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Fox Foundation for Parkinson's Research","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100000864","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100014055","name":"U.S. Army Medical Research Acquisition Activity","doi-asserted-by":"publisher","award":["W81XWH2010468"],"award-info":[{"award-number":["W81XWH2010468"]}],"id":[{"id":"10.13039\/100014055","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Annals of Neurology"],"published-print":{"date-parts":[[2025,7]]},"abstract":"<jats:sec><jats:title>Objective<\/jats:title><jats:p>The objective of this study was to investigate the differences in cyclic alternating patterns (CAP) metrics, a non\u2010rapid eye movement (NREM) sleep physiological rhythm, among recently diagnosed patients with Parkinson's disease (PD), and individuals at high and low risk for developing PD based on genetic and prodromal risk.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>In this cross\u2010sectional exploratory study, participants underwent clinical, cognitive, and motor evaluation to compute risk based on the Movement Disorder Society (MDS) prodromal criteria and a standard overnight polysomnography. CAP rate, CAP index, A index subtypes, number of CAP sequences, and CAP sequence duration were computed from the electroencephalogram (EEG) signal.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The study included 30 patients with early PD (mean age\u2009=\u200962.80\u2009\u00b1\u20097.69, disease duration\u2009=\u20091.10\u2009\u00b1\u20091.09), 26 participants at risk for PD (age\u2009=\u200964.88\u2009\u00b1\u200910.09), and 36 participants with low risk for PD (age\u2009=\u200956.83\u2009\u00b1\u20097.41). Despite comparable macrosleep architecture, most CAP measures were significantly lower in patients with PD compared with the low\u2010risk group, whereas the at\u2010risk group showed transitional values between PD and the low\u2010risk group. The A2 index was significantly lower in both the at\u2010risk and PD groups from the low\u2010risk group (at risk\u2009=\u20097.59\u2009\u00b1\u20094.59; PD\u2009=\u20097.71\u2009\u00b1\u20095.83; and low risk\u2009=\u200912.85\u2009\u00b1\u20098.63; <jats:italic>p<\/jats:italic>\u2009=\u20090.010). Lower CAP rate and lower CAP index were associated with greater disease severity (<jats:italic>r<\/jats:italic>\u2009=\u2009\u22120.23 and\u2009\u2212\u20090.24, respectively).<\/jats:p><\/jats:sec><jats:sec><jats:title>Interpretation<\/jats:title><jats:p>Patients with early clinical PD exhibit alterations in CAP dynamics despite having comparable macrosleep architecture. Alterations of the NREM microsleep structure may occur early in the neurodegenerative process and the A2 index may be an early event in the evolution of the disease with the potential to serve as an early marker for disease progression. 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