The association of dopamine agonists with daytime sleepiness, sleep problems and quality of life in patients with Parkinson's disease--a prospective study.
OBJECTIVE
Reports that dopamine agonists (DA) precipitate sudden daytime sleep episodes in Parkinson's disease (PD) patients have received widespread attention. It remains unclear if non-ergoline and ergoline DAs have differential sedating effects or if sedation rather represents a class effect of DAs. The aim of this study was the evaluation of sleep disturbances and the quality of life (QoL) in PD patients with different dopaminergic treatment strategies.


METHODS
This analysis is part of the FAQT-study, a prospective German cohort study evaluating determinants of QoL in PD patients. A subgroup of 111 PD patients was evaluated twice, at baseline and after one year of follow-up, using standardised and validated questionnaires (Unified Parkinson's disease rating scale (UPDRS), Hoehn and Yahr classification, Center for Epidemiologic Studies Depression Scale (CESD), Short Form-36 (SF-36), Parkinson Disease Questionnaire (PDQ-39)). The impact of treatment strategies on sleep problems, daytime sleepiness, bad dreams and hallucinations, depression and QoL in PD patients was analysed separately for ergoline DAs, non-ergoline DAs and the patient group taking no DA.


RESULTS
At baseline, sleep problems were reported by about one third of the patients with and without DA medication. Excessive daytime sleepiness (EDS) was higher in the two DA groups (ergoline 11.9%, non-ergoline 9.1%) than among patients not taking DAs (4.5 %). At follow-up, sleep problems in general had decreased among patients taking DAs continuously and among those newly taking DAs, while the sleep problems increased in patients discontinuing DAs. However, EDS had increased to 25% in patients newly taking DAs, and decreased to 15.9% in those taking them continuously. QoL scores at follow-up were slightly increased in the patient groups newly taking and discontinuing DAs (the latter except in physical functioning) while those on continuing DA-medication remained unchanged.


CONCLUSIONS
No differential effects of ergoline or non-ergoline DAs on sleep problems were found. Different dopaminergic treatment strategies did not influence QoL. Our results support the evidence that sedation may be rather a class effect of DAs.
Happe
S
S
Department of Neurology, University of Muenster, Germany. happes@uni-muenster.de
Berger
K
K
D000368:Aged; D000978:Antiparkinson Agents / Q000009:adverse effects*; D003430:Cross-Sectional Studies; D003866:Depressive Disorder / Q000150:complications; D018491:Dopamine Agonists / Q000009:adverse effects*; D004325:Dreams / Q000523:psychology; D005260:Female; D006212:Hallucinations / Q000139:chemically induced / Q000523:psychology; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D010300:Parkinson Disease / Q000150:complications* / Q000523:psychology*; D011446:Prospective Studies; D011788:Quality of Life / Q000523:psychology*; D012893:Sleep Wake Disorders / Q000139:chemically induced* / Q000523:psychology*; D011795:Surveys and Questionnaires
D000978:Antiparkinson Agents; D018491:Dopamine Agonists