SLEEP DISRUPTION IN PARKINSONS-DISEASE - ASSESSMENT BY CONTINUOUS ACTIVITY MONITORING

Objective: To assess differences in activity and immobility during sle ep between patients with Parkinson's disease (PD) and healthy subjects acid to evaluate the relations of clinical variables with the motor a ctivity measures in patients with PD. Design: Survey, case series. Set ting: University hospital outpatient neurology department and urban po pulation in Leiden, the Netherlands. Motor activity was recorded durin g 6 successive nights at home with a wrist-worn activity monitor. Part icipants: Eighty-nine patients with PD and 83 age-matched healthy cont rols. Main Outcome Measures: For each subject, three mean measures ref lecting activity or immobility during the nocturnal period were calcul ated. Results: Compared with the healthy elderly subjects, patients wi th PD have an elevated nocturnal activity level and an increased propo rtion of time with movement, indicating a more disturbed sleep. The me an duration of nocturnal immobility periods was similar for both group s. This measure, however, did reflect the self-reported disturbed slee p maintenance in both groups. The daily dose of levodopa or the use of dopamine agonists in patients not receiving levodopa, rather than dis ease severity, proved to be the best predictors of nocturnal activity. Conclusions: We hypothesize that in mildly to moderately affected pat ients with PD, levodopa or dopamine agonists cause sleep disruption by their effects on sleep regulation. In more severely affected patients , the beneficial effects of these drugs on nocturnal disabilities that cause sleep disruption in PD prevail.