Objective: To investigate the potential causes of excessive daytime sleepiness in patients with PD—poor sleep quality, abnormal sleep–wakefulness control, and treatment with dopaminergic agents. Methods: The authors performed night-time polysomnography and daytime multiple sleep latency tests in 54 consecutive levodopa-treated patients with PD referred for sleepiness, 27 of whom were also receiving dopaminergic agonists. Results: Sleep latency was 6.3 ± 0.6 minutes (normal >8 minutes), and the Epworth Sleepiness score was 14.3 ± 4.1 (normal 15/h; range 15.1 to 50.0). Severity of sleepiness was weakly correlated with Epworth Sleepiness score ( r = −0.34) and daily dose of levodopa ( r = 0.30) but not with dopamine-agonist treatment, age, disease duration, parkinsonian motor disability, total sleep time, periodic leg movement, apnea–hypopnea, or arousal indices. Conclusions: In patients with PD preselected for sleepiness, severity of sleepiness was not dependent on nocturnal sleep abnormalities, motor and cognitive impairment, or antiparkinsonian treatment. The results suggest that sleepiness—sudden onset of sleep—does not result from pharmacotherapy but is related to the pathology of PD.

Parkinson’s disease and sleepiness An integral part of PD

Study ObjectivesTo investigate the efficacy of melatonin compared to placebo in improving sleep parameters in patients with primary sleep disorders.DesignPubMed was searched for randomized, placebo-controlled trials examining the effects of melatonin for the treatment of primary sleep disorders. Primary outcomes examined were improvement in sleep latency, sleep quality and total sleep time. Meta-regression was performed to examine the influence of dose and duration of melatonin on reported efficacy.ParticipantsAdults and children diagnosed with primary sleep disorders.InterventionsMelatonin compared to placebo.ResultsNineteen studies involving 1683 subjects were included in this meta-analysis. Melatonin demonstrated significant efficacy in reducing sleep latency (weighted mean difference (WMD) = 7.06 minutes [95% CI 4.37 to 9.75], Z = 5.15, p < 0.001) and increasing total sleep time (WMD = 8.25 minutes [95% CI 1.74 to 14.75], Z = 2.48, p < 0.013). Trials with longer duration and using higher doses of mela...

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Meta-Analysis: Melatonin for the Treatment of Primary Sleep Disorders

Sleep is implicated in cognitive functioning in young adults. With increasing age, there are substantial changes to sleep quantity and quality, including changes to slow-wave sleep, spindle density, and sleep continuity/fragmentation. A provocative question for the field of cognitive aging is whether such changes in sleep physiology affect cognition (e.g., memory consolidation). We review nearly a half century of research across seven diverse correlational and experimental domains that historically have had little crosstalk. Broadly speaking, sleep and cognitive functions are often related in advancing age, though the prevalence of null effects in healthy older adults (including correlations in the unexpected, negative direction) indicates that age may be an effect modifier of these associations. We interpret the literature as suggesting that maintaining good sleep quality, at least in young adulthood and middle age, promotes better cognitive functioning and serves to protect against age-related cognitive declines.

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Sleep, cognition, and normal aging: integrating a half century of multidisciplinary research.

BACKGROUND: Correct diagnosis of rapid eye movement sleep behavior disorder (RBD) is important because it can be the first manifestation of a neurodegenerative disease, it may lead to serious injury, and it is a well-treatable disorder. We evaluated the electromyographic (EMG) activity in the Sleep Innsbruck Barcelona (SINBAR) montage (mentalis, flexor digitorum superficialis, extensor digitorum brevis) and other muscles to obtain normative values for the correct diagnosis of RBD for clinical practice. SETTING: Two university hospital sleep disorder centers. PARTICIPANTS: Thirty RBD patients (15 idiopathic [iRBD], 15 with Parkinson disease [PD]) and 30 matched controls recruited from patients with effectively treated sleep related breathing disorders. INTERVENTIONS: Not applicable. METHODS AND RESULTS: Participants underwent video-polysomnography, including registration of 11 body muscles. Tonic, phasic, and "any" (any type of EMG activity, irrespective of whether it consisted of tonic, phasic or a combination of both) EMG activity was blindly quantified for each muscle. When choosing a specificity of 100%, the 3-sec miniepoch cutoff for a diagnosis of RBD was 18% for "any" EMG activity in the mentalis muscle (area under the curve [AUC] 0.990). Discriminative power was higher in upper limb (100% specificity, AUC 0.987-9.997) than in lower limb muscles (100% specificity, AUC 0.813-0.852). The combination of "any" EMG activity in the mentalis muscle with both phasic flexor digitorum superficialis muscles yielded a cutoff of 32% (AUC 0.998) for patients with iRBD and with PD-RBD. CONCLUSION: For the diagnosis of iRBD and RBD associated with PD, we recommend a polysomnographic montage quantifying "any" (any type of EMG activity, irrespective of whether it consisted of tonic, phasic or a combination of both) EMG activity in the mentalis muscle and phasic EMG activity in the right and left flexor digitorum superficialis muscles in the upper limbs with a cutoff of 32%, when using 3-sec miniepochs. CITATION: Frauscher B; Iranzo A; Gaig C; Gschliesser V; Guaita M; Raffelseder V; Ehrmann L; Sola N; Salamero M; Tolosa E; Poewe W; Santamaria J; Hogl B. Normative EMG values during REM sleep for the diagnosis of REM sleep behavior disorder. SLEEP 2012;35(6):835-847. Language: en

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Normative EMG values during REM sleep for the diagnosis of REM sleep behavior disorder.

We examined the interrater (IRR) of clinical ratings of neuropsychological (NP) impairment and neurocognitive diagnoses in HIV. Thirty participants with advanced HIV-infection who were enrolled in a multicenter HIV brain banking research project underwent comprehensive NP and neuromedical evaluations. Using a standardized system of guidelines, neuropsychologists from six participating sites independently assigned clinical ratings of NP impairment, as well as multilevel diagnoses reflecting the inferred etiology of the impairments and their effects on everyday functioning. Findings indicated excellent IRR in rating the presence and severity of NP impairment, but overall modest IRR for neurocognitive diagnoses. Not surprisingly, most diagnostic disagreements concerned the etiology of impairments in persons with medical and neuropsychiatric risk factors in addition to HIV.

Interrater reliability of clinical ratings and neurocognitive diagnoses in HIV.

https://faculty.washington.edu/vitiello/Recent%20Publications/Bliwise%20Nocturia.pdf

Nocturia and disturbed sleep in the elderly

Objective Daytime sleep has been noted to accompany dementing illness and is more pronounced as dementia severity increases. Although acknowledged by caregivers, sleepiness during the daytime is among the least troublesome of sleep behaviors described in Alzheimer Disease (AD) patients. The purpose of this study was to examine whether patient and spouse/caregiver reports of daytime sleepiness in AD were associated with lower functional status in those patients. Methods The authors utilized the Epworth Sleepiness Scale to assess reported daytime sleepiness and a modification of the Lawton and Brody scale to assess functional status in a group of 137 AD patients. The authors also examined typical bedtimes and wakeup times via questionnaire. Results Higher levels of daytime sleepiness were associated with greater impairments in functional status. These results were independent of level of cognitive impairment, as assessed with Mini-Mental State Exam, and they were also detectable when the authors limited analyses to data reported only by spouse/caregiver. Findings were not associated with medication use. AD patients also had earlier bedtimes and later wake-up times than a comparison group. Conclusion Even apart from its association with impaired cognition, daytime sleepiness was associated with functional impairment in AD patients. Although daytime sleep may represent a welcome relief for caregivers, its presence may be associated with greater impairment in instrumental activities and may warrant intervention.

Daytime sleepiness and functional impairment in Alzheimer disease.

Recently described functional connections between basal ganglia and brainstem circuits provide a neurobiologic basis for the absence of REM sleep atonia in Parkinson's disease (PD). However, identifying atypical REM sleep in PD may be problematic. Reliable sleep staging has never been demonstrated in such patients. In this study, 3 experienced scorers independently evaluated overnight polysomnograms from 10 (PD) patients. Results indicated good agreement for distinguishing REM from NREM sleep and waking. Reliable differentiation among NREM stages was more difficult to achieve. The results suggest that, despite suspension of REM sleep atonia accompanying PD, trained scorers can distinguish REM from wakefulness and NREM sleep.

Inter-rater Reliability for Identification of REM Sleep in Parkinson's Disease

Objective Aging has been associated with increased nocturnal awakenings, increased napping, earlier bedtimes and wake-up times, and more regular sleep–wake schedules. These patterns have often been ascribed to both psychosocial and medical factors, but nearly all studies to-date have been cross-sectional. Methods The authors present self-reported sleep data from 31 elderly subjects followed over a decade. Results With aging, the number of nightly awakenings and daytime napping increased over time. Exploratory analyses suggested that individuals who lived with another person had earlier bedtimes, later wake-up times, and greater daytime napping. Intervening medical comorbidities also appeared to be associated with increased napping. Conclusion These results confirm previous cross-sectional studies and suggest a complex biopsychosocial matrix for the timing and placement of sleep in elderly persons within the 24-hour day.

Age changes in timing and 24-hour distribution of self-reported sleep.

Recording of electromyographic (EMG) activity is considered essential for defining rapid eye movement (REM) sleep and for quantifying certain types of movements in sleep, such as periodic leg movements in sleep (PLMS). However, routine analyses of EMG activity beyond such purposes is performed rarely and quantified seldom, and normative data are lacking. In this study, the authors examined systematic application of a visual scoring system for short-duration (approximately 100-millisecond) phasic EMG activity recorded from five different muscle groups (submentalis, left/right anterior tibialis, left/right brachioradialis) recorded from two different age groups of normal subjects and a group of patients with Parkinson's disease. Quantification of this activity was labeled as a phasic electromyographic metric (PEM). PEM data were compiled separately by REM and non-REM sleep. Results indicated that PEM is a normal part of REM sleep in all muscle groups, more specifically constituting about 5% (SD = 3.1%) of 2.5-second intervals of REM sleep in the mentalis in healthy young adults. It occurs at higher rates in patients with Parkinson's disease, and its quantification in the legs may be influenced to some degree by the presence of PLMS. PEM may be a useful metric amenable to quantification with digital techniques. It may have particular relevance for the identification of neurodegenerative conditions in which disinhibition of midbrain dopaminergic pathways results in excessive motor discharge during sleep.

Farzaneh Pour Ansari

Papers

Nocturia and disturbed sleep in the elderly

Daytime sleepiness and functional impairment in Alzheimer disease.

Inter-rater Reliability for Identification of REM Sleep in Parkinson's Disease

Age changes in timing and 24-hour distribution of self-reported sleep.

Quantification of electromyographic activity during sleep : A phasic electromyographic metric