Excessive daytime sleepiness in parkinsonism.
Excessive daytime sleepiness (EDS) can affect 20-50% of patients with Parkinson's disease (PD), whereas sleep attacks (SA), which are sleep episodes without prodroma, seem infrequent. EDS is associated with more advanced disease, higher doses of levodopa-equivalent, and sometimes the use of dopamine agonists. Patients at risk for SA have higher Epworth sleepiness scores (ESS) (although an important subset of patients under-score on this scale) and a more frequent use of ergot or non-ergot dopamine agonists. Polysomnography is a valuable tool in patients with PD, because sleep apnea may occur in 20% of patients, whereas a specific narcolepsy-like phenotype, identified on multiple-sleep latency tests, occurs in patients with most severe EDS; this suggests a lesion in sleep-wake systems. Removal or replacement of a recently introduced dopamine agonist may offer some relief for EDS. If not, the adjunction of modafinil has a good benefit-risk ratio in patients with PD. EDS (and sometimes the narcolepsy-like phenotype) may also affect patients with atypical parkinsonism, such as dementia with Lewy bodies, multiple-system atrophy, and progressive supranuclear palsy.
Arnulf
Isabelle
I
Fédération des Pathologies du Sommeil, Hôpital Pitié-Salpêtrière, 47-83 Boulevard de l'Hôpital, 75651 Paris Cedex 13, France. isabelle.arnulf@psl.ap-hop-paris.fr
D000978:Antiparkinson Agents / Q000009:adverse effects / Q000627:therapeutic use; D006970:Disorders of Excessive Somnolence / Q000139:chemically induced / Q000175:diagnosis*; D018491:Dopamine Agonists / Q000009:adverse effects / Q000627:therapeutic use; D006801:Humans; D009290:Narcolepsy / Q000139:chemically induced / Q000175:diagnosis; D010300:Parkinson Disease / Q000175:diagnosis* / Q000188:drug therapy; D020734:Parkinsonian Disorders / Q000175:diagnosis* / Q000188:drug therapy; D017286:Polysomnography / Q000187:drug effects; D012307:Risk Factors; D012891:Sleep Apnea Syndromes / Q000139:chemically induced / Q000175:diagnosis
D000978:Antiparkinson Agents; D018491:Dopamine Agonists