Sleep and Circadian Rhythm Regulation in Early Parkinson Disease

David P. Breen, Romina Vuono, Upekshani Nawarathna, Kate Fisher, John M. Shneerson, Akhilesh B. Reddy, Roger A. Barker

Research output: Contribution to journalArticlepeer-review

Abstract / Description of output

Importance: Sleep disturbances are recognized as a common nonmotor complaint in Parkinson disease but their etiology is poorly understood.

Objective: To define the sleep and circadian phenotype of patients with early-stage Parkinson disease.

Design, Setting, and Participants: Initial assessment of sleep characteristics in a large population-representative incident Parkinson disease cohort (N=239) at the University of Cambridge, England, followed by further comprehensive case-control sleep assessments in a subgroup of these patients (n=30) and matched controls (n=15).

Main Outcomes and Measures: Sleep diagnoses and sleep architecture based on polysomnography studies, actigraphy assessment, and 24-hour analyses of serum cortisol, melatonin, and peripheral clock gene expression (Bmal1, Per2, and Rev-Erbα).

Results: Subjective sleep complaints were present in almost half of newly diagnosed patients and correlated significantly with poorer quality of life. Patients with Parkinson disease exhibited increased sleep latency (P = .04), reduced sleep efficiency (P = .008), and reduced rapid eye movement sleep (P = .02). In addition, there was a sustained elevation of serum cortisol levels, reduced circulating melatonin levels, and altered Bmal1 expression in patients with Parkinson disease compared with controls.

Conclusions and Relevance: Sleep dysfunction seen in early Parkinson disease may reflect a more fundamental pathology in the molecular clock underlying circadian rhythms.
Original languageEnglish
Pages (from-to)589-595
Number of pages7
JournalJAMA Neurology
Issue number5
Early online date31 Mar 2014
Publication statusPublished - 1 May 2014


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