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mystery of yawning 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

mise à jour du
28 avril 2013
 
Parkinsonism Relat Disord
2013
Yawning: A behavioural marker of sleepiness
in de novo PD patients
Giganti F, Guidi S, Ramat S, Zilli I, Raglione LM, Sorbi S, Salzarulo P.
 
Department of Neurosciences, Psychology, Drug research and Child health, University of Florence, Italy

Chat-logomini

 
In healthy subjects, yawning usually occurs with increasing sleepiness [1], possibly in order to counteract low levels of arousal [2]. Excessive daytime sleepiness is a frequent complaint in patients with Parkinson's Disease (PD) and sleepiness could be an initial manifestation preceding other symptoms [3,4]. As a consequence, PD patients might experience an increase in yawning frequency, mainly of yawning bursts, which are an index of yawning production intensity.
 
We enrolled 18 untreated early stage PD patients (F 1/4 9, M 1/4 9; age 1/4 68.39 1.89, mean standard error) with 18 age-matched ( 3 years) healthy controls (F 1/4 9, M 1/4 9; age 1/4 67.22 1.98) [5]. All subjects signed informed consent to participate in the study. The study received institutional ethical approval. Subjects were provided with a wrist activity monitor (Actiwatch- Plus; Cambridge Neurotechnology Ltd, Pampisford, Cambridge, UK) to wear for three consecutive working days. Throughout this period they were also required to note each yawn by pushing an event marker button placed on the top of the actiwatch and to record in a personal log the time of onset of any quick succession (two or more) yawns, specifying the number of yawns. They were also asked to evaluate their level of sleepiness using the Karolinska Sleepiness Scale [6]. The overall yawning frequency (number of yawns per day/hour spent awake) was compared between the two groups through oneway ANOVA.
 
We analysed separately isolated yawning (IY) and yawning bursts (YB); a yawing burst was defined as a sequence of more than one yawn occurring within a minute. The frequency of IY and YB (the number of isolated yawns and of bursts of yawning/hours spent awake) were both compared between the two groups through one-way ANOVA. The time-course of yawning (overall, IY, YB) was assessed through ANOVA for repeated measures, with "group" as the between factor, "hour" as thewithin factor and "yawning" as the dependent variable. For overall ANOVA significant effects, differences between subjects were evaluated using Student's t-test for unpaired samples. Differences within subjectswere tested separately for each group applying an ANOVA for repeated measures with "hour" as the within factor and "yawning" as the dependent variable.
 
giganti parkinson

 

The results of rest-activity rhythm and sleepiness have been reported in a previous study [5]. The overall frequency of yawns (number of yawns per hour) during the awake period was higher in de novo PD patients (0.69 0.11) compared to healthy control subjects (0.49 0.09), although this difference failed to reach statistical significance.
 
The frequency of YB was higher in de novo PD patients compared to healthy control subjects (F1,34 1/4 4.89, p < 0.05), whereas no significant differences between the two groups were observed in the frequency of IY.
 
The analysis of the time-course revealed that the whole yawning frequency was higher in de novo PD patients than in healthy control subjects ("group": F1,331/44.79, p<0.05) and it varied according with the time of the day ("hour": F15,495 1/4 5.33, p < 0.001). Specifically yawning frequency peaked early in the morning, during the afternoon and late in the evening in both de novo PD patients ("hour": F15,240 1/4 2.808, p < 0.001) and healthy control subjects ("hour": F15,240 1/4 2.099, p < 0.05), however at 2p.m. yawning was higher in de novo PD patients than in healthy control subjects (t 1/4 2.99, p < 0.01).
 
The number of IY varied across the awake period ("hour": F15,495 1/4 3.13, p < 0.001) in both groups, without significant differences between the two. In particular, IY frequency peaked early in the morning, during the afternoon and late in the evening in both de novo PD patients ("hour": F15,240 1/4 1.932, p < 0.05) and healthy control subjects ("hour": F15,240 1/4 2.602, p < 0.01). PD patients performed more YB than healthy control subjects ("group": F1,33 1/4 7.01, p < 0.05) and the YB frequency varied across the awake period ("hour": F15,495 1/4 3.55, p < 0.001). In de novo PD patients YB frequency peaked early in the morning, during the afternoon and late in the evening ("hour": F15,240 1/4 2.224, p < 0.01), whereas in healthy control subjects YB frequency did not change during the day. Moreover, at 2 p.m., PD patients experienced more YB than healthy control subjects (t 1/4 2.05, p < 0.05).
 
Our results showed that the circadian distribution of yawning is not altered in untreated patients with early-stage Parkinson's disease, since the frequency of yawns was similar throughout the awake period in both de novo PD patients and in healthy controls. De novo PD patients yawnedmore frequently than healthy subjects, especially during the afternoon, when the increase of sleepiness is significant [5]. At that time, it is mainly yawning occurring in bursts that accounts for increased yawning frequency. One likely hypothesis might be that a quick succession of yawns represents the effort of PD patients trying to remain alert and awake.
 
References
 
[1] Giganti F, Zilli I, Aboudan S, Salzarulo P. Sleep, sleepiness and yawning. In: Walusinski O, editor. The mystery of yawning in physiology and disease. Basel: Front Neurol Neurosci. Karger; 2010. p. 42-46.
 
[2] Baenninger R, Binkley S, Baenninger M. Field observations of yawning and activity in humans. Physiol Behav 1996;59:421-425.
 
[3] Arnulf I, Leu-Semenescu S. Sleepiness in Parkinson's disease. Parkinsonism Relat Disord 2009;15(Suppl. 3):S101-104.
 
[4] Abbott RD, Ross GW, White LR, Tanner CM, Masaki KH, Nelson JS, et al. Excessive daytime sleepiness and subsequent development of Parkinson's disease. Neurology 2005;65:1442-426.
 
[5] Giganti F, Ramat S, Zilli I, Guidi S, Raglione LM, Sorbi S, Salzarulo P. Daytime course of sleepiness in de novo PD patients. J Sleep Res 2013;22:197-200.
 

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-Giganti F, Guidi S, Ramat S, Zilli I, Raglione LM, Sorbi S, Salzarulo P. Yawning: A behavioural marker of sleepiness in de novo PD patients. Parkinsonism Relat Disord 2013
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