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Associations of Sleep Disturbance Symptoms With Health-Related Quality of Life in Parkinson’s Disease
Alon Avidan, M.D., M.P.H.; Ron D. Hays, Ph.D.; Natalie Diaz, M.D.; Yvette Bordelon, M.D., Ph.D.; Alexander W. Thompson, M.D., M.P.H.; Stefanie D. Vassar, M.S.; Barbara G. Vickrey, M.D., M.P.H.
The Journal of Neuropsychiatry and Clinical Neurosciences 2013;25:319-326. doi:10.1176/appi.neuropsych.12070175
View Author and Article Information

This work was previously presented at the 25th Anniversary Meeting of the Associated Professional Sleep Societies, LLC, June 11–15, 2011, in Minneapolis, MN.

Study support was provided by the Parkinson Alliance, by National Institute of Neurological Disorders and Stroke NS038367, and by the Veteran’s Administration. Dr. Hays was supported in part by a National Institute of Aging (P30AG021684) and National Center on Minority Health and Health Disparities (P20MD000182) grants.

From the Dept. of Neurology, UCLA, Los Angeles, CA; Depts. of Medicine and Health Policy and Management, UCLA, Los Angeles CA; Dept. of Neurology, Harbor-UCLA, Los Angeles CA; Group Health Cooperative, Behavioral Health Service, Seattle, WA; Parkinson's Disease Research, Education, and Clinical Center; VA Greater Los Angeles Healthcare System; Los Angeles, CA.

Send correspondence to Dr. Avidan; e-mail: avidan@mednet.ucla.edu

Copyright © 2013 by the American Psychiatric Association

Received July 18, 2012; Revised November 30, 2012; Accepted December 12, 2012.

Abstract

The authors examined associations of various sleep-disturbance symptoms with health-related quality of life (HRQOL) in 153 adults with Parkinson’s disease (PD). PD patients reported more snoring, sleep inadequacy, daytime somnolence, and sleep-maintenance problems than the general population. Symptoms having the broadest and strongest unique associations with generic HRQOL (eight scales; two composites of SF−36) were daytime somnolence (five scales; one composite), sleep initiation (eight scales; two composites), and awakening short of breath or with headache (six scales; two composites). Associations of selected sleep-disturbance symptoms—some unanticipated—suggest that assessing specific symptoms is worthwhile in clinical care.

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TABLE 1.Characteristics of Parkinson’s Disease Sample (N=153)
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SD: standard deviation; IQR: interquartile ratio.

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a Responded “Don’t know” or refused: N=7.

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TABLE 2.MOS Sleep Measure and SF–36 (version 2.0) Scores of Study Participants and Comparison With U.S. General Population Norms (N=153)
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SD: standard deviation.

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a MOS Sleep measure scales are scored such that 0: least extent of symptom (best), and 100: worst extent of symptom (worse).

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b SF–36 version 2 scales are T-scores (mean: 50; SD: 10) calculated against a U.S. general population, where higher scores mean better HRQOL.

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TABLE 3.Unique Associations of Types of Sleep Symptoms and Parkinson’s Disease Severity With Health-Related Quality of Life and Depression, From Multivariate Regression Models (N=153)
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CI: confidence interval.

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Each of the SF–36 scales and both depression measures served as dependent variables in 12 separate regression analyses. Backward stepwise regression (MOS-Sleep scales into the model initially, followed by removal of nonsignificant variables sequentially) was used to determine a reduced model with only significant sleep measure associations (i.e., p ≤0.05). All models include age, gender, and Hoehn & Yahr disease severity/stage (off medication); only Hoehn & Yahr values are shown in the table.

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a Comorbidities variable was significant in the model for Depression: PHQ–9; β coefficient (95%CI): 0.86 (0.17, 1.55); p=0.02.

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