Sleep Dysfunction in Parkinson’s Disease

INTRODUCTION: Sleep is defined as a periodic reversible physiological state of loss of consciousness from which a person can be aroused by adequate sensory stimuli and it is necessary for the recoupment and well being of the individual. We spend around 8 hours per day for sleep which means 56 hours per week, 224 hours per month and 2688 hours per year (ie) almost nearly 1/3 of our lives we spent for sleep. Sleep helps in energy conservation, physical restoration, memory reinforcement and consolidation, thermoregulation, preserving synaptic efficiency and brain plasticity, immune function, brain growth and development. Parkinson’s disease (PD) is a progressive neurodegenerative disorder associated with a loss of dopaminergic nigrostriatal neurons. It is named after James Parkinson, the English physician who in an “Essay on the Shaking Palsy” in 1817 described Parkinson’s disease as “involuntary tremulous motion, with lessened muscular power, in parts not in action and even when supported, with a propensity to bend the trunk forward, and to pass from a walking to a running pace, the sense and intellect being uninjured.” Sleep disorders have been mentioned since the first description of the extra-pyramidal diseases in James Parkinson’s Essay on the Shaking Palsy, but only recently they have become the subject of attention, thanks to new acquisitions in clinical knowledge and polysomnography technology. AIMS & OBJECTIVES: 1. To evaluate the frequency and the nature of the sleep abnormalities in Idiopathic parkinson’s disease. 2. To analyse the sleep architecture in Parkinson’s disease using polysomnography and to correlate the results with the disease parameters. MATERIALS AND METHODS: STUDY DESIGN: Cross sectional study. STUDY SITE: This study was carried out in the Department of Neurology, Madras Institute of Neurology, Chennai. STUDY PERIOD: December 2011 to December 2012. INCLUSION CRITERIA: Patients who fulfill the “UK Parkinson’s Disease Society- Brain Bank Clinical Diagnostic Criteria” admitted in Neurology ward/consulting in Neurology outpatient clinic in Rajiv Gandhi Government General Hospital. EXCLUSION CRITERIA: Patients who are bedridden associated with co-morbidities which affects the sleep like uncontrolled diabetes, LV dysfunction, Bronchial Asthma, Chronic obstructive Pulmonary disease, vascular Parkinsonism, head injury, dementia, Parkinson plus syndromes. METHODS AND ANALYSIS: 1) Detailed history and neurological examination. 2) Assessment of severity of Parkinsons disease using Unified Parkinsons Disease Rating Scale(UPDRS). 3) Sleep assessment using Parkinsons disease sleepiness scale (PDSS) and Epworth Sleepiness Scale(ESS). 4) Polysomnography. SAMPLE SIZE: 50 patients suffering from Idiopathic Parkinsons Disease STASTITICAL DATA ANALYSIS: Pearson’s Correlation Analysis and logistic regression, SPSS16. RESULTS: Fifty patients of Idiopathic Parkinson’s disease were recruited based on United Kingdom Parkinson’s Disease Society brain bank Criteria for the sleep study. All of them underwent clinical assessment. Their staging and severity was scored using Hoehn and Yahr staging system and Unified Parkinsons Disease Rating Scale part III respectively. Subjective sleep disturbance was assessed using standard sleep related questionnaire (Parkinsons Disease sleepiness scale). They were asked about their nature of sleep disturbance. Disturbed sleep was reported by 35 patients. Of them 30 have difficulty in falling sleep and 24 have difficulty in maintaining the sleep due to frequent awakenings. Most of the patients told that they woke up in the night mainly for passing urine. Objective sleep analysis was done using overnight polysomnography. The day time disturbance was assessed using Epworth sleepiness scale. ESS Score more than ten was considered significant. Day time somnolence was reported by 15 patients. CONCLUSION: 1. Sleep disturbance occurred in 80% of the patients with Idiopathic Parkinson’s disease. 2. Total sleep time is significantly decreased in patients with increased severity, staging and duration of the disease. 3. There is a significant prolongation in the sleep latency and the sleep efficiency is also markedly diminished. 4. Patients spent less time in slow wave sleep (N3) and there is significant prolongation of N1/N2 stages of sleep. 5. The mean REM sleep duration is also reduced. 6. REM sleep behaviour disorder is seen in 20% of the patients which did not correlate with the disease parameters. 7. Periodic limb movements in sleep is noted in 36% of patients and Restless leg syndrome is noted in 20% of our patients. They showed a significant positive correlation with the progression of the disease and higher staging and severity. 8. Sleep disordered breathing is noted in 42% of the patients which did not correlate with the disease parameters and sleep scores. 9. Snoring is noted in 28% of patients and it correlated well with the Epworth sleepiness score. Sleep architecture is markedly affected in patients with Parkinson’s disease. The latency of sleep is prolonged causing difficulty in falling asleep. The sleep efficiency is grossly diminished as there is defect in the maintenance of sleep due to frequent awakenings. Periodic limb movements in sleep, restless leg syndrome, and obstructive sleep apnoea also contribute to the sleep fragmentation resulting in defective day time functioning. It is essential that all the patients with Parkinson’s disease should be evaluated for sleep disorders so that appropriate intervention can be taken to improve their quality of life

Mathematical approach towards non-stepwise performance assessment in HUASB reactor for wastewater treatment from pulp and paper mills

A lab-scale Hybrid Upflow Anaerobic Sludge Blanket (HUASB) reactor with a working volume of 6.5 litres has been taken for the performance analysis, in the treatability study of pulp and paper mill wastewater. In order to analyze the performance of the reactor, operational parameter like hydraulic retention time (HRT) was varied from 10, 20, 30 and 40 h. In addition to that, performance parameters like chemical oxygen demand (COD), pH, volatile fatty acids (VFA), alkalinity, gas production and VFA/alkalinity ratio are analyzed to check the reactor efficacy. The maximum COD removal efficiency of 81.3% is obtained at 40 h HRT, with gas production (methane content of 58%). Also, the obtained results are fitted to the kinetic models like the standard first order, first order and second order to evaluate the performance of the HUASB reactor

Mathematical approach towards non-stepwise performance assessment in HUASB reactor for wastewater treatment from pulp and paper mills

110-116A lab-scale Hybrid Upflow Anaerobic Sludge Blanket (HUASB) reactor with a working volume of 6.5 litres has been taken for the performance analysis, in the treatability study of pulp and paper mill wastewater. In order to analyze the performance of the reactor, operational parameter like hydraulic retention time (HRT) was varied from 10, 20, 30 and 40 h. In addition to that, performance parameters like chemical oxygen demand (COD), pH, volatile fatty acids (VFA), alkalinity, gas production and VFA/alkalinity ratio are analyzed to check the reactor efficacy. The maximum COD removal efficiency of 81.3% is obtained at 40 h HRT, with gas production (methane content of 58%). Also, the obtained results are fitted to the kinetic models like the standard first order, first order and second order to evaluate the performance of the HUASB reactor