Elsevier

Parkinsonism & Related Disorders

Volume 42, September 2017, Pages 90-94
Parkinsonism & Related Disorders

Short communication
Subjective perception of sleep benefit in Parkinson's disease: Valid or irrelevant?

https://doi.org/10.1016/j.parkreldis.2017.06.026Get rights and content

Highlights

  • 22% of patients had objective motor improvement on waking compared to end of dose.

  • 77% of patients reported subjective sleep benefit without objective motor benefit.

  • Predicting objective motor benefit using a questionnaire is not possible.

  • Feeling indifferent or worse after 1st levodopa dose suggest motor sleep benefit.

Abstract

Introduction

The phenomenon of sleep benefit (SB) in Parkinson's disease (PD), whereby waking motor function is improved despite no dopaminergic treatment overnight, is controversial. Previous studies suggested a significant discrepancy between subjective functional and objective motor improvement. The aim of this study was to determine how well subjective reporting of SB correlates with objective measures and if true motor improvement can be predicted by a standardized questionnaire.

Methods

Ninety-two patients with PD participated. A structured questionnaire was developed to assess subjective SB. Quantitative motor assessment was performed using a validated smartphone application. Objective motor SB was considered to be present when the waking motor function was similar or superior to the daytime on-state.

Results

Twenty (22%) patients showed objective motor improvement on waking compared to end-of-dose. Most patients (77%) reported subjective SB without corresponding objective motor benefit. Our structured questionnaire could not predict Motor SB. The ability to delay morning medications and a perception of indifference or paradoxical worsening following the morning levodopa dose may suggest Motor SB.

Conclusions

Most patients experience subjective SB with no measureable motor improvement. This perceived benefit could be related to non-motor improvement that is distinctly different to objective motor benefit.

Introduction

Sleep benefit (SB) refers to the poorly understood phenomenon in Parkinson's disease (PD) where patients wake up in the morning with improved motor function [1], [2], [3], [4], [5], [6]. Previous studies in SB relied heavily on subjective reporting [1], [2], [3], [4], [7] and attempts to incorporate objective motor measurement have yielded conflicting results [2], [5], [6]. There seems to be an unexplained discrepancy between self-perceived functional and objective motor improvement in patients with PD on waking in the morning [1], [2], [3], [4], [5], [6]. To clarify these issues, we carried out the Effect on Motor symptoms in Parkinson's disease Resulting from Sleep (EMPIRES) study. The first part of this study aimed to characterize and quantitatively measure SB. We confirmed that SB is a genuine phenomenon with the morning waking motor function of 20/92 (22%) patients improving from end-of-dose at least by the same extent as their on-state (Motor SB) [8]. Here we sought to determine how well subjective reporting correlates with objective measurement of Motor SB and whether Motor SB can be predicted using a standardized structured questionnaire.

Section snippets

Methods

The Alfred and Royal Melbourne Hospitals' Human Research and Ethics Committees approved this study. All patients provided informed consent.

Results

Ninety-two patients with PD participated. Mean age was 65 years (range 38–87) and disease duration was 8.7 years (range 2–24). Mean LEDD was 930 mg/d (range 150–3046) and treatment duration was 6.3 years (range 0–21). Mean on-state MDS-UPDRS-III total score was 20 (range 1–47) and Hoehn and Yahr stage was 2 (range 1–3). The waking motor function of 57/92 patients (62%) either remained stable or improved while 35/92 patients (38%) deteriorated. Of the 57 patients with stable or enhanced waking

Discussion

To date, characterization of SB has been largely based on subjective reporting with few studies also incorporating objective measures. We combined the use of a structured questionnaire and ambulatory quantitative motor assessment in a large population of patients with PD. We found most (77%) perceived subjective SB, in contrast to substantially fewer (22%) that actually showed objective motor improvement upon waking. As such, trying to identify individuals with true Motor SB through direct

Conclusion

Sleep benefit traditionally refers to improved motor symptoms upon waking. This seems to be a genuine and measurable phenomenon. However, subjective reporting does not predict Motor SB. Most patients described general improved function upon waking and this subjective experience may represent a completely different phenomenon. The enhancement of non-motor symptoms such as mood, apathy and fatigue could account for this subjective improvement. Further studies examining the non-motor benefit of

Financial disclosures

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. David Williams and Andrew Evans declare intellectual property rights to Parkinson's Disease Assessment App.

Acknowledgement

Nil.

References (12)

  • E. Sherif et al.

    Sleep benefit in Parkinson's disease is associated with short sleep times

    Park. Relat. Disord.

    (2014)
  • M. Merello et al.

    Sleep benefit in Parkinson's disease

    Mov. Disord.

    (1997)
  • D.E. Bateman et al.

    Sleep benefit in Parkinson's disease

    J. Neurol. Neurosurg. Psychiatry

    (1999)
  • L.J. Currie et al.

    Clinical correlates of sleep benefit in Parkinson's disease

    Neurology

    (1997)
  • S.A. Factor et al.

    Sleep disorders and sleep effect in Parkinson's disease

    Mov. Disord.

    (1990)
  • B.E. Hogl et al.

    A clinical, pharmacologic, and polysomnographic study of sleep benefit in Parkinson's disease

    Neurology

    (1998)
There are more references available in the full text version of this article.
View full text