title: Sleep attacks, daytime sleepiness, and dopamine agonists in Parkinson's disease.
abstract: To study the putative association of dopamine agonists with sleep attacks in patients with Parkinson's disease (PD) and their relation to daytime sleepiness, we performed a survey of 2,952 PD patients in two German counties. In 177 patients, sudden, unexpected, and irresistible sleep episodes while engaged in some activity were identified in a structured telephone interview. Ninety-one of these patients denied the occurrence of appropriate warning signs. A total of 133 patients (75%) had an Epworth Sleepiness Scale (ESS) score >10; 65 (37%) >15. Thirty-one patients (18%) had an ESS score < or =10 and yet experienced sleep attacks without warning signs. Thus, although a significant proportion of patients at risk for sleep attacks might be identified using the ESS, roughly 1% of the PD patient population seems to be at risk for sleep attacks without appropriate warning signs and without accompanying daytime sleepiness. Sleep attacks occurred with all dopamine agonists marketed in Germany (alpha-dihydroergocryptine, bromocriptine, cabergoline, lisuride, pergolide, pramipexole, ropinirole), and no significant difference between ergot and nonergot drugs was evident. Levodopa (L-dopa) monotherapy carried the lowest risk for sleep attacks (2.9%; 95% confidence interval [CI], 1.7-4.0%) followed by dopamine agonist monotherapy (5.3%; 95% CI, 1.5-9.2%) and combination of L-dopa and a dopamine agonist (7.3%; 95% CI, 6.1-8.5%). Neither selegeline nor amantadine or entacapone appeared to influence the occurrence of sleep attacks. A high ESS score, intake of dopamine agonists, and duration of PD were the main influencing factors for the occurrence of sleep attacks. The odds ratio for dopamine agonist therapy was 2.9 compared to 1.9 with L-dopa therapy and 1.05 for a 1-year-longer disease duration.
authors.affiliation: Department of Neurology, University of Bonn, Bonn, Germany. spaus@uni-bonn.de
authors.forename: Sebastian
authors.initials: S
authors.lastname: Paus
authors.forename: Hans Michael
authors.initials: HM
authors.lastname: Brecht
authors.forename: Jürgen
authors.initials: J
authors.lastname: Köster
authors.forename: Gert
authors.initials: G
authors.lastname: Seeger
authors.forename: Thomas
authors.initials: T
authors.lastname: Klockgether
authors.forename: Ullrich
authors.initials: U
authors.lastname: Wüllner
mesh_terms: D000203:Activities of Daily Living; D000368:Aged; D000704:Analysis of Variance; D000978:Antiparkinson Agents / Q000009:adverse effects* / Q000627:therapeutic use; D006970:Disorders of Excessive Somnolence / Q000139:chemically induced* / Q000503:physiopathology; D018491:Dopamine Agonists / Q000009:adverse effects* / Q000627:therapeutic use; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010300:Parkinson Disease / Q000188:drug therapy*; D012307:Risk Factors; D012890:Sleep / Q000187:drug effects; D011795:Surveys and Questionnaires
chemical_list: D000978:Antiparkinson Agents; D018491:Dopamine Agonists