Evaluation and treatment of circadian rhythm disorders in parkinson's disease (PD): Practice patterns

OBJECTIVE: To assess the current treatment practices of clinicians caring for PD patients with complaints suggestive of a circadian rhythm sleep disorder (CRSD). BACKGROUND: Circadian dysfunction in PD patients may contribute to complaints of insomnia and daytime fatigue. Studies show treatment for CRSD may improve sleep, mood, and motor function in PD. Clinicians treating PD patients may be inadequately trained in the assessment and management of CRSD. DESIGN/METHODS: American Academy of Neurology members were randomly selected to complete an anonymous online survey assessing sleep management in PD patients. Results were collected and analyzed using chi square analyses. Trainees' responses were excluded from analyses. RESULTS: There were 174 responses. Of these, 42% were movement disorder (MD) specialists, 28.2% general neurologists, 16.7% sleep specialists, 5.7% other specialists and 7.5% trainees. Participants included those who primarily practiced in an academic hospital (47.1%), community based hospital (14.9%), and those in private practice (urban 29.4%; rural 8.6%). Over 50% of those surveyed saw >20 PD patients/month; most noted sleep complaints in at least 25% of PD patients. Sleep specialists were more likely than others to use sleep diaries (p < .001). Forty-one percent of non-sleep specialists used sleep diaries in PD patients compared to 89% of sleep specialists. 18.3% of practitioners never prescribed melatonin; there was no significant difference between specialties. In patients with CRSDs, 75.9% were never prescribed phototherapy or prescribed <25% of the time. Sleep specialists were significantly more likely to prescribe phototherapy (p<.001). Primary barriers to prescribing phototherapy were” lack of knowledge” and “cost”. CONCLUSIONS: Although sleep diaries are the recommended method for assessing CRSD, they are sub-optimally utilized by practitioners. Scheduled phototherapy is effective in treating CRSD, but is infrequently prescribed in PD patients with CRSD. Educational programs could bridge this knowledge gap.