
    Valko PO, Hauser S, Werth E, et al. Heart rate variability in patients with idiopathic Parkinson’s disease with and without obstructive sleep apnea syndrome. Parkinsonism Relat Disord. 2012;18:525–31.CrossRefPubMedGoogle Scholar
  55. 55.
    Vendette M, Gagnon JF, Decary A, et al. REM sleep behavior disorder predicts cognitive impairment in Parkinson disease without dementia. Neurology. 2007;69:1843–9.CrossRefPubMedGoogle Scholar
  56. 56.
    Stavitsky K, Neargarder S, Bogdanova Y. The impact of sleep quality on cognitive functioning in Parkinson’s disease. J Int Neuropsychol Soc. 2011;18:108–17.CrossRefPubMedCentralPubMedGoogle Scholar
  57. 57.
    Scullin MK, Fairley JA, Trotti LM, et al. Sleep correlates of trait executive function and memory in Parkinson’s disease. J Parkinsons Dis. 2015;5:49–54.Google Scholar
  58. 58.
    Rasch B, Born J. About sleep’s role in memory. Physiol Rev. 2013;93:681–766.CrossRefPubMedCentralPubMedGoogle Scholar
  59. 59.
    Scullin MK, Trotti LM, Wilson AG, et al. Nocturnal sleep enhances working memory training in Parkinson’s disease but not Lewy body dementia. Brain. 2012;135:2789–97.CrossRefPubMedCentralPubMedGoogle Scholar
  60. 60.
    Marinelli L, Crupi D, Di Rocco A, et al. Learning and consolidation of visuo-motor adaptation in Parkinson’s disease. Parkinsonism Relat Disord. 2009;15:6–11.CrossRefPubMedCentralPubMedGoogle Scholar
  61. 61.
    Terpening Z, Naismith S, Melehan K, et al. The contribution of nocturnal sleep to the consolidation of motor skill learning in healthy ageing and Parkinson’s disease. J Sleep Res. 2013.Google Scholar
  62. 62.
    Andersen JK. Oxidative stress in neurodegeneration: cause or consequence? Nat Rev Neurosci. 2004;5:S18–25.CrossRefGoogle Scholar
  63. 63.
    Jenner P. Oxidative stress in Parkinson’s disease. Ann Neurol. 2003;53:S26–38.CrossRefPubMedGoogle Scholar
  64. 64.
    Young A, Horne M, Churchward T, et al. Comparison of sleep disturbance in mild versus severe Parkinson’s disease. Sleep. 2002;25:573–7.PubMedGoogle Scholar
  65. 65.
    Scullin MK, Trotti LM, Goldstein FC et al. PSG-recorded sleep as a possible biomarker of worsening motor function in Parkinson’s disease. In: Abstracts of the annual SLEEP meeting, Baltimore, June 2013.Google Scholar
  66. 66.
    Yoshida T, Kono I, Yoshikawa K, et al. Improvement of sleep hypopnea by antiparkinsonian drugs in a patient with Parkinson’s disease: a polysomnographic study. Intern Med. 2003;42:1135–8.CrossRefPubMedGoogle Scholar
  67. 67.
    Schäfer D. Schlafbezogene Atmungsstörungen bei Parkinsonsyndromen: Häufigkeit, Art und Behandlungsansätze [Sleep related breathing disorders in parkinsonism: frequency, nature, and therapeutical approaches]. Somnologie. 2001;5:103–14.CrossRefGoogle Scholar
  68. 68.
    Högl B. Sleep apnea in Parkinson’s disease: when is it significant? Sleep Med. 2010;11:233–5.CrossRefPubMedGoogle Scholar
  69. 69.
    Neikrug AB, Liu L, Avanzino JA, et al. Continuous positive airway pressure improves sleep and daytime sleepiness in patients with Parkinson’s disease and sleep apnea. Sleep. 2014;37:177–85.Google Scholar
  70. 70.
    Mehta A, Qian J, Petocz P, et al. A randomized, controlled study of a mandibular advancement splint for obstructive sleep apnea. Am J Respir Crit Care Med. 2001;163:1457–61.CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag Wien 2015

Authors and Affiliations

  • Michael K. Scullin
    • 1
    Email author
  • Lynn Marie Trotti
    • 2
  • Donald L. Bliwise
    • 2
  1. 1.Department of Psychology and NeuroscienceBaylor UniversityWacoUSA
  2. 2.Department of NeurologyEmory University School of MedicineAtlantaUSA

Personalised recommendations