key: cord-1028982-2gtp89yz
authors: Xia, Yun; Kou, Liang; Zhang, Guoxin; Han, Chao; Hu, Junjie; Wan, Fang; Yin, Sijia; Sun, Yadi; Wu, Jiawei; Li, Yunna; Zhang, Zhentao; Huang, Jinsha; Xiong, Nian; Wang, Tao
title: Investigation on sleep and mental health of patients with Parkinson's disease during the Coronavirus disease 2019 pandemic
date: 2020-09-10
journal: Sleep Med
DOI: 10.1016/j.sleep.2020.09.011
sha: a260fef9da0aaa9a18f43f096e6d8077c7f4cf7b
doc_id: 1028982
cord_uid: 2gtp89yz

BACKGROUND: The coronavirus disease 2019 (COVID-19) pandemic is adversely affecting sleep quality and mental health, especially in individuals with chronic disease such as Parkinson’s disease (PD). METHODS: We conducted a quantitative study, which included 119 Chinese PD patients who had been treated in an outpatient neurology clinic in Wuhan and 169 age- and sex-matched healthy controls. The questionnaire survey focused on the impact of the COVID-19 pandemic on sleep, mental status, symptoms, and daily life and medical treatment of PD patients. RESULTS: Compared to healthy controls, PD patients had significantly higher scores in both the Pittsburgh Sleep Quality Index (PSQI) (8.13 vs 5.36, p<0.001) and the Hospital Anxiety and Depression Scale (HADS) -Depression (4.89 vs 3.82, p=0.022), as well as a higher prevalence of sleep disturbances with PSQI > 5 points (68.9% vs 44.4%, p<0.001). Sleep disturbance was identified in 68.9% of PD patients. A logistic regression analysis showed that sleep disturbance of PD patients was independently associated with exacerbation of PD symptoms (OR=3.616, 95%CI= (1.479, 8.844), p=0.005) and anxiety (OR=1.379, 95%CI= (1.157, 1.642), p<0.001). Compared to male PD patients, female ones had higher PSQI scores (9.28 ± 4.41 vs 7.03 ± 4.01, p=0.009) and anxiety (32.8% vs 0.1%, p=0.002) and depression prevalence (34.5% vs 11.5%, p=0.003). CONCLUSION: The findings of the present study emphasize the importance of mental and sleep health interventions in PD patients during the COVID-19 pandemic. Additional attention should be paid to the difficulty encountered by PD patients in seeking medical treatment.

impact of the COVID-19 pandemic on sleep, mental status, symptoms, and daily life 9 and medical treatment of PD patients. p=0.009) and anxiety (32.8% vs 0.1%, p=0.002) and depression prevalence (34.5% vs 20 11.5%, p=0.003). March 2020, the World Health Organization declared COVID-19 a global pandemic 2 . 5 With the spread of COVID-19, daily hospital activities were suspended and many 6 hospitals in Wuhan began to focus solely on treating COVID-19 patients. Individuals 7 with chronic disease could be influenced substantially by the psychological pressure 8 and the inconvenience caused by inadequate medical consultation due to the 9 COVID-19 pandemic, resulting in worsening of sleep quality and mental health. 10 It is well known that deficiency of dopamine in the nigrostriatal system is the 11 core pathological feature of Parkinson's disease (PD) 3 . The lack of dopamine can lead 12 to a loss of emotional control and increased mental stress 4 . This may explain the 13 frequent stress-related symptoms such as anxiety and depression in PD patients even 14 in the absence of particular life events that may cause these symptoms 5 . The questionnaire consisted of five parts: socio-demographic characteristics, 5 sleep quality, psychological distress, COVID-19 epidemic-related questions and 6 clinical characteristics of PD. 7 Data regarding sex, age, education, and geographic location were collected. headaches, myalgia, sore throat, diarrhea and dry cough, and access to medical care. 

The COVID-19 epidemic has caused a parallel epidemic of fear, anxiety, The relationship between sleep disturbance and progression of PD is 5 noteworthy 23 . Our findings suggest that subjective exacerbation of PD symptoms is an 6 independent risk factor for sleep disturbance, including the appearance of any new 7 symptoms or exacerbation of these symptoms, such as tremor, stiffness, sluggish 8 movement, fatigue, pain, salivation, disturbed gait, and difficulty in turning over in 9 bed. Since the maintenance of the sleep-wake cycle is closely related to the 10 dopamine 24,25 , PD patients with advanced motor symptoms inclined to experience 11 aggravation of non-motor symptoms such as sleep disturbance, which may be related 12 to the degeneration of the dopaminergic system in the nigrostriatal pathway. In tyrosine hydroxylase, the rate-limiting enzyme for dopamine synthesis, is regulated by 20 CLOCK and SIRT1 genes and abnormal circadian rhythm may cause fluctuation of 21 motor symptoms in PD patients 28, 29 . Therefore, the sleep disturbance of PD patients 22 needs to be taken seriously.

Our results show that female PD patients have worse sleep quality and pay more 24 attention to COVID-19 related news. The proportion of female patients with anxiety 25 and depression is much higher than that of male ones. This finding is consistent with 26 previous studies that have shown that women were more likely to suffer from mood 27 disorders, such as depression 30 , anxiety 31 , and sleep disturbance 32 .

This study has also some limitations. All participants were from a single 29 outpatient neurology clinic in Wuhan. Most of them were from the Hubei province 30 and its surrounding areas, leading to the restrictions of the generalization of our search 31 results. And sleep quality was evaluated using a self-report questionnaire investigation, 32 rather than actigraphic recording or polysomnography, which makes the analysis We thank all of the participants of this study. Difficulties in buying medicines, n (%) 8 (6.7%) 6 (7.3%) 2 (5.4%) 1.000

Continuous variables are expressed as mean ± standard deviation. Categorical variables are expressed as frequency (percent).

Abbreviations J o u r n a l P r e -p r o o f 

Generalized anxiety disorder, depressive symptoms and sleep quality during 20 COVID-19 outbreak in China: a web-based cross-sectional survey

Prevalence, risk factors, and clinical correlates of insomnia in 23 volunteer and at home medical staff during the COVID-19

Non-motor symptoms in early Parkinson's disease with Clinical characteristics of PD Hoehn and Yahr scale

Conceptualization；Formal analysis；Writing -Original Draft Liang Kou: Conceptualization；Formal analysis；Writing -Original Draft Tao Wang: Conceptualization；Writing -Review & Editing ；Funding acquisition Junjie Hu: Investigation Fang Wan: Investigation Sijia Yin: Investigation Yadi Sun: Investigation Jiawei Wu: Investigation Yunna Li: Investigation Jinsha Huang: Investigation Nian Xiong: Investigation Guoxin Zhang: Writing -Review & Editing Chao Han: Writing -Review & Editing Zhentao Zhang: Writing -Review & Editing

Global PSQI score (mean ± SD) 9. 28 • Anxiety, lack of medical consultation and exacerbation of symptoms affects the sleep health of PD patients profoundly.• The exacerbation of PD related symptoms, was independently and closely associated with sleep quality.• The sleep and mental health of female PD patient need more consideration and treatment.• Special attention should be paid to the difficulty in seeking medical treatment for PD patients during the epidemic.