Sleep Disorders in Parkinson's Disease

Parkinson’s disease is primarily recognised for its motor symptoms, yet non-motor disturbances, notably sleep disorders, are pervasive and often precede classical motor signs. Up to 90 per cent of patients experience one or more sleep impairments over the course of the illness. Insomnia, rapid eye movement (REM) sleep behaviour disorder, excessive daytime sleepiness, restless legs syndrome and sleep-disordered breathing represent the principal phenotypes. These disturbances arise from neurodegeneration within brainstem nuclei and hypothalamic centres, neurotransmitter imbalances and the effects of dopaminergic therapy. Sleep pathology not only exacerbates cognitive decline, mood disorders and autonomic dysfunction, but also diminishes quality of life. Diagnostic approaches such as polysomnography and actigraphy have provided detailed characterisation of altered sleep architecture. Recognising the bidirectional interactions between sleep-wake regulation and neurodegenerative processes has fostered interest in circadian-based interventions, pharmacological modulation of neurotransmitters and neuromodulation techniques. Advances in digital monitoring further promise scalable real-world assessment, guiding personalised management strategies to improve global patient outcomes.

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Sleep Disorders in Parkinson's Disease publication trend

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Technical terms

Insomnia: Difficulty initiating or maintaining sleep despite adequate opportunity.

REM sleep behaviour disorder (RBD): Loss of normal muscle atonia during REM sleep leading to dream enactment.

Excessive daytime sleepiness (EDS): Persistent propensity to fall asleep during usual waking hours.

Restless legs syndrome (RLS): Uncomfortable sensations in the legs with an urge to move, worsening at rest.

Sleep-disordered breathing (SDB): Repeated episodes of airway obstruction or hypoventilation during sleep.

Polysomnography: Comprehensive overnight recording of physiological parameters to assess sleep stages.

Digital biomarker: Objective measure of physiological or behavioural data collected via digital devices.

Circadian rhythm: Endogenous, approximately 24-hour cycle regulating sleep-wake patterns and other physiological functions.

References

1. Digital biomarkers for non-motor symptoms in Parkinson’s disease: the state of the art. npj Digital Medicine (2024).
2. Circadian disruption and sleep disorders in neurodegeneration. Translational Neurodegeneration (2023).
3. Sleep disorders in Parkinson’s disease, an early and multiple problem. npj Parkinson's Disease (2024).