Abstract
Objective: To explore the clinical features and correlates of excessive daytime sleepiness (EDS) in a Chinese population of Parkinson's disease (PD) patients.Methods: Patients with clinically established or clinically probable PD were recruited. Clinical and demographic data were collected, and participants were evaluated using standardized assessment protocols. Patients were divided into PD with EDS and PD without EDS groups based on the Epworth sleepiness scale (ESS) scores, with a cutoff score of 10. Clinical manifestations were compared between patients with and without EDS, and correlates of EDS were also studied. In addition, the relationship between EDS and poor nighttime sleep quality was analyzed.Results: A total of 1,221 PD patients were recruited in our study. The mean ESS (min, max) score was 7.6 ± 6.1 (0, 24), and 34.1% of the patients had ESS scores ≥10. No difference was seen in lifestyle (except for alcohol consumption), environmental factors, BMI, levodopa equivalent dose (LED), initial presentation of motor symptoms, motor subtype, and wearing off between patients with and without EDS. The PD with EDS group had a higher proportion of male patients and a higher average patient age. Moreover, the PD with EDS group showed older age at PD onset, lower educational level, and longer disease duration. Patients with EDS had higher scores on the Hoehn-Yahr scale and the Unified Parkinson's Disease Rating Scale (UPDRS) parts I, II, and III score, more severe non-motor symptoms, and poorer quality of sleep and life. Logistic regression analyses demonstrated that EDS was associated with male sex, age, cognitive impairment, PD-related sleep problems, rapid eye movement sleep behavior disorder (RBD), and worse quality of life (QoL).Conclusion: EDS is a general clinical manifestation in PD, and there were significant differences in clinical features between patients with and without EDS. Moreover, our study proved that many factors were associated with EDS, including male sex, age, cognitive impairment, PD-related sleep problems, RBD, and worse QoL. Understanding the clinical characteristics of EDS in PD patients may help identify EDS early, improve QoL, and reduce the occurrence of accidents.
Highlights
Parkinson’s disease (PD) is a common neurodegenerative disease
A total of 1,221 PD patients were included in this study
When comparing non-motor symptoms (NMS) between patients with and without Excessive daytime sleepiness (EDS), we found that participants with EDS had higher scores for Epworth sleepiness scale (ESS), cardiovascular symptoms, urinary symptoms, and PDQ39, but lower scores for Mini-Mental State Examination (MMSE) and Parkinson’s disease sleep scale (PDSS)
Summary
While environmental exposure and genetic background are thought to be major risk factors for PD [1, 2], the etiology of the disease is not fully understood. The clinical manifestations of PD are identified as heterogeneous, and the disease presents with a wide range of non-motor symptoms (NMS) [3, 4]. The reported incidence of EDS varies widely due to differences in sample sizes, assessment methods, and diagnostic criteria for sleep disorders. Except for disease-related pathological changes, many variables have been revealed to be associated with EDS in PD, including male gender, poorer nighttime sleep, cognitive impairment, autonomic dysfunction, hallucinations, depression, anxiety, advanced disease, non-tremor dominant motor phenotype, dosage of dopamine agonists, and use of antihypertensives [7,8,9,10,11]. Because of the diversity in sample sizes and research methods, the results of previous studies on EDSassociated factors were inconsistent
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