Abstract
There is limited information available concerning the treatment of daytime somnolence associated with Parkinson’s disease (PD); the most frequently applied therapeutic strategies include decreasing the dose of dopamine agonists or adding potential wake-promoting agents. There is recent data from a placebo-controlled trial concluding on a non-significant trend in favor of caffeine. We aimed to evaluate the efficacy of espresso-coffee in the treatment of daytime somnolence in PD. To evaluate the efficacy of espresso-coffee in the treatment of daytime somnolence in PD, we have conducted multiple single-patient (n-of-1) clinical trials comparing regular espresso coffee to decaffeinated coffee in PD patients presenting moderate to severe daytime somnolence defined as an Epworth Sleepiness Scale score >9. Each single-patient (n-of-1) trial included a sequence of three crossovers (two treatment periods separated by two days of washout). Four patients were included in the studies and three completed the three pairs of treatment periods. In two of the four patients, espresso coffee was considered beneficial. This study concludes that multiple single patient trials are feasible in PD and suggests that espresso-coffee may have a beneficial effect on daytime somnolence in some patients. These results cannot be generalized beyond the patients included in these trials.
Highlights
Daytime somnolence is a frequent problem in Parkinson’s disease (PD). [1]
Noneligibility criteria were: intake of antidepressants or anxiolytics that had not been provided at a stable dose for at least 1 month; relevant medical diseases, malignancy or other progressive neurological disorder; clinically significant or unstable arterial hypertension or ECG abnormalities; cognitive impairment as defined by mini-mental state examination (MMSE) score ≤24; clinically significant psychiatric illness, including previous hallucinations or psychotic symptoms; history of alcohol or coffee abuse or other substance abuse within the past 2 years; patients with migraine or other headache types related to the consumption of coffee; and patients who were unlikely to comply with a coffee intake suspension
This study is the first to investigate the efficacy of espresso coffee in the treatment of daytime somnolence in PD, using multiple single-patient (n-of 1) clinical trials
Summary
Daytime somnolence is a frequent problem in Parkinson’s disease (PD). [1]. Clinical and epidemiological data suggest that many factors may disturb sleep quality and/or induce sedation in PD patients. The respective role of all these contributing factors may vary from one patient to another, and it is often difficult to assess and conclude whether the effects of a given drug on sleep or alertness results from a direct or an indirect mechanism involving one or several of these factors. It represents a relevant problem for the management of PD patients, no treatment intervention other than the control of the precipitating factors has shown a clear benefit. No other potential psychostimulant drugs (selegiline, amphetamines, methylphenidate) or any other non-pharmacological treatments have yet been properly evaluated for their ability to treat daytime somnolence in PD patients
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