title: Association between dopaminergic medications and nocturnal sleep in early-stage Parkinson's disease.
abstract: BACKGROUND
  Poor nocturnal sleep is common in Parkinson's disease (PD) and negatively impacts quality of life. There is little data on how dopaminergic drugs influence nocturnal sleep in PD, particularly in relation to medication timing. We examined the association between dopaminergic medications and subjective and objective nocturnal sleep in PD.
  
  
  METHODS
  Individuals with PD were recruited from the outpatient clinic. Demographics and disease information were collected. Patients underwent one-night polysomnography and responded to SCOPA-SLEEP, a self-administered questionnaire which includes a section on nighttime sleep and an overall measure of sleep quality; higher scores indicate worse sleep. Medication intake, including medication timing in relation to bedtime, was obtained and converted to levodopa equivalents.
  
  
  RESULTS
  41 Males and 21 females, median age 63.9 years, participated. Median disease duration was 5 years. After adjusting for age, sex, disease severity, and disease duration, greater total levodopa equivalent intake within 4 h of sleep was associated with higher total SCOPA-nighttime score (p = 0.009) and greater wake time after sleep onset (p = 0.049). Greater dopaminergic medication intake prior to sleep was also associated with less rapid eye movement (REM) sleep as a percent of total sleep time (p = 0.004).
  
  
  CONCLUSIONS
  Higher amounts of dopaminergic medications taken prior to sleep were associated with poor sleep quality and less REM sleep. Although poor nocturnal sleep in PD is likely multi-factorial in etiology, our findings suggest that timing and dose of medications prior to sleep need to be considered in its management.
authors.affiliation: Department of Neurology, Perelman School of Medicine at The University of Pennsylvania, Philadelphia, PA 19107, USA. lamachahine@hotmail.com
authors.forename: Lama M
authors.initials: LM
authors.lastname: Chahine
authors.forename: Joseph
authors.initials: J
authors.lastname: Daley
authors.forename: Stacy
authors.initials: S
authors.lastname: Horn
authors.forename: John E
authors.initials: JE
authors.lastname: Duda
authors.forename: Amy
authors.initials: A
authors.lastname: Colcher
authors.forename: Howard
authors.initials: H
authors.lastname: Hurtig
authors.forename: Charles
authors.initials: C
authors.lastname: Cantor
authors.forename: Nabila
authors.initials: N
authors.lastname: Dahodwala
mesh_terms: D017668:Age of Onset; D000368:Aged; D000978:Antiparkinson Agents / Q000009:adverse effects* / Q000627:therapeutic use; D003430:Cross-Sectional Studies; D015259:Dopamine Agents / Q000009:adverse effects* / Q000627:therapeutic use; D005260:Female; D006801:Humans; D006993:Hypnotics and Sedatives / Q000627:therapeutic use; D007980:Levodopa / Q000008:administration & dosage / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010300:Parkinson Disease / Q000150:complications* / Q000188:drug therapy; D017286:Polysomnography; D012890:Sleep / Q000187:drug effects*; D012894:Sleep Stages / Q000187:drug effects; D012893:Sleep Wake Disorders / Q000139:chemically induced* / Q000188:drug therapy; D012895:Sleep, REM / Q000187:drug effects
chemical_list: D000978:Antiparkinson Agents; D015259:Dopamine Agents; D006993:Hypnotics and Sedatives; D007980:Levodopa
keywords: Dopamine; Parkinson disease; Parkinson's disease; Sleep; Sleep initiation and maintenance disorders