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Arquivos de Neuro-Psiquiatria

Print version ISSN 0004-282XOn-line version ISSN 1678-4227

Arq. Neuro-Psiquiatr. vol.66 no.1 São Paulo Mar. 2008 



Sleep and its disturbances at parkinson disease: polysomnographic characteristics (abstract)*. Thesis. Londrina, 2007.



Monica Marcos de Souza**



Sleep disorders are often seen in Parkinson disease patients, causing impairment to their quality of life. Studies over Parkinson disease, its sleep characteristics, and polysomnographic aspects, are uncommon.
OBJECTIVE: To determine the main sleep disorders and its polysomnographic characteristics in patients with Parkinson disease in the Department of Neurology at the Hospital das Clinicas at Londrina State University (Universidade Estadual de Londrina - UEL), from 2005 to 2007. And to compare the results to a paired control population (control group).
METHOD: 253 patients of idiopathic Parkinson disease, and 246 sample population, thru this controlled process were evaluated. The polysomnograghy was performed in 156 patients and 64 of the control group. The informed consent forms were obtained; this research was approved by the Ethics Committee. The patients were evaluated using Sleep Questionnaire, Unified Parkinson Scale, Hoehn & Yahr Scale, Pittsburgh Sleep Quality Index (PSQI), Epworth Sleepiness Scale (ESS), Schwab England Scale, Mini Probe of Mental Status, and Scale for Evaluation of Economic Index. Evaluation of quantitative standards at the polysomnography included the sleep myoclonus periodicity, the apnea-hypopnea index, and digital oximetry. At the statistical analyses were used the Parson's Chi Square, Student T, and the Mann-Whitney, with significant level of 5%.
RESULTS: 126 men and 127 women with Parkinson disease, 125 men and 121 women at the control group were evaluated. The average age was 68 years old. The disease time was of 6.06±5.12 years. Bedtime, time to fall asleep, and sleep duration were similar in both groups. The sleep quality was impaired in Parkinson disease (p>0.001). The number of awakenings was higher the Parkinson patients (p=0.001). Insomnia and excessive daytime sleepiness were more common in Parkinson disease, with significant statistic differences. Complaints related to restless legs and REM behavior disorder were higher in Parkinson group patients. The Epworth Sleepiness Scale scores were similar in both groups. The Pittsburgh Sleep Quality Index showed the Parkinson disease group as poor sleeper (p<0.001). The insomnia was linked with movement difficulties, illness time and Levodopa dosage. The diurnal sleepiness was related to the time of the illness and to the Hoehn & Yahr scale. At the polysomnography, the total sleeping time was decreased at the Parkinson disease group (p<0.001). The total time awake and sleep latency were higher at the Parkinson disease, respectively p<0.001 and p=0.0012. REM latency and number of awakenings were similar in both groups. The stages 1 and 2 of the sleep were higher at the Parkinson disease group with sleep efficacy impairment (p<0.0001). Significant statistical differences in percentage of deep (stages 3 and 4) sleep and REM sleep were present. The periodic legs movement index and the obstructive sleep apnea index did not show significant differences. REM sleep without atonia was detected in 11 (7.1%) and central apnea in 3 (1.92%) of the patients.
CONCLUSION: The sleep impairment is a relevant finding in Parkinson disease. Characteristically, insomnia and the excessive daytime sleepiness were predominant. The polysomnographic findings show intense impairment of the sleep architecture within patients with Parkinson disease.

Key words: Parkinson disease, sleep, sleep disorders, insomnia.



* Sono e suas alterações na Doença de Parkinson. (Resumo). Tese de Doutorado, Universidade Estadual de Londrina (UEL) (Área: Medicina e Ciências da Saúde). Orientador: Damácio Ramón Kaimen Maciel; Co-Orientador: Rubens Reimão.
** Address: Rua dos Bogarís 38, 04047-020 São Paulo SP, Brasil. (E-mail:

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