Sleep Disorders and Future Diagnosis of Parkinsonism: A Prospective Study Using the Canadian Longitudinal Study on Aging

Article type: Research Article

Authors: Zolfaghari, Sheida^{a; b} | Yao, Chun W.^{a; b} | Wolfson, Christina^{b; c; d; e} | Pelletier, Amelie^{b; f} | Postuma, Ronald B.^{b; e; f; *}

Affiliations: [a] Integrated Program in Neuroscience, McGill University, Montreal, Quebec, Canada | [b] Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada | [c] Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, QC, Canada | [d] Department of Medicine, McGill University, Montreal, QC, Canada | [e] Department of Neurology and Neurosurgery, McGill University, Montreal, Quebec, Canada | [f] Centre for Advanced Research in Sleep Medicine, Hôpital du Sacrä-Coeur de Monträal, Montreal, Quebec

Correspondence: [*] Correspondence to: Dr. Ronald B. Postuma, Department of Neurology, L7-305, Montreal General Hospital, 1650 Cedar Ave., Montreal, Quebec, Canada H3G 1A4. Tel.: +514 934 8026; Fax: +514 934 8265; E-mail: [email protected].

Abstract: Background:Earlier detection of parkinsonism, specifically during its prodromal stage, may be key to preventing its progression. Previous studies have produced contradictory results on the association between sleep symptoms and prodromal parkinsonism. Objective:We conducted a prospective study within the Canadian Longitudinal Study on Aging (CLSA) to determine whether self-reported symptoms of insomnia, somnolence, apnea, and restless legs syndrome predate the diagnosis of parkinsonism after three years of follow-up. Methods:At baseline, amongst other information, participants completed a questionnaire for difficulty initiating or maintaining sleep, daytime somnolence, snoring or stopping breathing during sleep, and symptoms of restless legs syndrome. After 3 years of follow-up, baseline responses from participants who self-reported a new diagnosis of parkinsonism (cases) were compared to those who did not (controls). For each case, 10 controls were individually matched by age, sex, education, BMI, caffeine, smoking, and alcohol. Binary unconditional logistic regression models were used to estimate the association between sleep symptoms and new-onset parkinsonism, adjusting for age, sex, education, BMI, smoking, alcohol, and caffeine. Results:We identified 58 incident-parkinsonism cases and 580 matched controls (65.5%male, mean age = 69.60, SD = 8.0). Baseline symptoms of sleep-onset insomnia (12.1%vs. 13.0%, Adjusted OR[95%CI] = 0.87[0.32,2.33]), sleep-maintenance insomnia (24.1%vs. 20.2%, AOR = 1.01[0.46,2.20]), daytime somnolence (8.6%vs. 7.4%, AOR = 1.11[0.37,3.39]), obstructive sleep apnea (27.3%vs. 26.2%, AOR = 0.84[0.40,1.79]), and restless leg syndrome (20.6%vs. 9.9%, AOR = 1.34[0.42,4.25]) were similar among those who developed parkinsonism and those who did not. Conclusion:Symptoms of insomnia, somnolence, apnea, and restless legs did not predate a new diagnosis of parkinsonism over 3 years.

Keywords: Parkinsonism, insomnia, daytime somnolence, obstructive sleep apnea, restless leg syndrome, CLSA

DOI: 10.3233/JPD-212796

Journal: Journal of Parkinson's Disease, vol. 12, no. 1, pp. 257-266, 2022