title: Daytime sleepiness in Japanese patients with multiple system atrophy: prevalence and determinants.
abstract: BACKGROUND
  The recent SLEEMSA study that evaluated excessive daytime sleepiness (EDS) in Caucasian patients with multiple system atrophy (MSA) demonstrated that EDS was more frequent in patients (28%) than in healthy subjects (2%). However, the prevalence and determinants of EDS in other ethnic populations have not been reported to date.
  
  
  METHODS
  We performed a single-hospital prospective study on patients with probable MSA. To ascertain the prevalence and determinants of EDS in Japanese MSA patients, we assessed the patients' degree of daytime sleepiness by using the Japanese version of the Epworth Sleepiness Scale (ESS). In addition, we investigated the effects of sleep-disordered breathing (SDB) and abnormal periodic leg movements in sleep (PLMS), which were measured by polysomnography, on the patients' ESS scores.
  
  
  RESULTS
  A total of 25 patients with probable MSA (21 patients with cerebellar MSA and 4 patients with parkinsonian MSA) were included in this study. All patients underwent standard polysomnography. The mean ESS score was 6.2 ± 0.9, and EDS was identified in 24% of the patients. SDB and abnormal PLMS were identified in 24 (96%) and 11 (44%) patients, respectively. The prevalences of EDS in patients with SDB and abnormal PLMS were 25% and 18%, respectively. No correlations were observed between ESS scores and the parameters of SDB or abnormal PLMS.
  
  
  CONCLUSIONS
  The frequency of EDS in Japanese patients with MSA was similar to that in Caucasian MSA patients. SDB and abnormal PLMS were frequently observed in MSA patients, although the severities of these factors were not correlated with EDS. Further investigations using objective sleep tests need to be performed.
authors.affiliation: Department of Neurology, Brain Research Institute, Niigata University, Niigata, Japan. t-shimo@bri.niigata-u.ac.jp
authors.forename: Takayoshi
authors.initials: T
authors.lastname: Shimohata
authors.forename: Hideaki
authors.initials: H
authors.lastname: Nakayama
authors.forename: Masahiko
authors.initials: M
authors.lastname: Tomita
authors.forename: Tetsutaro
authors.initials: T
authors.lastname: Ozawa
authors.forename: Masatoyo
authors.initials: M
authors.lastname: Nishizawa
mesh_terms: D017677:Age Distribution; D000368:Aged; D015897:Comorbidity; D006970:Disorders of Excessive Somnolence / Q000175:diagnosis* / Q000453:epidemiology*; D005260:Female; D006801:Humans; D015994:Incidence; D007564:Japan / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D019578:Multiple System Atrophy / Q000175:diagnosis* / Q000453:epidemiology*; D012148:Restless Legs Syndrome / Q000175:diagnosis* / Q000453:epidemiology*; D012307:Risk Factors; D017678:Sex Distribution