Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2021 Apr 1;17(4):779-789.
doi: 10.5664/jcsm.9022.

Association of sleep disturbance and freezing of gait in Parkinson disease: prevention/delay implications

Xiaohui Tang  1 , Lijia Yu  1 , Jingyun Yang  2   3 , Wenjing Guo  1 , Ying Liu  1 , Yaling Xu  1 , Xijin Wang  1
Affiliations

Association of sleep disturbance and freezing of gait in Parkinson disease: prevention/delay implications

Xiaohui Tang et al. J Clin Sleep Med. .

Abstract

Study objectives: Freezing of gait (FOG) severely impairs life quality of Parkinson disease (PD) patients. The relationship between sleep disturbance and FOG in PD remains unclear, so in this study, we aimed to investigate that relationship.

Methods: First, we assessed clinical characteristics of freezers and nonfreezers among PD patients. Next, we assessed clinical characteristics of PD patients with different PDSS1 scores (score on first item of Parkinson's Disease Sleep Scale). Finally, we prospectively followed a cohort of nonfreezers from a baseline clinical visit and to a maximum of 18 months and performed a Cox regression analysis to further investigate the relationship between PDSS1 score and FOG in PD.

Results: A total of 163 participants with PD were included in the baseline analysis. The freezers had significantly worse sleep compared with the nonfreezers. The proportion of freezers in the patients with low PDSS1 score (PDSS1 < 6) was significantly higher than that in the patients with high PDSS1 score (PDSS1 ≥ 6). A total of 52 nonfreezers were prospectively followed. During a maximum 18-month follow-up, FOG incidence (73%) in the PDSS1 < 6 group was significantly higher than that (24%) in the PDSS1 ≥ 6 group (P = .008). Low PDSS1 score (hazard ratio = 4.23, 95% CI 1.64-10.92, P = .003) and high levodopa equivalent daily dose (hazard ratio = 4.18, 95% CI 1.62-10.75, P = .003) were significantly associated with an increased hazard of FOG.

Conclusions: Our study indicated that low PDSS1 score may be a risk indicator for the development of FOG and provided important insights into potential targets for the prevention/delay of FOG in PD.

Keywords: Parkinson disease; freezing of gait; levodopa; risk indicator; sleep disturbance.

PubMed Disclaimer

Conflict of interest statement

All authors have seen and approved the manuscript. Institutions where work was conducted: Department of Neurology, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine. This study was funded by the Projects of the National Natural Science Foundation of China [grant number 81671273], [grant number 81171204], [grant number 30772280], [grant number 81400925], [grant number 81471148], [grant number 81771211], and [grant number 81703852]; the Project of Shanghai Municipal Education Commission of China [grant number 14YZ046]; the Project of Shanghai Municipal Health and Family Planning Commission of China [grant number 20134049], the Project of Shanghai Jiao Tong University of China [grant number YG2013MS22]; the Project of National Eastern Tech-transfer Center [grant number 201713972877]; the Projects of Shanghai Committee of Science and Technology [grant number 17401901000]; National Key R&D Program of China [grant number 2017YFC1310300]; SHSMU-ION Research Center for Brain Disorders [grant number 2015NKX007]. Jingyun Yang received research support from US National Institutes of Health grant nos. RF1AG015819, RF1AG052476, R01AG054058, and U01AG046152. The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1. Flow diagram of the study cohorts.
DBS = deep brain stimulation, MDS-UPDRS III = part III of the Movement Disorders Society Unified Parkinson Disease Rating Scale, NFOG-Q = New Freezing of Gait Questionnaire, PDSS1 = the first item of the Parkinson’s Disease Sleep Scale.
Figure 2
Figure 2. Cumulative hazard of FOG in the PDSS1 < 6 and PDSS1 ≥ 6 groups during the follow-up.
FOG = freezing of gait, PDSS1 = the first item of the Parkinson’s Disease Sleep Scale.
See this image and copyright information in PMC

References

    1. Liu J, Heinsen H, Grinberg LT, et al. . Pathoarchitectonics of the cerebral cortex in chorea-acanthocytosis and Huntington’s disease. Neuropathol Appl Neurobiol. 2019;45(3):230–243. 10.1111/nan.12495 - DOI - PMC - PubMed
    1. Schlenstedt C, Mancini M, Nutt J, et al. . Are hypometric anticipatory postural adjustments contributing to freezing of gait in Parkinson’s disease? Front Aging Neurosci. 2018;10:36. 10.3389/fnagi.2018.00036 - DOI - PMC - PubMed
    1. Nutt JG, Bloem BR, Giladi N, Hallett M, Horak FB, Nieuwboer A. Freezing of gait: moving forward on a mysterious clinical phenomenon. Lancet Neurol. 2011;10(8):734–744. 10.1016/S1474-4422(11)70143-0 - DOI - PMC - PubMed
    1. Macht M, Kaussner Y, Möller JC, et al. . Predictors of freezing in Parkinson’s disease: a survey of 6,620 patients. Mov Disord. 2007;22(7):953–956. 10.1002/mds.21458 - DOI - PubMed
    1. Carden KA. Sleep is essential: a new strategic plan for the American Academy of Sleep Medicine. J Clin Sleep Med. 2020;16(1):1–2. 10.5664/jcsm.8156 - DOI - PMC - PubMed

Publication types

LinkOut - more resources