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. 2023 Nov 10;13(11):1591.
doi: 10.3390/jpm13111591.

Exploring the Association Linking Head Position and Sleep Architecture to Motor Impairment in Parkinson's Disease: An Exploratory Study

Oriella Gnarra  1   2 , Carmen Calvello  3 , Tommaso Schirinzi  3   4 , Francesca Beozzo  3 , Claudia De Masi  4 , Matteo Spanetta  5 , Mariana Fernandes  3 , Piergiorgio Grillo  4 , Rocco Cerroni  4 , Mariangela Pierantozzi  3   4 , Claudio L A Bassetti  1 , Nicola Biagio Mercuri  3   6 , Alessandro Stefani  3   4 , Claudio Liguori  3   6
Affiliations

Exploring the Association Linking Head Position and Sleep Architecture to Motor Impairment in Parkinson's Disease: An Exploratory Study

Oriella Gnarra et al. J Pers Med. .

Abstract

Patients with Parkinson's disease (PD) tend to sleep more frequently in the supine position and less often change head and body position during sleep. Besides sleep quality and continuity, head and body positions are crucial for glymphatic system (GS) activity. This pilot study evaluated sleep architecture and head position during each sleep stage in idiopathic PD patients without cognitive impairment, correlating sleep data to patients' motor and non-motor symptoms (NMS). All patients underwent the multi-night recordings, which were acquired using the Sleep Profiler headband. Sleep parameters, sleep time in each head position, and percentage of slow wave activity (SWA) in sleep, stage 3 of non-REM sleep (N3), and REM sleep in the supine position were extracted. Lastly, correlations with motor impairment and NMS were performed. Twenty PD patients (65.7 ± 8.6 y.o, ten women) were included. Sleep architecture did not change across the different nights of recording and showed the prevalence of sleep performed in the supine position. In addition, SWA and N3 were more frequently in the supine head position, and N3 in the supine decubitus correlated with REM sleep performed in the same position; this latter correlated with the disease duration (correlation coefficient = 0.48, p-value = 0.03) and motor impairment (correlation coefficient = 0.53, p-value = 0.02). These preliminary results demonstrated the importance of monitoring sleep in PD patients, supporting the need for preventive strategies in clinical practice for maintaining the lateral head position during the crucial sleep stages (SWA, N3, REM), essential for permitting the GS function and activity and ensuring brain health.

Keywords: PD; glymphatic system; head position; sleep profiler; slow wave activity.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Graphical representation of sleep parameters in the last two nights of recording (n = 17). _1 = second last night, _2 = last night. S = supine, SW = slow waves, SW_S = slow waves in the supine position, N3 = stage 3 of non-REM sleep, N3_S = stage 3 of non-REM sleep in the supine position, REM = REM sleep, REM_S = REM sleep in the supine position, ns = not significant. The diamonds represent the outliers.
Figure 2
Figure 2
(A) Distribution of the head positions during the sleep recording. (B) Slow wave distribution over the different head positions during the sleep recording. (C) Stage 3 of non-REM sleep distribution over the different head positions during the sleep recording. The diamonds represent the outliers.
Figure 3
Figure 3
Heatmap, correlation matrix. Only values with a p-value < 0.05 were highlighted. S_mean = average time spent in supine position; SW_mean = average time in slow wave; SW_S_mean = average time in slow wave and supine position; N3_mean = average time in N3; N3_S_mean = average time in N3 and supine position; REM_S_mean = average time in REM and supine position.
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