Mood and Sleep in Parkinson's Disease. [CME]
J Clin Psychiatry 2006;67(6):958-963
© Copyright 2014 Physicians Postgraduate Press, Inc.
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Objective: To determine whether severity
of depression and severity of anxiety were associated with particular types of sleep disturbance
in patients with Parkinson's disease.
Method: 120 patients with a diagnosis of
idiopathic Parkinson's disease were consecutively recruited from a movement disorders clinic
from July 2004 to May 2005. Idiopathic Parkinson's disease was diagnosed by a board-certified
neurologist (J.H.F) and defined by the presence of
3 of the 4 cardinal signs of Parkinson's disease: resting tremor, rigidity, bradykinesia, and
postural instability. Patients were administered the
Hamilton Rating Scale for Depression, Hamilton
Rating Scale for Anxiety, Covi Anxiety Scale,
Pittsburgh Sleep Quality Index (PSQI), and Epworth
Sleepiness Scale (ESS). Patients were assessed for nightmares and rapid eye movement (REM)
sleep behavior disorder (RBD) using a structured
questionnaire and dream log. Multivariate analyses evaluated whether severity of depression and
severity of anxiety correlated with the sleep outcome measures (PSQI, ESS, nightmares,
Results: The mean ± SD age of the patients
was 71 ± 10.8 years with a mean Parkinson's
disease duration of 7.3 ± 4.7 years. Thirty-eight
percent were female, 41.7% had a psychiatric
history, 53.3% had nightmares, and 30% had
clinically defined RBD. Severity of depression and
severity of anxiety significantly correlated with poor
sleep quality, daytime somnolence, and nightmares. Severity of depression contributed significantly
to the overall variance in poor sleep quality and nightmares. Severity of anxiety contributed
significantly to the overall variance in daytime
Conclusions: Depressive and anxiety
symptoms were associated with sleep disturbances
in patients with Parkinson's disease. It is
important to examine for the presence of depression
and anxiety in patients presenting with sleep
disorders, as depression and anxiety impair quality
of life and are treatable conditions.