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Sleep disturbance in movement disorders: Insights, treatments and challenges

Lookup NU author(s): Dr Kirstie Anderson


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© Author(s) (or their employer(s)) 2021. No commercial re-use. See rights and permissions. Published by BMJ. Sleep and circadian rhythm disturbances are central features of many movement disorders, exacerbating motor and non-motor symptoms and impairing quality of life. Understanding these disturbances to sleep is clinically important and may further our understanding of the underlying movement disorder. This review evaluates the current anatomical and neurochemical understanding of normal sleep and the recognised primary sleep disorders. In addition, we undertook a systematic review of the evidence for disruption to sleep across multiple movement disorders. Rapid eye movement sleep behaviour disorder has emerged as the most reliable prodromal biomarker for the alpha synucleinopathies, including Parkinson's disease and multiple system atrophy, often preceding motor symptom onset by several years. Abnormal sleep has also been described for many other movement disorders, but further evidence is needed to determine whether this is a primary or secondary phenotypic component of the underlying condition. Medication used in the treatment of motor symptoms also affects sleep and can aggravate or cause certain sleep disorders. Within the context of movement disorders, there is also some suggestion of a shared underlying mechanism for motor and sleep pathophysiology, with evidence implicating thalamic and brainstem structures and monoaminergic neurotransmission. This review highlights the need for an understanding of normal and abnormal sleep within the movement disorder clinic, an ability to screen for specific causes of poor sleep and to treat sleep disturbance to improve quality of life. Key sleep disorders also act as important biomarkers and have implications in diagnosis, prognosis and the development of future therapies.

Publication metadata

Author(s): Bailey GA, Hubbard EK, Fasano A, Tijssen MAJ, Lynch T, Anderson KN, Peall KJ

Publication type: Review

Publication status: Published

Journal: Journal of Neurology, Neurosurgery and Psychiatry

Year: 2021

Volume: 92

Issue: 7

Pages: 723-736

Print publication date: 14/06/2021

Online publication date: 19/03/2021

Acceptance date: 01/02/2021

ISSN (print): 0022-3050

ISSN (electronic): 1468-330X

Publisher: BMJ Publishing Group


DOI: 10.1136/jnnp-2020-325546