Activity-rest rhythm abnormalities in Parkinson's disease patients are related to dopaminergic therapy.
OBJECTIVE
To compare going to bed, waking-up, and immobility onset and offset times in Parkinson's disease (PD) patients receiving levodopa and/or dopamine agonists (i.e., dopaminergic therapy or DT) with "de novo" patients and healthy controls and to correlate these parameters with self-reported sleep disturbances.


METHODS
Fifteen "de novo" and 60 PD patients on DT were included in the study. Twenty-three subjects without history of sleep complaints and similar age and sex distributions as the PD patients served as controls. Going to bed and waking-up times were registered in 7-day sleep logs. Nocturnal immobility onset and offset times were measured using actigraphy. Sleep disorders were assessed applying the PD sleep scale (PDSS).


RESULTS
Patients on DT showed earlier waking-up and immobility offset times (40 min) compared with controls and "de novo" patients. Multivariable regression analysis showed that DT but not Hoehn & Yahr score was a significant and independent predictor of early awakening time (OR = 4.0, 95% CI = 1.15-14.13). Patients manifesting more frequent nighttime psychotic symptoms and more frequent daytime somnolence showed earlier going to bed and waking-up times.


CONCLUSIONS
Results suggest that activity-rest rhythm alteration in PD may be a consequence of DT but not of disease stage. Altered sleep cycles correlated with diurnal somnolence and nocturnal psychosis.
Movement Disorders Section, Raul Carrea Institute for Neurological Research, FLENI, Buenos Aires, Argentina.
Santiago
S
Perez-Lloret
Perez-Lloret
PL
Santiago
Malco
M
Rossi
Daniel P
DP
Cardinali
Marcelo
M
Merello
D056044:Actigraphy / Q000379:methods; D000203:Activities of Daily Living; D000368:Aged; D016022:Case-Control Studies; D002940:Circadian Rhythm / Q000187:drug effects*; D015259:Dopamine Agents / Q000009:adverse effects* / Q000494:pharmacology*; D005260:Female; D006801:Humans; D007980:Levodopa / Q000009:adverse effects* / Q000494:pharmacology*; D008297:Male; D010147:Pain Measurement; D010300:Parkinson Disease / Q000188:drug therapy; D017286:Polysomnography / Q000379:methods; D011237:Predictive Value of Tests; D011569:Psychiatric Status Rating Scales; D012893:Sleep Wake Disorders / Q000139:chemically induced* / Q000503:physiopathology; D018709:Statistics, Nonparametric; D014851:Wakefulness / Q000187:drug effects
D015259:Dopamine Agents; D007980:Levodopa