Abstract
BackgroundExcessive daytime sleepiness is a frequent complaint in Parkinson’s disease (PD); however the frequency and risk factors for objective sleepiness remain mostly unknown. We investigated both the frequency and determinants of self-reported and objective daytime sleepiness in patients with Parkinson’s disease (PD) using a wide range of potential predictors.MethodsOne hundred and thirty four consecutive patients with PD, without selection bias for sleep complaint, underwent a semi-structured clinical interview and a one night polysomnography followed by a multiple sleep latency test (MSLT). Demographic characteristics, medical history, PD course and severity, daytime sleepiness, depressive and insomnia symptoms, treatment intake, pain, restless legs syndrome, REM sleep behaviour disorder, and nighttime sleep measures were collected. Self-reported daytime sleepiness was defined by an Epworth Sleepiness Scale (ESS) score above 10. A mean sleep latency on MSLT below 8 minutes defined objective daytime sleepiness.ResultsOf 134 patients with PD, 46.3% had subjective and only 13.4% had objective sleepiness with a weak negative correlation between ESS and MSLT latency. A high body mass index (BMI) was associated with both ESS and MSLT, a pain complaint with ESS, and a higher apnea/hypopnea index with MSLT. However, no associations were found between both objective and subjective sleepiness, and measures of motor disability, disease onset, medication (type and dose), depression, insomnia, restless legs syndrome, REM sleep behaviour disorder and nighttime sleep evaluation.ConclusionWe found a high frequency of self-reported EDS in PD, a finding which is however not confirmed by the gold standard neurophysiological evaluation. Current treatment options for EDS in PD are very limited; it thus remains to be determined whether decreasing pain and BMI in association with the treatment of sleep apnea syndrome would decrease significantly daytime sleepiness in PD.
Highlights
Since initial descriptions of sleep attacks at the wheel in patients with Parkinson’s Disease (PD) treated with dopamine agonists, [1] many cross-sectional studies have reported a high frequency of self-reported excessive daytime sleepiness (EDS) in Parkinson’s disease (PD) [2,3,4,5,6,7,8,9,10,11]
We explored a wide range of potential predictors of either subjective or objective EDS, such as demographic characteristics, medical history, PD course and severity, levodopa equivalent dose and time of intake, other psychotropic drugs, comorbid clinical sleep problems (restless legs syndrome-RLS, REM sleep behaviour disorder (RBD) and insomnia symptoms), cognitive problems, depressive symptoms, pain and nighttime sleep characteristics using polysomnography assessment
Clinical assessment of RLS was present in 31.3% of patients, clinical RBD in 47.3%, insomnia symptoms (ISI$8) in 83.9%, a complaint of pain in 76% based on the West Haven-Yale Multidimensional Pain Inventory (WHYMPI) questionnaire, and depressive symptoms (BDI$19) in 27.7%
Summary
Since initial descriptions of sleep attacks at the wheel in patients with Parkinson’s Disease (PD) treated with dopamine agonists, [1] many cross-sectional studies have reported a high frequency (up to 50%) of self-reported excessive daytime sleepiness (EDS) in PD [2,3,4,5,6,7,8,9,10,11]. The most frequently associated factors with the complaint of EDS in PD are dopaminergic drugs (the dose rather than the specific type of dopamine agonist), [5,6,10,12,13,14] disease severity and duration, [10,14] reduced activity of daily living, [2,11,15] and nighttime sleep problems including the apnea/hypopnea index [10,12,14]. The frequency and determinants of objective sleepiness in PD remain mostly unknown, due to differences in study populations included either with EDS or unselected for sleep problems, low sample sizes, and various associated potential confounding factors. Excessive daytime sleepiness is a frequent complaint in Parkinson’s disease (PD); the frequency and risk factors for objective sleepiness remain mostly unknown We investigated both the frequency and determinants of selfreported and objective daytime sleepiness in patients with Parkinson’s disease (PD) using a wide range of potential predictors
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