title: Insomnia, Sleep Quality, and Quality of Life in Mild to Moderate Parkinson's Disease.
abstract: BACKGROUND
  Sleep disorders are prevalent in Parkinson's disease but underreported in clinical settings. The contribution of sleep disorders to health-related quality of life (HRQOL) for patients with this degenerative neurological disease are not well known.
  
  
  OBJECTIVE
  To evaluate the impact of insomnia symptoms, obstructive sleep apnea (OSA), and poor sleep quality on HRQOL in a cohort of patients with idiopathic Parkinson's disease.
  
  
  METHODS
  We enrolled a convenience sample of 66 adults seen in the University of Miami Movement Disorders Clinic between July 2011 and June 2013. Participants completed validated questionnaires to determine insomnia symptoms, OSA risk, depression, anxiety, and HRQOL. All patients underwent unattended polysomnography to confirm OSA. Results were compared for those with and without insomnia symptoms. Principal component and regression analyses were performed to evaluate determinants of HRQOL.
  
  
  RESULTS
  Participants were predominately Hispanic males with mild to moderate Parkinson's disease. Insomnia symptoms were reported for 46% of the study subjects. OSA (apnea-hypopnea index, ≥5) was noted in 47%, with a mean apnea-hypopnea index of 8.3 ± 11.0. Fairly bad to very bad sleep quality was reported by 21% of the participants. Insomnia (r = 0.71; P < 0.001), daytime sleepiness (r = 0.36; P = 0.003), depression symptoms (r =  0.44; P < 0.001), and anxiety symptoms (r = 0.33; P = 0.006) were significant correlates of poor sleep quality. OSA, severity of Parkinson's disease, and dopaminergic therapy were not. In the principal component analysis, sleep quality was a significant component of the "psychological factor" that in turn was a significant determinant of overall HRQOL.
  
  
  CONCLUSIONS
  Insomnia symptoms, OSA, and subsequent poor sleep quality are prevalent in Parkinson's disease. In this single-center, exploratory study, we found that insomnia and poor sleep quality, but not OSA, play important roles in determining overall quality of life for patients with this disease. Clinical trial registered with www.clinicaltrials.gov (NCT02034357).
authors.affiliation: 1 Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, Department of Medicine, Miller School of Medicine.
authors.forename: Shirin
authors.initials: S
authors.lastname: Shafazand
authors.affiliation: 2 Department of Neurology, Miller School of Medicine, and.|3 Neurology Service, Bruce W. Carter Department of Veterans Affairs Medical Center, Miami, Florida.
authors.forename: Douglas M
authors.initials: DM
authors.lastname: Wallace
authors.affiliation: 4 Division of Biostatistics, Department of Public Health Sciences, University of Miami, Miami, Florida; and.
authors.forename: Kristopher L
authors.initials: KL
authors.lastname: Arheart
authors.affiliation: 1 Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, Department of Medicine, Miller School of Medicine.|2 Department of Neurology, Miller School of Medicine, and.
authors.forename: Silvia
authors.initials: S
authors.lastname: Vargas
authors.affiliation: 2 Department of Neurology, Miller School of Medicine, and.
authors.forename: Corneliu C
authors.initials: CC
authors.lastname: Luca
authors.affiliation: 2 Department of Neurology, Miller School of Medicine, and.
authors.forename: Henry
authors.initials: H
authors.lastname: Moore
authors.affiliation: 2 Department of Neurology, Miller School of Medicine, and.
authors.forename: Heather
authors.initials: H
authors.lastname: Katzen
authors.affiliation: 2 Department of Neurology, Miller School of Medicine, and.
authors.forename: Bonnie
authors.initials: B
authors.lastname: Levin
authors.affiliation: 2 Department of Neurology, Miller School of Medicine, and.
authors.forename: Carlos
authors.initials: C
authors.lastname: Singer
mesh_terms: D000368:Aged; D001007:Anxiety / Q000523:psychology; D003863:Depression / Q000523:psychology; D005260:Female; D005431:Florida; D006801:Humans; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010300:Parkinson Disease / Q000150:complications* / Q000523:psychology*; D017286:Polysomnography; D011569:Psychiatric Status Rating Scales; D011788:Quality of Life; D012720:Severity of Illness Index; D020181:Sleep Apnea, Obstructive / Q000453:epidemiology*; D007319:Sleep Initiation and Maintenance Disorders / Q000453:epidemiology*; D012894:Sleep Stages; D011795:Surveys and Questionnaires
keywords: Parkinson’s disease; health-related quality of life; idiopathic; sleep initiation and maintenance disorders; sleep–wake disorders