Will Lee1, Andrew Evans2, David R Williams3. 1. Neuroscience Department, The Alfred Hospital, Commercial Road, Melbourne, Victoria 3004, Australia; Van Cleef Roet Centre for Nervous Diseases, Monash University, The Alfred Hospital, Melbourne, Victoria 3004, Australia. 2. Neurology Department, The Royal Melbourne Hospital, Grattan Street, Parkville, Victoria 3050, Australia. 3. Neuroscience Department, The Alfred Hospital, Commercial Road, Melbourne, Victoria 3004, Australia; Van Cleef Roet Centre for Nervous Diseases, Monash University, The Alfred Hospital, Melbourne, Victoria 3004, Australia. Electronic address: david.williams@monash.edu.
Abstract
INTRODUCTION: The phenomenon of sleep benefit (SB) in Parkinson's disease (PD), whereby waking motor function is improved despite no dopaminergic treatment overnight, is controversial. Previous studies suggested a significant discrepancy between subjective functional and objective motor improvement. The aim of this study was to determine how well subjective reporting of SB correlates with objective measures and if true motor improvement can be predicted by a standardized questionnaire. METHODS: Ninety-two patients with PD participated. A structured questionnaire was developed to assess subjective SB. Quantitative motor assessment was performed using a validated smartphone application. Objective motor SB was considered to be present when the waking motor function was similar or superior to the daytime on-state. RESULTS: Twenty (22%) patients showed objective motor improvement on waking compared to end-of-dose. Most patients (77%) reported subjective SB without corresponding objective motor benefit. Our structured questionnaire could not predict Motor SB. The ability to delay morning medications and a perception of indifference or paradoxical worsening following the morning levodopa dose may suggest Motor SB. CONCLUSIONS: Most patients experience subjective SB with no measureable motor improvement. This perceived benefit could be related to non-motor improvement that is distinctly different to objective motor benefit.
INTRODUCTION: The phenomenon of sleep benefit (SB) in Parkinson's disease (PD), whereby waking motor function is improved despite no dopaminergic treatment overnight, is controversial. Previous studies suggested a significant discrepancy between subjective functional and objective motor improvement. The aim of this study was to determine how well subjective reporting of SB correlates with objective measures and if true motor improvement can be predicted by a standardized questionnaire. METHODS: Ninety-two patients with PD participated. A structured questionnaire was developed to assess subjective SB. Quantitative motor assessment was performed using a validated smartphone application. Objective motor SB was considered to be present when the waking motor function was similar or superior to the daytime on-state. RESULTS: Twenty (22%) patients showed objective motor improvement on waking compared to end-of-dose. Most patients (77%) reported subjective SB without corresponding objective motor benefit. Our structured questionnaire could not predict Motor SB. The ability to delay morning medications and a perception of indifference or paradoxical worsening following the morning levodopa dose may suggest Motor SB. CONCLUSIONS: Most patients experience subjective SB with no measureable motor improvement. This perceived benefit could be related to non-motor improvement that is distinctly different to objective motor benefit.
Authors: E Ray Dorsey; Alistair M Glidden; Melissa R Holloway; Gretchen L Birbeck; Lee H Schwamm Journal: Nat Rev Neurol Date: 2018-04-06 Impact factor: 42.937