Short communicationSubjective perception of sleep benefit in Parkinson's disease: Valid or irrelevant?
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.
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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.
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