Acupuncture helps people with Parkinson’s disease sleep better

Patients with Parkinson’s disease (PD) may fare well with acupuncture, which has been shown in a recent study to have promising therapeutic effects on sleep quality that last for up to 2 months.

In a cohort of 78 adults with PD (Hoehn and Yahr stage ≤3, mean age 64.1 years, 52.6 percent men) and sleep problems who completed the study, the primary endpoint of Parkinson Disease Sleep Scale (PDSS) scores significantly increased after 4 weeks of acupuncture treatment (29.65, 95 percent confidence interval [CI], 24.65–34.65; p<0.001). [JAMA Netw Open 2024;7:e2417862]

The PDSS scores also improved with sham procedure (10.47, 95 percent CI, 5.35–15.60; p<0.001), which the investigators attributed to a placebo effect.

Of note, the difference in the magnitude of improvement in sleep quality between the two interventions favoured acupuncture (19.75, 95 percent CI, 11.02–28.49; p<0.001), with its effects persisting through 8 weeks of follow-up (20.24, 95 percent CI, 11.51–28.98; p<0.001).

“[These findings] underscore the potential of acupuncture as a beneficial adjunct in managing sleep-related issues among patients with PD,” which is encouraging, given that current management options for sleep disorder in this population remain limited, the investigators stated.

Sleep problems, a common nonmotor symptom that is caused by the disease itself and medications, is associated with a more severe PD clinical phenotype. There is consistent evidence showing that poor sleep contributes to faster gait deterioration and dyskinesia, as well as progression in mood and cognitive symptoms. PD patients with sleep problems consequently have a lower quality of life. [J Parkinsons Dis 2017;7:465-470; Gait Posture 2021;85:157-163; Parkinsonism Relat Disord 2018;48:68-73]

“The primary approach [to managing sleep disorder in PD] is to optimize dopaminergic therapy, particularly if the [problem] is related to nocturnal motor symptoms. Medications such as benzodiazepines, sedative antidepressants, and antipsychotics are beneficial but frequently accompanied by side effects, including excessive daytime sleepiness, morning sedation, imbalance, or confusion,” the investigators said. [Chin Med J (Engl) 2018;131:2976-2985; Mov Disord 2017;32:659-668]

A total of 83 adults were enrolled in the study and randomly assigned to receive either real acupuncture or sham acupuncture treatment for 4 weeks, but only those who completed the study (40 in the real group and 38 in the sham group) were included in the analysis. Five patients (6.0 percent) dropped out due to adjustment of anti-Parkinson medication or for personal reasons, and multiple imputation was used for missing data.

Results for secondary outcomes were also favourable in the real acupuncture group. Significant improvements were seen in motor symptoms (Unified Parkinson Disease Rating Scale [UPDRS] score: −14.53; UPDRS section III score: −6.88), nonmotor symptoms (Non-Motor Symptoms Scale score: −6.88, Epworth Sleepiness Scale score: −3.78; Hamilton Anxiety Rating Scale score: −5.28), and health-related quality of life (39-item Parkinson Disease Questionnaire score: −14.75).

As for safety, the most common self-reported acupuncture-related adverse events (AEs) included severe tremor; bleeding, numbness, or infection; and sharp pain during treatment, with no significant between-group differences. None of the participants overall experienced severe AEs. All AEs were resolved, with none leading to study withdrawal.