Ruey-Meei Wu, Rwei-Ling Yu, Chun-Hsiang Tan

The aims of this study were to explore nocturnal disturbances in patients with Parkinson's disease (PD) and to assess their impact on quality of life (QoL). A total of 211 patients with PD were recruited for this study, and each participant was evaluated using the mini-mental state examination, PD sleep scale - second version (PDSS-2), pittsburgh sleep quality index (PSQI), PD QoL questionnaire (PDQ), Epworth sleepiness scale, Hoehn and Yahr (H&Y) staging, and unified Parkinson's disease rating scale (UPDRS). Multiple regression analyses were performed to determine the contribution of the predictive variables on QoL. There were 56.4% males (mean age: 64.08 years; disease duration: 6.02 years; H&Y stage: 2.25; and UPDRS: 33.01) in this study. Our patients' actual sleep time was 5.96±1.16 hours and the average sleep efficiency was 82.93%±12.79%. Up to 64.4% of patients were classified as "poor" sleepers and 23.8% suffered from daytime sleepiness. The final stepwise regression model revealed that UPDRS parts I and II, the sleep disturbance and daytime dysfunction components of the PSQI, the PD symptoms at night subscale of the PDSS-2, and the levodopa equivalent dose were significant predictors of the PDQ score (R (2)=53, F 7,165=28.746; P<0.001). Most of the PD patients have sleep problems, and nearly one-quarter of them have abnormal daytime somnolence. The nocturnal disturbances were found to result in worse QoL in PD patients. Ethnicity-specific effects of susceptibility to sleep disturbances were discussed, and these results also highlighted the direction for further studies to explore when examining effective management programs toward these disturbances.