Sleep and circadian rhythm regulation in early Parkinson disease

Research output: Contribution to journalArticle


IMPORTANCE: Sleep disturbances are recognized as a common nonmotor complaint in Parkinson disease but their etiology is poorly understood.

OBJECTIVE: To define the sleep and circadian phenotype of patients with early-stage Parkinson disease.

DESIGN, SETTING, AND PARTICIPANTS: Initial assessment of sleep characteristics in a large population-representative incident Parkinson disease cohort (N=239) at the University of Cambridge, England, followed by further comprehensive case-control sleep assessments in a subgroup of these patients (n=30) and matched controls (n=15).

MAIN OUTCOMES AND MEASURES: Sleep diagnoses and sleep architecture based on polysomnography studies, actigraphy assessment, and 24-hour analyses of serum cortisol, melatonin, and peripheral clock gene expression (Bmal1, Per2, and Rev-Erbα).

RESULTS: Subjective sleep complaints were present in almost half of newly diagnosed patients and correlated significantly with poorer quality of life. Patients with Parkinson disease exhibited increased sleep latency (P = .04), reduced sleep efficiency (P = .008), and reduced rapid eye movement sleep (P = .02). In addition, there was a sustained elevation of serum cortisol levels, reduced circulating melatonin levels, and altered Bmal1 expression in patients with Parkinson disease compared with controls.

CONCLUSIONS AND RELEVANCE: Sleep dysfunction seen in early Parkinson disease may reflect a more fundamental pathology in the molecular clock underlying circadian rhythms.


  • David P Breen
  • Romina Vuono
  • Upekshani Nawarathna
  • Kate Fisher
  • John M Shneerson
  • Akhilesh B Reddy
  • Roger A Barker
External organisations
  • University of Cambridge
Research areas and keywords


  • Aged, Case-Control Studies, Circadian Rhythm, Cohort Studies, Early Diagnosis, Female, Humans, Male, Middle Aged, Parkinson Disease, Sleep, Sleep Disorders, Circadian Rhythm, Journal Article, Research Support, Non-U.S. Gov't
Original languageEnglish
Pages (from-to)589-95
Number of pages7
JournalJAMA Neurology
Issue number5
Publication statusPublished - 2014 May
Publication categoryResearch