Consensus practice recommendations for management of sleep dysfunction in Parkinson disease

Sleep disturbances are highly prevalent in people with Parkinson's disease (PD). Adhering to practical, evidence-informed guidelines enhances care delivery and quality of life in PD. Therefore, we sought to develop consensus statements on screening, diagnosis, and treatment of sleep dysfunction in PD.

The application of a modified Delphi panel allowed for the synthesis of expert opinions into clinical statements. Consensus was predefined as a level of agreement of 100% for each item. Four virtual Delphi rounds were held. After selecting the topics for consideration, 2-3 neurologists reviewed the literature and developed draft statements. Draft statements were distributed among the panel that included 11 movement-, sleep-, or dual-trained neurologists representing all geographic areas of the contiguous United States. All members reviewed the statements and references in advance of the virtual meetings. During the virtual meetings, each statement was discussed, edited, and a vote was conducted. Statements not achieving unanimity were discussed in the text to identify potential avenues of further inquiry.

A total of 114 statements were developed for screening, diagnosis, and treatment of common sleep symptoms in PD and were organized by subtopic. Subtopics included insomnia, excessive daytime sleepiness, REM sleep behavior disorder and non-REM parasomnias, and other common sleep disorders (restless legs syndrome, periodic limb movements of sleep, sleep-disordered breathing, and circadian rhythm sleep wake-disorders).

These consensus recommendations offer a practical framework for the diagnosis and treatment of sleep dysfunction in PD.