Cyclic Alternating Pattern and Sleep Microstructure in Parkinson's Disease: A Systematic Review and Meta-Analysis

To systematically review polysomnographic sleep differences, with emphasis on cyclic alternating pattern (CAP) microstructure, between patients with Parkinson's disease (PD) and healthy controls (HC).

We searched MEDLINE (via OVID), EMBASE (via OVID), CINAHL (via EBSCOhost), APA PsycArticles (via EBSCOhost), and Evidence-Based Medicine databases (via EBSCOhost) for studies published from January 1, 2020, to September 15, 2025. Eligible studies enrolled adults with idiopathic PD, included an internal HC group, used overnight polysomnography, and reported extractable CAP-related outcomes. Study quality was assessed with the Newcastle-Ottawa Scale. Random-effects meta-analyses were performed using Hedges' g with restricted maximum-likelihood estimation, and certainty of evidence was appraised with GRADE.

Four studies were included. PD patients showed significant reductions in CAP rate, CAP sequence duration, and CAP index (all p<0.05), with low statistical heterogeneity. Macrostructural parameters showed no statistically significant pooled differences, and several had moderate-to-high heterogeneity. GRADE certainty was very low because the evidence came from a small number of observational studies.

Within a limited evidence base, CAP-related microstructure shows a consistent pattern of reduction in clinically diagnosed PD, whereas macrostructural alterations were not stable across the included studies. CAP measures may provide complementary information in future PD sleep research, but the present evidence is insufficient to support their use as validated biomarkers.