Evidence-based therapy for sleep disorders in neurodegenerative diseases

Abstract

Objective To evaluate the effectiveness of the treatments for sleep disorders in neurodegenerative diseases so as to provide the best therapeutic regimens for the evidence-based treatment. Methods Search PubMed, MEDLINE, Cochrane Library, Wanfang Data and China National Knowledge Infrastructure (CNKI) databases with "sleep disorder or sleep disturbance", "neurodegenerative diseases", "Parkinson's disease or PD", "Alzheimer's disease or AD", "multiple system atrophy or MSA" as retrieval words. The quality of the articles were evaluated with Jadad Scale. Results A total of 35 articles, including 2 systematic reviews, 5 randomized controlled trials, 13 clinical controlled trials, 13 case series and 2 epidemiological investigation studies were included for evaluation, 13 of which were high grade and 22 were low grade articles. Clinical evidences showed that: 1) advice on sleep hygiene, careful use of dopaminergic drugs and hypnotic sedative agents should be considered for PD. Bright light therapy (BLT) may improve circadian rhythm sleep disorders and clonazepam may be effective for rapid eye movement sleep behavior disorder (RBD). However, to date, very few controlled studies are available to make a recommendation for the management of sleep disorders in PD; 2) treatments for sleep disorders in AD include drug therapy (e.g. melatonin, acetylcholinesterase inhibitors, antipsychotic drugs, antidepressants) and non-drug therapy (e.g. BLT, behavior therapy), but very limited evidence shows the effectiveness of these treatments; 3) the first line treatment for sleep-related breathing disorder in MSA is nasal continuous positive airway pressure (nCPAP), and clonazepam is effective for RBD in MSA; 4) there is rare evidence related to the treatment of sleep disorders in dementia with Lewy body (DLB) and amyotrophic lateral sclerosis (ALS). Conclusion Evidence-based medicine can provide the best clinical evidence on sleep disorders' treatment in neurodegenerative diseases.