title: Excessive daytime sleepiness in Parkinson disease: is it the drugs or the disease?
abstract: OBJECTIVE
  To examine associated demographic and clinical correlates and the development of excessive daytime sleepiness (EDS) over 8 years in a community-based cohort of patients with Parkinson disease (PD).
  
  
  METHODS
  A total of 232 patients with PD were included in a population-based prevalence study in 1993. Patients were followed prospectively and reexamined after 4 and 8 years. At all study visits, the authors administered semistructured interviews to obtain information on clinical and demographic variables. Standardized rating scales of parkinsonism, depression, and cognitive impairment were used. The diagnosis of EDS was based on a sleep questionnaire and in 2001 also on the Epworth Sleepiness Scale. Population-averaged logistic regression models for correlated data were performed to study the relationship between EDS and various demographic and clinical variables.
  
  
  RESULTS
  Of the 232 patients included at baseline, 138 were available for re-evaluation after 4 years and 89 patients after 8 years. Frequency rates of EDS increased from 5.6% in 1993 to 22.5% in 1997 and 40.8% in 2001, with an 8-year prevalence of 54.2%. In the majority of patients, EDS was a persistent feature. In the logistic regression model, EDS was related to age, gender, and use of dopamine agonists. In those never having used dopamine agonists, hypersomnia was associated with the Hoehn and Yahr stage only.
  
  
  CONCLUSIONS
  Excessive daytime sleepiness is a frequent and highly persistent feature in Parkinson disease, with multifactorial underlying pathophysiology. The authors' findings indicate that both age and disease related disturbances of the sleep-wake regulation contribute to hypersomnia in PD. Treatment with dopamine agonists also contributed to excessive daytime sleepiness in our patients.
authors.affiliation: Norwegian Centre for Movement Disorders, Department of Neurology, Stavanger University Hospital, Stavanger, Norway.
authors.forename: M D
authors.initials: MD
authors.lastname: Gjerstad
authors.forename: G
authors.initials: G
authors.lastname: Alves
authors.forename: T
authors.initials: T
authors.lastname: Wentzel-Larsen
authors.forename: D
authors.initials: D
authors.lastname: Aarsland
authors.forename: J P
authors.initials: JP
authors.lastname: Larsen
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000978:Antiparkinson Agents / Q000009:adverse effects*; D003695:Delivery of Health Care; D003710:Demography; D006970:Disorders of Excessive Somnolence / Q000139:chemically induced* / Q000209:etiology*; D018491:Dopamine Agonists / Q000009:adverse effects*; D005260:Female; D006801:Humans; D016015:Logistic Models; D008137:Longitudinal Studies; D008297:Male; D015999:Multivariate Analysis; D010300:Parkinson Disease / Q000150:complications* / Q000188:drug therapy; D011446:Prospective Studies; D012720:Severity of Illness Index
chemical_list: D000978:Antiparkinson Agents; D018491:Dopamine Agonists