Patient with Parkinson’s and freezing of gait sleeps poorly – 03/04/2024 – Balance

Patients with Parkinson’s who present a symptom known as freezing of gait – characterized by the sudden loss of the ability to move their feet, which can lead to falls – wake up more often during the night, feel a greater need to sleep during the day and have a movement deficit of the eyes, which can affect REM sleep, which is essential for maintaining cognitive functions.

The conclusion is from a study supported by Fapesp and conducted by researchers from the Universidade Estadual Paulista (Unesp) and Grenoble (France). The results were published in the journal Sleep Medicine.

After a systematic review of 20 studies on sleep quality and freezing of gait, the authors observed the correlation between these two important symptoms of Parkinson’s disease. The finding, according to them, could be decisive for the creation of new treatment protocols.

“There was a suspicion that these two phenomena were interconnected and the analysis of the studies reinforces the hypothesis. This happens because freezing of gait presents a pathophysiology similar to the issue of sleep quality [ou seja, os processos fisiológicos que estão alterados são similares]. Studies show that both patients with one symptom and the other have a brain lesion in the pedunculopontine nucleus, a region located in the basal ganglia”, explains Fabio Barbieri, coordinator of the Human Movement Research Laboratory (Movi-Lab) and the extension project “Ativa Parkinson” at Unesp in Bauru.

However, the researcher emphasizes, it is not yet known which comes first: the freezing of gait or the worsening of sleep quality. “Studies show that the chance of a patient with freezing of gait experiencing an exacerbated worsening in sleep quality is above 95%. But it has also been observed that a marked worsening in sleep quality tends to be a sign that the individual may develop freezing of gait in the future. Therefore, they are interconnected symptoms and it has not yet been possible to define which one appears first”, he states.

Treatment

It is worth remembering that Parkinson’s disease affects sleep in general, regardless of whether the patient experiences freezing of gait. In an unpublished study, Barbieri’s group and collaborators from Grenoble compared the effect of medication on sleep quality.

“We observed that when dopaminergic medication is withdrawn for sleep, there is a worsening in sleep quality”, he reveals.

Although there is no specific treatment, freezing of gait is one of the main reasons for falls among people with Parkinson’s disease. Along with tremors and cognitive damage, the problem is one of those responsible for the loss of quality of life among individuals with the disease.

“Freezing of gait does not characterize a more advanced stage of Parkinson’s. That’s not it, not every patient will develop the symptom, but it is confirmed that it affects the quality of sleep”, he says.

Barbieri explains that the review work was important to group different research and findings on the relationship between freezing of gait and sleep quality.

“We noticed, for example, that most studies use indirect criteria to measure sleep quality. These are measurements that come from questionnaires. We only saw two studies that used direct measurements through polysomnography [exame que monitora as variáveis fisiológicas durante o sono] to assess sleep quality. The same happens with the floor freezing. It is diagnosed using questionnaires. For this reason, we are starting a new study, in partnership with North American researchers, to try to directly monitor freezing of gait”, he tells Agência Fapesp.

The article “Comparison of sleep characteristics between Parkinson’s disease with and without freezing of gait: A systematic review” can be read here.