Parkinson’s: Sleep Disturbances Affect Clinical Motor Subtypes, Disability

man sleeping in a bed
man sleeping in a bed
Patients with postural instability and gait disturbances had worse sleep scores than those with tremor-dominant Parkinson's.

There is a significant association between sleep disturbances and clinical motor subtypes, as well as disease-related disability, among patients with Parkinson’s disease (PD), according to findings from a multicenter study published in the Journal of Neurology, Neurosurgery, and Psychiatry.

Investigators examined the effect of sleep-related symptoms and clinical motor subtypes, including tremor dominant, intermediate, and postural instability and gait disturbances, in 436 patients with PD and 410 age-matched control patients. The researchers used the PD sleep scale (PDSS[1] ) 2, Epworth Sleepiness Scale (ESS), and REM sleep behavior disorder screening questionnaire-Japanese version (RBDSQ-J) to assess various sleep-related variables.

The researchers found that patients with PD were more likely to experience PD-related sleep problems (PD-SP), excessive daytime sleepiness (EDS), and probable RBD (pRBD) compared with control patients (PDSS-2 ≥18, 35.1% vs 7.0% [P <.0001]; ESS ≥10, 37.8% vs 15.5% [P <.0001]; RBDSQ-J ≥5, 35.1% vs 7.7% [P <.0001]). Compared with patients with tremor dominant, patients with postural instability and gait disturbance had higher PDSS-2 and ESS adjusted scores.

The Movement Disorder Society-Unified PD Rating Scale part II score, which assessed disease-related disability, was significantly associated with disease duration (P <.0001), disease severity (P <.0001[2] ), EDS (P <.0001), and PD-SP (P <.0001).

According to the investigators, 1 limitation of this study was the lack of polysomnography use for evaluation of the patients’ sleep status. In addition, the cross-sectional design and the lack of assessment of mild cognitive impairment or impulse control disorder may have presented additional limitations related to the final analysis.

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The researchers concluded that the findings of this study “demonstrate the importance of the clinical assessment and management of sleep-related symptoms (PD-SP, EDS and pRBD), which have a significant impact on disease-related disability compared with motor symptoms in patients with PD.”


Suzuki K, Okuma Y, Uchiyama T, et al. Impact of sleep-related symptoms on clinical motor subtypes and disability in Parkinson’s disease: a multicentre cross-sectional study [published online August 28, 2017]. J Neurol Neurosurg Psychiatry. doi:10.1136/jnnp-2017-316136