Assessment of sleepiness and unintended sleep in Parkinson's disease patients taking dopamine agonists

“…Data on the frequency of sleep onset REM (SOREM) have been variable. SOREM was found in 29–39% of PD patients with EDS [5,6] and in up to 70% of PD patients with hallucinations [7]. SOREM was also observed in a case of juvenile PD [8] and in 20–28% of unselected PD patients [4,9,10].…”

Section: Introductionmentioning

confidence: 99%

“…In 6 studies, consecutive unselected PD patients were included [3,4,9,10,12,13]. In 2 studies, only PD patients referred for sleepiness or with ESS >10 were examined [5,6]. Various factors including age [14,15], gender [1,16], dopaminergic treatment [9,17,18], severity of PD [18,19] and night-time sleep disturbances [5,12] have been discussed as causes of EDS in PD.…”

Section: Introductionmentioning

confidence: 99%

Excessive Daytime Sleepiness in Parkinson’s Disease: Characteristics and Determinants

et al. 2010

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Background/Aims: Excessive daytime sleepiness (EDS) is frequent in patients with Parkinson’s disease (PD). Occasionally, EDS in PD exhibits narcolepsy-like features. We aimed to assess characteristics and determinants of EDS in consecutive patients with PD. Methods: Thirty consecutive patients with PD underwent a detailed clinical examination. EDS was assessed using the Epworth Sleepiness Scale (ESS) and Multiple Sleep Latency Test (MSLT). Sleep was assessed using video-polysomnography. Cerebrospinal fluid (CSF) hypocretin-1 levels were obtained in 3 patients. Results: ESS was >10 in 17 patients (57%). Mean sleep latency (MSL) on MSLT was <5 min in 11 patients (37%). There was a significant negative correlation between ESS and MSL. None of the 11 patients with MSL <5 min showed a sleep onset REM (SOREM) episode. Patients with EDS had higher dopamine agonists/levodopa equivalent doses, higher apnea/hypopnea index and exhibited wearing-off symptoms more often. Hypocretin-1 was normal in 3 patients tested. Conclusion: EDS, which can sometimes be severe, is common in PD patients even in the absence of SOREM and detectable CSF-hypocretin deficiency. In PD, EDS is a multifaceted phenomenon, the determinants of which include severity of PD, wearing-off symptoms, dosage of antiparkinsonian drugs and sleep-disordered breathing.

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“…Although sleep attacks were initially described in patients receiving pramipexole and ropinirole, it is clear that sedative effects and unintended sleep episodes can be seen with any of the dopaminergic agents, including levodopa, 364,365,937,938 and that these effects are dose related, occurring with greater frequency in patients taking relatively high doses. Thus, somnolence is more likely to occur in patients taking higher doses of dopaminergic medications and is greatest when a given dose reaches its maximal concentration.…”

mentioning

confidence: 99%

The scientific and clinical basis for the treatment of Parkinson disease (2009)

Olanow¹,

Stern²,

Sethi³

2009

Neurology

759

658

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Parkinson disease (PD) is an age-related neurodegenerative disorder that affects as many as 1-2% of persons aged 60 years and older. With the aging of the population, the frequency of PD is expected to increase dramatically in the coming decades. Current therapy is largely based on a dopamine replacement strategy, primarily using the dopamine precursor levodopa. However, chronic treatment is associated with the development of motor complications, and the disease is inexorably progressive. Further, advancing disease is associated with the emergence of features such as freezing, falling, and dementia which are not adequately controlled with dopaminergic therapies. Indeed, it is now appreciated that these nondopaminergic features are common and the major source of disability for patients with advanced disease. Many different therapeutic agents and treatment strategies have been evaluated over the past several years to try and address these unmet medical needs, and many promising approaches are currently being tested in the laboratory and in the clinic. As a result, there are now many new therapies and strategic approaches available for the treatment of the different stages of PD, with which the treating physician must be familiar in order to provide patients with optimal care. This monograph provides an overview of the management of PD patients, with an emphasis on pathophysiology, and the results of recent clinical trials. It is intended to provide physicians with an understanding of the different treatment options that are available for managing the different stages of the disease and the scientific rationale of the different approaches. 1 PD is the second most common neurodegenerative disorder, with an average age at onset of about 60 years. An estimated 5 million people throughout the world have PD, with 1 million individuals each in the United States and in Europe with the disorder. PD affects approximately 0.3% of the population and 1% to 2% of those older than 60 years.2 With the aging of the population and the substantial increase in the number of at-risk individuals older than 60 years, it is anticipated that the prevalence of PD will increase dramatically in the coming decades.

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Assessment of sleepiness and unintended sleep in Parkinson's disease patients taking dopamine agonists

Cited by 88 publications

References 30 publications

Subjectively reported sleep quality and excessive daytime somnolence in Parkinson's disease with and without dementia, dementia with Lewy bodies and Alzheimer's disease

Subjectively reported sleep quality and excessive daytime somnolence in Parkinson's disease with and without dementia, dementia with Lewy bodies and Alzheimer's disease

Excessive Daytime Sleepiness in Parkinson’s Disease: Characteristics and Determinants

The scientific and clinical basis for the treatment of Parkinson disease (2009)

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