Excessive daytime sleepiness in Parkinson's disease: characteristics and determinants.
OBJECTIVE
Excessive daytime sleepiness (EDS) is frequent in patients with Parkinson's disease (PD). Occasionally, EDS in PD exhibits narcolepsy-like features. We aimed to assess characteristics and determinants of EDS in consecutive patients with PD.


METHODS
Thirty consecutive patients with PD underwent a detailed clinical examination. EDS was assessed using the Epworth Sleepiness Scale (ESS) and Multiple Sleep Latency Test (MSLT). Sleep was assessed using video-polysomnography. Cerebrospinal fluid (CSF) hypocretin-1 levels were obtained in 3 patients.


RESULTS
ESS was >10 in 17 patients (57%). Mean sleep latency (MSL) on MSLT was <5 min in 11 patients (37%). There was a significant negative correlation between ESS and MSL. None of the 11 patients with MSL <5 min showed a sleep onset REM (SOREM) episode. Patients with EDS had higher dopamine agonists/levodopa equivalent doses, higher apnea/hypopnea index and exhibited wearing-off symptoms more often. Hypocretin-1 was normal in 3 patients tested.


CONCLUSIONS
EDS, which can sometimes be severe, is common in PD patients even in the absence of SOREM and detectable CSF-hypocretin deficiency. In PD, EDS is a multifaceted phenomenon, the determinants of which include severity of PD, wearing-off symptoms, dosage of antiparkinsonian drugs and sleep-disordered breathing.
Poryazova
R
R
Department of Neurology, University Hospital Zurich, Zurich, Switzerland.
Benninger
D
D
Waldvogel
D
D
Bassetti
C L
CL
D000368:Aged; D000369:Aged, 80 and over; D000978:Antiparkinson Agents / Q000627:therapeutic use; D006970:Disorders of Excessive Somnolence / Q000150:complications* / Q000503:physiopathology*; D006801:Humans; D047908:Intracellular Signaling Peptides and Proteins / Q000134:cerebrospinal fluid; D008875:Middle Aged; D009479:Neuropeptides / Q000134:cerebrospinal fluid; D000068797:Orexins; D010300:Parkinson Disease / Q000150:complications* / Q000188:drug therapy / Q000503:physiopathology; D017286:Polysomnography; D013995:Time
D000978:Antiparkinson Agents; C000596229:HCRT protein, human; D047908:Intracellular Signaling Peptides and Proteins; D009479:Neuropeptides; D000068797:Orexins