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Abstract
Objective: The objective of this cross-sectional study was to test the hypothesis that patients with Parkinson disease (PD) and freezing of gait (PD+FOG) would demonstrate sleep disturbances comparable to those seen in patients with REM sleep behavior disorder (RBD) and these changes would be significantly different from those in PD patients without FOG (PD-FOG) and age-matched controls.
Methods: We conducted overnight polysomnography studies in 4 groups of subjects: RBD, PD-FOG, PD+FOG, and controls. Tonic and phasic muscle activity during REM sleep were quantified using EMG recordings from the chin, compared among study groups, and correlated with disease metrics.
Results: There were no significant differences in measures of disease severity, duration, or dopaminergic medications between the PD+FOG and PD-FOG groups. Tonic muscle activity was increased significantly (p < 0.007) in the RBD and PD+FOG groups compared to the PD-FOG and control groups. There was no significant difference in tonic EMG between the PD+FOG and RBD group (p = 0.364), or in tonic or phasic EMG between the PD-FOG and control group (p = 0.107). Phasic muscle activity was significantly increased in the RBD group compared to all other groups (p = 0.029) and between the PD+FOG and control group (p = 0.001), but not between the PD+FOG and PD-FOG groups (p = 0.059).
Conclusions: These findings provide evidence that increased muscle activity during REM sleep is a comorbid feature of patients with PD who exhibit FOG as a motor manifestation of their disease.
GLOSSARY
- ESS=
- Epworth Sleepiness Scale;
- FOG=
- freezing of gait;
- LED=
- levodopa equivalent dose;
- MMSE=
- Mini-Mental State Examination;
- NFOG-Q=
- New Freezing of Gait Questionnaire;
- PD=
- Parkinson disease;
- PPN=
- pedunculopontine nucleus;
- PSG=
- polysomnography;
- PSQI=
- Pittsburgh Sleep Quality Index;
- RBD=
- REM sleep behavior disorder;
- RSWA=
- REM sleep without atonia;
- UPDRS=
- Unified Parkinson’s Disease Rating Scale
Footnotes
Go to Neurology.org for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the article.
Editorial, page 1026
- Received January 17, 2013.
- Accepted in final form May 23, 2013.
- © 2013 American Academy of Neurology
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