Exploring obstructive sleep apnea and sleep architecture in Parkinson's disease motor subtypes.
Amanda Scanga, Andrea Benedetti, R John Kimoff, Anne-Louise Lafontaine, Ann Robinson, Marianne Gingras, Marta Kaminska
Author Information
Amanda Scanga: Division of Experimental Medicine, McGill University, Montr��al, Canada; Respiratory Epidemiology and Clinical Research Unit, McGill University Health Centre, Montr��al, Canada.
Andrea Benedetti: Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montr��al, Canada; Respiratory Epidemiology and Clinical Research Unit, McGill University Health Centre, Montr��al, Canada.
R John Kimoff: Respiratory Epidemiology and Clinical Research Unit, McGill University Health Centre, Montr��al, Canada; Respiratory Division, Sleep Laboratory, McGill University Health Centre, McGill University, Montr��al, Canada.
Anne-Louise Lafontaine: Montr��al Neurological Institute-Hospital, McGill University Health Centre, McGill University, Montr��al, Canada.
Ann Robinson: Respiratory Division, Sleep Laboratory, McGill University Health Centre, McGill University, Montr��al, Canada.
Marianne Gingras: Respiratory Division, Sleep Laboratory, McGill University Health Centre, McGill University, Montr��al, Canada.
Marta Kaminska: Division of Experimental Medicine, McGill University, Montr��al, Canada; Respiratory Epidemiology and Clinical Research Unit, McGill University Health Centre, Montr��al, Canada; Respiratory Division, Sleep Laboratory, McGill University Health Centre, McGill University, Montr��al, Canada. Electronic address: marta.kaminska@mcgill.ca.
INTRODUCTION: Parkinson's disease (PD) can be divided into motor subtypes: postural instability/gait difficulty (PIGD), tremor dominant, and indeterminate. This study aimed to assess differences in sleep structure and obstructive sleep apnea (OSA) between the PIGD and non-PIGD subtypes. METHODS: PD participants with or without OSA (defined as apnea-hypopnea index (AHI) ��� 15 events/hour on overnight polysomnography) were included. Patients were separated into two groups: PIGD and non-PIGD. Linear regression was used to explore differences in sleep, AHI, and other respiratory parameters between groups (adjusted for variables determined a priori). Logistic regression adjusted for the same variables was used to determine if the proportion of patients with OSA differed across groups. Subset analyses were performed: subset 1 excluding patients on psychoactive medication; subset 2 excluding patients taking levodopa or dopaminergic agonists (DAs) at nighttime and subset 3 excluding patients on either of the abovementioned drugs. RESULTS: 146 participants were studied. The non-PIGD group had less N3 sleep compared to the PIGD group (12.4% vs 16.9% p = 0.06), reaching significance in subsets 1 and 3. The AHI was significantly lower in the PIGD group (p = 0.047), including when medication effects were removed (p < 0.05). OSA was more frequent in the non-PIGD group, but only significantly in subset 3 (adjusted OR 0.3, p = 0.04). CONCLUSION: OSA may be more severe in non-PIGD subtypes, and more frequent, in a subset free of psychoactive medication, and of levodopa and DAs, possibly owing to motor complications and dyskinesia. Future studies are required to confirm this.
