Abstract
Sleep disturbances occur frequently in patients with Parkinson's disease (PD). The aim of this study was to investigate the effects of rotigotine on sleep fluctuations in a sample of PD patients with self-reported complaints of nocturnal awakenings. This prospective, open-label, observational, and multicenter study enrolled consecutive outpatients with PD and administered rotigotine (mean dose 8.9 mg/day) for 3 months. The primary endpoint was the change from baseline in sleep fragmentation, assessed using the sleep maintenance subscale score of the Parkinson's Disease Sleep Scale (PDSS). The newly designed Parkinson's Disease Sleep Fragmentation Questionnaire (PD-SFQ) was used to measure other sleep parameters. A total of 62 patients were enrolled (mean age 70.2 years; 66% male). At 3 months, rotigotine significantly improved sleep fragmentation from baseline on the PDSS-2 sleep maintenance subscale (from 3.4 ± 0.9 to 1.9 ± 1.4; P < 0.0001). Rotigotine also significantly improved nocturnal motor symptoms (P < 0.0001), restless legs-like symptoms (P < 0.005), and nocturia (P = 0.004). Rotigotine significantly improved self-reported complaints of sleep fragmentation in PD patients and could be a useful treatment to improve this specific sleep problem in PD. However, these results are based on a small and clinically heterogeneous sample so they must be taken cautiously.
Highlights
Sleep disturbances occur frequently in patients with Parkinson’s disease (PD) [1, 2], with up to 70% of patients experiencing disrupted sleep in the early to midstages of the disease [1, 3], increasing up to 90% over time [4]
No specific treatment for sleep fragmentation is currently established in clinical guidelines, but some of its causes could be treated by the use of longacting dopaminergic agents
This study aimed to explore the relationships of sleep fragmentation—as measured by the Parkinson’s Disease Sleep Scale (PDSS)-2 sleep maintenance subscore—with different nocturnal sleep disturbances and the response of different nocturnal disturbances to rotigotine
Summary
Sleep disturbances occur frequently in patients with Parkinson’s disease (PD) [1, 2], with up to 70% of patients experiencing disrupted sleep in the early to midstages of the disease [1, 3], increasing up to 90% over time [4]. The most frequent sleep disorder in PD is sleep fragmentation [13, 14], clinically defined as the presence of recurrent, involuntary, and frequent nocturnal awakenings that interrupt normal sleep maintenance. It is one of the earliest sleep problems to develop, present in 35–50% of patients within the first 5 years of the disease and increasing in frequency to 60–70% after 10 years of follow-up [4, 13, 14]. Different strategies that provide a more continuous dopaminergic stimulation, such as the use of nocturnal apomorphine [15, 16] or levodopa/carbidopa intestinal gel infusion [17], have been shown to improve sleep by significant reductions of motor PD symptoms at night [18]
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