Sleep and circadian rhythm regulation in early Parkinson disease

JAMA Neurol. 2014 May;71(5):589-595. doi: 10.1001/jamaneurol.2014.65.


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.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Case-Control Studies
  • Circadian Rhythm / physiology*
  • Cohort Studies
  • Early Diagnosis
  • Female
  • Humans
  • Male
  • Middle Aged
  • Parkinson Disease / diagnosis*
  • Parkinson Disease / epidemiology*
  • Parkinson Disease / physiopathology
  • Sleep / physiology*
  • Sleep Disorders, Circadian Rhythm / diagnosis*
  • Sleep Disorders, Circadian Rhythm / epidemiology*
  • Sleep Disorders, Circadian Rhythm / physiopathology