AUTHOR=Koh Matthew Rui En , Chua Cong Yang , Ng Samuel Yong-Ern , Chia Nicole Shuang-Yu , Saffari Seyed Ehsan , Chen Regina Yu-Ying , Choi Xinyi , Heng Dede Liana , Neo Shermyn Xiumin , Tay Kay Yaw , Au Wing Lok , Tan Eng-King , Tan Louis Chew-Seng , Xu Zheyu TITLE=Poor sleep quality is associated with fatigue and depression in early Parkinson's disease: A longitudinal study in the PALS cohort JOURNAL=Frontiers in Neurology VOLUME=13 YEAR=2022 URL=https://www.frontiersin.org/journals/neurology/articles/10.3389/fneur.2022.998103 DOI=10.3389/fneur.2022.998103 ISSN=1664-2295 ABSTRACT=Background

Sleep disorders are common in Parkinson's disease (PD). However, the longitudinal relationship between sleep quality and the other non-motor symptoms of PD has not been well characterized, especially in early PD.

Objective

To explore the value of baseline sleep quality in predicting the progression of other non-motor symptoms in early PD.

Methods

109 early PD patients were recruited to the study. Patients were stratified into good and poor sleepers using the Pittsburgh Sleep Quality Index (PSQI). Assessments performed at baseline and 1 year follow-up included the Epworth Sleepiness Scale, Fatigue Severity Scale, Non-Motor Symptom Scale, Geriatric Depression Scale, Hospital Anxiety and Depression Scale, Apathy Scale, Montreal Cognitive Assessment and detailed neuropsychological assessments. Multivariable linear regression was performed at baseline to investigate differences in clinical scores between poor and good sleepers, while multivariable regression models were used to investigate associations between sleep quality and progression of test scores at 1 year follow-up.

Results

59 poor sleepers and 50 good sleepers were identified. At baseline, poor sleepers had greater HADS anxiety scores (p = 0.013) [2.99 (95% CI 2.26, 3.73)] than good sleepers [1.59 (95% CI 0.75, 2.42)]. After 1 year, poor sleepers had greater fatigue (FSS scores +3.60 as compared to −2.93 in good sleepers, p = 0.007) and depression (GDS scores +0.42 as compared to −0.70, p = 0.006).

Conclusion

This study shows a longitudinal association between sleep quality, fatigue, and depression in early PD patients, independent of medication effect and disease severity, this may support the hypothesis that a common serotonergic pathway is implicated in these non-motor symptoms.