title: Is obstructive sleep apnea a problem in Parkinson's disease?
abstract: BACKGROUND
  Parkinson's disease (PD) is associated with sleep disorders and daytime sleepiness. Upper airway dysfunction in PD may promote obstructive sleep apnea. However, the frequency and clinical relevance of sleep-disordered breathing in PD remains unclear.
  
  
  METHODS
  Sleep apnea symptoms, cardiovascular events and treatment were collected in 100 patients with PD (50 unselected, consecutive patients matched for age, sex and body mass index with 50 patients referred for sleepiness) and 50 in-hospital controls. The motor and cognitive status was evaluated in patients with PD. The 150 subjects underwent a video-polysomnography.
  
  
  RESULTS
  Sleep apnea (defined as an apnea-hypopnea index greater than 5) was less frequent in the PD group (27% patients, including 6% with mild, 11% with moderate and 10% with severe sleep apnea) than in the control group (40% in-hospital controls, p<0.002). Sleep apnea was not associated with increased sleepiness, nocturia, depression, cognitive impairment and cardiovascular events in patients with PD. Sleep apnea was more frequent and severe in the most disabled patients. Patients with PD did not display sleep hypoventilation, stridor and abnormal central sleep apnea. In patients with REM sleep behavior disorders, snoring and obstructive sleep apnea occurred during REM sleep, although the chin muscle tone was maintained.
  
  
  CONCLUSIONS
  Obstructive sleep apnea does not seem to be a clinically relevant issue in PD. Daytime sleepiness, nocturia and cognitive impairment are mostly caused by other, non-apneic mechanisms. The maintenance of chin muscle tone during REM sleep behavior disorder has no influence on the frequency of apneic events.
authors.affiliation: Sleep Disorders Unit, Pitié-Salpêtrière Hospital, APHP, Paris, France.
authors.forename: Valérie
authors.initials: V
authors.lastname: Cochen De Cock
authors.forename: Maher
authors.initials: M
authors.lastname: Abouda
authors.forename: Smaranda
authors.initials: S
authors.lastname: Leu
authors.forename: Delphine
authors.initials: D
authors.lastname: Oudiette
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Roze
authors.forename: Marie
authors.initials: M
authors.lastname: Vidailhet
authors.forename: Thomas
authors.initials: T
authors.lastname: Similowski
authors.forename: Isabelle
authors.initials: I
authors.lastname: Arnulf
mesh_terms: D000368:Aged; D002318:Cardiovascular Diseases / Q000150:complications; D016022:Case-Control Studies; D003072:Cognition Disorders / Q000209:etiology; D004569:Electroencephalography; D005221:Fatigue / Q000209:etiology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010300:Parkinson Disease / Q000150:complications* / Q000503:physiopathology; D017286:Polysomnography; D012135:Respiratory Sounds; D012891:Sleep Apnea Syndromes / Q000209:etiology; D020181:Sleep Apnea, Obstructive / Q000209:etiology*; D012892:Sleep Deprivation / Q000209:etiology; D012895:Sleep, REM / Q000502:physiology; D012913:Snoring / Q000209:etiology