Evaluation of the Frequency and Severity of Sleep Abnormalities in Patients With Parkinson's Disease (PD)

Background Sleep disturbances are one of the most common non-motor symptoms in PD, with an estimated prevalence as high as 40-90%. Sleep disturbances (particularly sleep duration, sleep fragmentation, Rapid Eye Movement (REM) sleep behaviour disorder and sleep-disordered breathing) have been associated with an increased risk of neurodegeneration and are an independent risk for cognitive decline and dementia in PD. The etiology of impaired sleep and alertness in PD is multifactorial and may be due to the interactions between internal and external factors such as primary sleep disorders, primary neurodegeneration, medication side effects, environmental conditions and genetic factors (either associated with sleep or associated with disease phenotype). Each can contribute to sleep disturbances alone or as modifiers, resulting in variability of presentation and symptoms, affecting both the diagnosis, and the treatment of these disorders. Although much is currently unknown about sleep changes in PD, sleep-related symptoms are increasingly recognized as a major contributor to disease burden and reduced quality of life among people with PD.

The "gold standard" evaluation of nocturnal sleep is polysomnographic monitoring (PSG). PSG consists of measuring neural function, eye movements, muscle activity, respiratory status and electrocardiography activity while the person sleeps over-night in a laboratory setting. This assessment allows for quantification of the different sleep stages during non-REM and REM, evaluation of their distribution over the course of the night, and the identification of impairments in each of these stages. However, PSG is time, cost and labor-intensive, may not reflect the typical behavior of the person due to the unfamiliar environment and irregular sleeping conditions, and more importantly, only provides information on one night of sleep.

In recent years, there is heightened interest in home-based sleep monitoring via wearable sensors to address these shortcomings. Body-fixed electrophysiological sensors can objectively quantify sleep quality, generating a detailed map of the person's sleeping pattern and nocturnal movements. They are relatively inexpensive enabling wide-spread use.

This study proposes to use novel wireless skin electrodes and wearable sensors to provide a "home PSG test" incorporating several physiologic recordings, over multiple nights in the person's home, enabling the objective evaluation of night-to-night fluctuations. By applying these novel tools to the study of people with PD as well as controls and subjects at risk for developing PD, the results of this study will open the door for using a new method for assessment of prodromal signs and disease progression.

Study objective