Abstract
ObjectiveTo clarify whether antiparkinsonian drugs contribute to nocturnal sleep disturbances in patients with Parkinson’s disease (PD).BackgroundAlthough the major antiparkinsonian drugs L-dopa and dopamine agonists (DAs) have been found to affect sleep, little is known about the effects of specific drugs on sleep in PD patients.MethodsThe study participants consisted of 112 PD patients (median age 72.5 years [inter-quartile range: IQR 65–79]; mean disease duration 8.44 years [standard deviation: 7.33]; median Hoehn and Yahr stage 3 [IQR 2–3.75]) taking one of three types of non-ergot extended-release DAs (rotigotine 32; pramipexole 44; ropinirole 36) with or without L-dopa (median daily total dosage of antiparkinsonian drugs 525.5 mg [IQR 376.25–658] levodopa equivalent dose [LED]). Participants were assessed using the PD Sleep Scale-2 (PDSS-2).ResultsFor the whole PD patient cohort, the PDSS-2 sleep disturbance domain score and the scores for item 1 assessing sleep quality and item 8 assessing nocturia were positively correlated with daily total dosage of antiparkinsonian drugs and dosage of L-dopa, but not with the dosage of DAs. Sub-analysis according to DA treatment revealed that DA dosage was not correlated with item 1 or 8 score in any of the subgroups. The LED ratio of rotigotine to the total dosage of antiparkinsonian drugs was inversely correlated with the item 1 score.ConclusionsThese data suggest that antiparkinsonian drugs, in particular L-dopa, adversely affect nocturnal sleep in PD patients, especially in terms of sleep quality and nocturia. Thus, adjusting both the total dosage of antiparkinsonian drugs and the dose-ratio of L-dopa might be key actions for alleviating poor sleep quality in patients with PD. Among DAs, we found a clear positive correlation between the dose-ratio of rotigotine and sleep quality. Thus, partial L-dopa replacement with rotigotine could improve sleep quality in patients with PD.
Highlights
Parkinson’s disease (PD) is a chronic progressive neurological condition characterized by motor symptoms including resting tremor, rigidity, bradykinesia, and postural instability, as well as non-motor symptoms such as sleep disturbance, constipation, and orthostatic hypotension [1]
We found that the PD Sleep Scale-2 (PDSS-2) total score was significantly positively correlated only with the dosage of L-dopa, and that this correlation coefficient was much higher than that between dopamine agonists (DAs) and PDSS-2 total score
Among the three domains of the PDSS-2, only the score in the sleep disturbance domain was significantly positively correlated with the daily total dosage of antiparkinsonian drugs and the dosage of L-dopa, with the DA dosage not being significantly correlated with either the total PDSS-2 score or the score of any of the three domains
Summary
Parkinson’s disease (PD) is a chronic progressive neurological condition characterized by motor symptoms including resting tremor, rigidity, bradykinesia, and postural instability, as well as non-motor symptoms such as sleep disturbance, constipation, and orthostatic hypotension [1]. The major antiparkinsonian drug types, L-dopa and dopamine agonists (DAs), have been reported to affect sleep. Therapy-related sleep disturbances have been found to occur more frequently in PD patients treated with L-dopa than in those receiving DAs [3]. Little is known about how the pharmacokinetic and pharmacodynamic profiles of specific dopamine drugs affect sleep disturbances. The patients were surveyed about their nocturnal sleep disturbances and the survey results were analyzed with a focus on the effects of two major drug types: L-dopa and DAs. the major antiparkinsonian drugs L-dopa and dopamine agonists (DAs) have been found to affect sleep, little is known about the effects of specific drugs on sleep in PD patients
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