Ventricular orexin-A (hypocretin-1) levels correlate with rapid-eye-movement sleep without atonia in Parkinson’s disease

OBJECTIVE: Patients with Parkinson’s disease frequently complain of sleep disturbances and loss of muscle atonia during rapid-eye-movement (REM) sleep is not rare. The orexin-A (hypocretin-1) hypothalamic system plays a central role in controlling REM sleep. Loss of orexin neurons results in narcolepsy-cataplexy, a condition characterized by diurnal sleepiness and REM sleep without atonia. Alterations in the orexin-A system have been also documented in Parkinson’s disease, but whether these alterations have clinical consequences remains unknown. METHODS: Here, we measured orexin-A levels in ventricular cerebrospinal fluid from eight patients with Parkinson’s disease (four males and four females) who underwent ventriculography during deep brain-stimulation surgery and performed full-night polysomnography before surgery. RESULTS: Our results showed a positive correlation between orexin-A levels and REM sleep without muscle atonia. CONCLUSION: Our results suggest that high levels of orexin-A in Parkinson’s disease may be associated with loss of REM muscle atonia.