Daytime Sleepiness in Parkinson's Disease: Perception, Influence of Drugs, and Mood Disorder

Abstract

Parkinson's disease (PD) is associated with sleep complaints as excessive daytime sleepiness (EDS) and several factors have been implicated in the genesis of these complaints. Objective. To correlate the subjective perception of EDS with variables as the severity of the motor symptoms, medications, and the presence of depressive symptoms. Materials and Methods. A cross-sectional study, using specific scales as Epworth sleepiness scale (ESS), Beck depression inventory (iBeck) and Hoehn and Yahr (HY), in 42 patients with PD. Results. The patients had a mean age of 61.2 ± 11.3 years and mean disease duration of 4.96 ± 3.3 years. The mean ESS was 7.5 ± 4.7 and 28.6% of patients reached a score of abnormally high value (>10). There was no association with gender, disease duration, and dopamine agonists. Patients with EDS used larger amounts of levodopa (366.7 ± 228.0 versus 460.4 ± 332.25 mg, P = 0.038), but those who had an iBeck >20 reached lower values of ESS than the others (5.9 ± 4.1 versus 9.3 ± 4.8, P = 0.03). Conclusions. EDS was common in PD patients, being related to levodopa intake. Presence of depressed mood may influence the final results of self-assessment scales for sleep disorders.

Monitoring of 30 marker candidates in early Parkinson disease as progression markers

“…26 Daytime sleepiness progressively worsens in PD, confirming that it may be dependent on dopaminergic therapy 27 or an intrinsic factor of disease progression. RBD may be a useful marker to monitor progression of PD either with PSG or with a similar effect size by a 10-item self-rating questionnaire (RBD-SQ).…”

“…The effects of dopaminergic treatment on NMS vary depending up on the underlying mechanisms; i.e., a symptom influenced by dopaminergic deficit may respond positively to dopaminergic treatment (such as depression and NMS), 24 whereas a non-dopamine-responsive symptom may worsen with such treatment (such as daytime sleepiness, especially in the early titration phase; further discussion can be found in appendix e-1). 27 Therefore, we cannot remove any influence conferred by therapy on our investigational markers, but purposefully included 8 markers that are likely independent of any introduced symptomatic therapy, 34 such as MRI volumetry and blood and CSF markers.…”

Heterogeneity of excessive daytime sleepiness in Parkinson’s disease

“…Интерес представляют данные о существовании обратной корреляции тяжести депрессии и ДС [112]. Так, пациенты с более высоким уровнем депрессии имели меньшие значения по шкале ESS.…”

“…Пациенты с БП могут не знать или забывать об эпизодах засыпания [114]. У больных с сопут-ствующей депрессией это может быть выражено в большей степени, поэтому результаты их тестирова-ния могут быть значительно искажены, и необходи-ма более внимательная оценка состояния больного для выявления ДС [112].…”

Sleep Dysfunction and its Management in Parkinson’s Disease

“…Polysomnographic studies suggest increasing doses of dopamine prior to bedtime result in worsening sleep efficiency, increasing sleep fragmentation, and decreased REM sleep, along with poorer subjective sleep quality [24]. Not surprisingly then, levodopa use has been strongly correlated to symptoms of excessive daytime sleepiness [25, Class III].…”