title: Age, drugs, or disease: what alters the macrostructure of sleep in Parkinson's disease?
abstract: OBJECTIVE
  To describe the alterations in the macrostructure of sleep in a large cohort of sleep-disturbed patients with Parkinson's disease (PD) and investigate influencing factors.
  
  
  METHODS
  A cohort of sleep-disturbed but otherwise unselected PD patients (n=351) was investigated with video-supported polysomnography. We analyzed the influence of age, disease duration, disease severity, and dopaminergic medication on subjective sleep perception, sleep efficiency, the amount of slow wave sleep, awakenings, periodic leg movements in sleep (PLMS), and REM sleep behavior disorder (RBD).
  
  
  RESULTS
  Sleep efficiency and slow wave sleep decreased with age (p=0.003 and p=0.041, respectively). The number of awakenings and the frequency of RBD increased with age (p=0.028 and p=0.006, respectively). Higher Hoehn & Yahr stages were associated with more PLMS (p=0.017). A higher daily dose of levodopa corresponded to more RBD (p<0.001). Neither disease duration nor levodopa dosage had any influence on sleep efficiency, slow wave sleep, awakenings, or PLMS. Dopamine agonists increased awakenings (p<0.001) and lowered PLMS (p<0.001). Subjective sleep perception was not influenced by any of the factors analyzed. The only path model that could be replicated identified disease severity and dopamine agonists as interdependent factors influencing awakenings and PLMS.
  
  
  CONCLUSIONS
  Age leads to less sleep and a higher risk for RBD, and disease severity increases motor phenomena such as PLMS; dopamine agonists reduce PLMS but increase awakenings. No single factor analyzed influenced subjective sleep perception in this cohort of sleep disturbed PD patients.
authors: Paracelsus-Elena-Klinik, Kassel, Germany. friederike.sixel@pk-mx.de
authors: Friederike
authors: F
authors: Sixel-Döring
authors: Ellen
authors: E
authors: Trautmann
authors: Brit
authors: B
authors: Mollenhauer
authors: Claudia
authors: C
authors: Trenkwalder
mesh_terms: D000367:Age Factors; D000368:Aged; D000978:Antiparkinson Agents / Q000009:adverse effects* / Q000627:therapeutic use; D005260:Female; D006801:Humans; D008297:Male; D020189:Nocturnal Myoclonus Syndrome / Q000139:chemically induced / Q000209:etiology; D010300:Parkinson Disease / Q000150:complications / Q000188:drug therapy / Q000503:physiopathology*; D017286:Polysomnography; D020187:REM Sleep Behavior Disorder / Q000139:chemically induced / Q000209:etiology; D012890:Sleep / Q000187:drug effects / Q000502:physiology*; D012894:Sleep Stages / Q000187:drug effects / Q000502:physiology; D012893:Sleep Wake Disorders / Q000139:chemically induced / Q000209:etiology
chemical_list: D000978:Antiparkinson Agents