Excessive daytime sleepiness and unintended sleep in Parkinson’s disease

Abstract

Patients with Parkinson's disease and parkinsonian syndromes (eg, dementia with Lewy body disease, multisystem atrophy, and Shy-Drager syndrome) suffer from daytime sleepiness. This sleepiness is common and very real, often approaching levels observed in the prototypical disorder of sudden-onset sleep, namely narcolepsy/cataplexy. Physicians need to be vigilant in assessing parkinsonian patients for sleepiness because treatment can dramatically enhance quality of life and prevent the significant morbidity and mortality that attends daytime sleepiness. Male patients with advanced disease, cognitive impairment, drug-induced psychosis, and orthostatic hypotension are most at risk for developing pathologic sleepiness. Because primary sleep disorders can coexist with parkinsonism (eg, sleep apnea, insufficient or interrupted sleep), these potential causes should be carefully assessed with polysomnography and treated appropriately. Dopaminomimetics exacerbate sleepiness in a small subset of patients in a dose-dependent fashion. Nonetheless, the primary pathologies involved in parkinsonism appear to be the greatest contributors to daytime sleepiness. Sleepiness in parkinsonism, especially a narcolepsy-like phenotype, may necessitate treatment with wake-promoting agents such as bupropion, modafinil, or traditional psychostimulants.

Association of daytime sleepiness with nigrostriatal dopaminergic degeneration in early Parkinson's disease

“…Previous studies have shown an impact of levodopa and dopamine agonists on EDS in PD [3,6,7]. Dopaminergics may exacerbate sleepiness in a subset of patients in a dose-dependent fashion [28]. There might be an individual susceptibility to specific antiparkinsonian drugs, which may play a role in the etiology of sleepiness in PD patients [29].…”

Excessive Daytime Somnolence Associated with Parkinson’s Disease

“…Bupropion, an antidepressant that increases synaptic dopamine by blocking the dopamine transporter, may be useful not only in improving depression in patients with PD but also in improving daytime alertness [ 42 ]. Quetiapine, an antipsychotic drug that has fewer extrapyramidal effects than older antipsychotics, is effective for treating psychosis and hallucinations allowing more restful nocturnal sleep [ 43 ].…”

Pharmacologic Safety Concerns in Parkinson's Disease: Facts and Insights

“…Since this report, sleepiness in PD has been critically reappraised and EDS is common [10,11] [12]. Sudden daytime sleep episodes that occur without warning ("sleep attacks") are also associated with DAs [9][10][11][12][13] [14][15][16][17] [29][30][31][32][33].…”