Associations of Sleep Disorders With Depressive Symptoms in Early and Prodromal Parkinson's Disease

Jiangnan Ma; Kaixin Dou; Ruize Liu; Yajin Liao; Zengqiang Yuan; Anmu Xie

doi:10.3389/fnagi.2022.898149

Associations of Sleep Disorders With Depressive Symptoms in Early and Prodromal Parkinson's Disease

Front Aging Neurosci. 2022 Jun 10:14:898149. doi: 10.3389/fnagi.2022.898149. eCollection 2022.

Authors

Jiangnan Ma¹, Kaixin Dou¹, Ruize Liu², Yajin Liao³, Zengqiang Yuan^{1

3}, Anmu Xie¹

Affiliations

¹ Departmentof Neurology, Affiliated Hospital of Qingdao University, Qingdao, China.
² Department of Intensive Care Unit, Affiliated Qingdao Municipal Hospital of Qingdao University, Qingdao, China.
³ The Brain Science Center, Beijing Institute of Basic Medical Sciences, Beijing, China.

Abstract

Background: Non-motor symptoms, including sleep disorders and depression, are common in Parkinson's disease (PD). The purpose of our study is to explore the effect of sleep disorders, including the probable rapid eye movement (REM) sleep behavior disorder (pRBD) and the daytime sleepiness, on depressive symptoms in patients with early and prodromal PD.

Methods: A total of 683 participants who obtained from the Parkinson Progression Markers Initiative (PPMI) were included, consisting of 423 individuals with early PD, 64 individuals with prodromal PD, and 196 healthy controls (HCs), who were followed up to 5 years from baseline. Multiple linear regression models and linear mixed-effects models were conducted to explore the relationship between sleep disorders and depression at baseline and longitudinally, respectively. Multiple linear regression models were used to further investigate the association between the change rates of daytime sleepiness score and depression-related score. Mediation analyses were also performed.

Results: At baseline analysis, individuals with early and prodromal PD, who had higher RBD screening questionnaire (RBDSQ) score, or who were considered as pRBD, or who manifested specific behaviors of RBD (things falling down when sleep or disturbance of sleep), showed significantly the higher score of depression-related questionnaires. Our 5-year follow-up study showed that sleep disorders, including pRBD and daytime sleepiness, were associated with the increased depressive-related score in individuals with early and prodromal PD. Interestingly, we also found that the increased possibilities of daytime sleepiness were associated with depressive-related score. Finally, mediation analysis demonstrated that the relationship between RBD and depressive symptoms was partially mediated by autonomic symptoms, such as postural hypertension, salivation, dysphagia, and constipation.

Conclusion: Our study shows that sleep disorders, including pRBD and daytime sleepiness, are associated with depression at baseline and longitudinally, which is partially mediated by the autonomic dysfunction in early and prodromal PD, with an implication that sleep management is of great value for disease surveillance.

Keywords: Parkinson’s disease; autonomic dysfunction; daytime sleepiness; depression; rapid-eye-movement sleep behavior disorder; sleep disorders.