Influence of autonomic dysfunction on sleep disturbance in drug-naïve patients with Parkinson's disease

Sleep disturbance (SD) is a common non-motor symptom of Parkinson's disease (PD), and autonomic dysfunction is believed to play a key role in its worsening. However, the independent contribution of each autonomic domain to SD remains unclear. We aimed to investigate the influence of autonomic dysfunction on SD in drug-naïve patients with PD.

We conducted a cross-sectional study of 89 drug-naïve patients with PD. SD was assessed using the PD Sleep Scale-version-2 (PDSS-2) and Rapid Eye Movement Sleep Behavior Disorder Screening Questionnaire. Autonomic symptoms were evaluated using the Scale for Outcomes in PD-Autonomic Dysfunction (SCOPA-AUT). Multiple regression analyses were performed to identify the autonomic domains contributing to the PDSS-2 after adjusting for age, sex, disease duration, motor severity, frontal executive function, depression, and visual illusion.

In the multivariable analyses, SCOPA-AUT gastrointestinal (β = 0.252, P = 0.018), urinary (β = 0.296, P = 0.004), cardiovascular (β = 0.230, P = 0.024), and thermoregulatory domains (β = 0.240, P = 0.019), along with depression, were independently associated with high PDSS-2 scores. The pupillomotor and sexual domains were not significantly associated with SD. In addition, a decline in blood pressure during the head-up tilt test was associated with high PDSS-2 scores.

Multiple autonomic domains may contribute to SD in drug-naïve patients with PD. Early identification and management of autonomic dysfunction could improve sleep quality and overall quality of life in this population.