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Cyclic Alternating Pattern and Sleep Microstructure in Parkinson's Disease: A Systematic Review and Meta-Analysis.
Jiajun Jiang1, Yi Huang1, Min Wang1
1School of Psychiatry, North Sichuan Medical College, Nanchong, 637000, People's Republic of China.
Nature and Science of Sleep
|June 18, 2026
Summary
Patients with Parkinson's disease (PD) show reduced cyclic alternating pattern (CAP) microstructure during sleep compared to healthy controls. However, current evidence is limited, and CAP measures are not yet validated biomarkers for PD.
Area of Science:
- Neurology
- Sleep Medicine
- Biomarkers
Background:
- Parkinson's disease (PD) is a neurodegenerative disorder affecting motor function.
- Sleep disturbances are common in PD patients.
- Cyclic alternating pattern (CAP) is a measure of sleep microstructural instability.
Purpose of the Study:
- To systematically review polysomnographic sleep differences between PD patients and healthy controls.
- To specifically analyze cyclic alternating pattern (CAP) microstructure variations.
- To assess the potential of CAP measures as biomarkers for PD.
Main Methods:
- Systematic literature search of multiple databases (MEDLINE, EMBASE, CINAHL, PsycArticles, EBM) from 2020-2025.
- Inclusion of studies with idiopathic PD, healthy controls, polysomnography, and extractable CAP outcomes.
- Random-effects meta-analyses (Hedges' g) and GRADE certainty assessment.
Main Results:
- Four studies were included in the meta-analysis.
- PD patients exhibited significantly reduced CAP rate, sequence duration, and index (p<0.05) with low heterogeneity.
- No significant pooled differences in macrostructural sleep parameters were found, with moderate-to-high heterogeneity.
Conclusions:
- A consistent reduction in CAP microstructure is observed in PD patients.
- Macrostructural sleep alterations in PD were not consistently found across studies.
- While promising, CAP measures require further validation before clinical use as PD biomarkers.
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