Continuous positive airway pressure improves sleep and daytime sleepiness in patients with Parkinson disease and sleep apnea.
OBJECTIVE
Obstructive sleep apnea (OSA), common in Parkinson disease (PD), contributes to sleep disturbances and daytime sleepiness. We assessed the effect of continuous positive airway pressure (CPAP) on OSA, sleep, and daytime sleepiness in patients with PD.


METHODS
This was a randomized placebo-controlled, crossover design. Patients with PD and OSA were randomized into 6 w of therapeutic treatment or 3 w of placebo followed by 3 w of therapeutic treatment. Patients were evaluated by polysomnography (PSG) and multiple sleep latency test (MSLT) pretreatment (baseline), after 3 w, and after 6 w of CPAP treatment. Analyses included mixed models, paired analysis, and within-group analyses comparing 3 w to 6 w of treatment.


METHODS
Sleep laboratory.


METHODS
Thirty-eight patients with PD (mean age = 67.2 ± 9.2 y; 12 females).


METHODS
Continuous positive airway pressure.


METHODS
PSG OUTCOME MEASURES: sleep efficiency, %sleep stages (N1, N2, N3, R), arousal index, apnea-hypopnea index (AHI), and % time oxygen saturation < 90% (%time SaO2 < 90%). MSLT outcome measures: mean sleep-onset latency (MSL).


RESULTS
There were significant group-by-time interactions for AHI (P < 0.001), % time SaO2 < 90% (P = 0.02), %N2 (P = 0.015) and %N3 (P = 0.014). Subjects receiving therapeutic CPAP showed significant decrease in AHI, %time SaO2 < 90%, %N2, and significant increase in %N3 indicating effectiveness of CPAP in the treatment of OSA, improvement in nighttime oxygenation, and in deepening sleep. The paired sample analyses revealed that 3 w of therapeutic treatment resulted in significant decreases in arousal index (t = 3.4, P = 0.002). All improvements after 3 w were maintained at 6 w. Finally, 3 w of therapeutic CPAP also resulted in overall decreases in daytime sleepiness (P = 0.011).


CONCLUSIONS
Therapeutic continuous positive airway pressure versus placebo was effective in reducing apnea events, improving oxygen saturation, and deepening sleep in patients with Parkinson disease and obstructive sleep apnea. Additionally, arousal index was reduced and effects were maintained at 6 weeks. Finally, 3 weeks of continuous positive airway pressure treatment resulted in reduced daytime sleepiness measured by multiple sleep latency test. These results emphasize the importance of identifying and treating obstructive sleep apnea in patients with Parkinson disease.
San Diego State University and University of California, San Diego Joint Doctoral Program in Clinical Psychology, San Diego, CA.
Ariel B
AB
Neikrug
Department of Psychiatry, University of California San Diego, San Diego, CA.
Lianqi
L
Liu
Department of Psychiatry, University of California San Diego, San Diego, CA.
Julie A
JA
Avanzino
Department of Psychiatry, University of California San Diego, San Diego, CA.
Jeanne E
JE
Maglione
Department of Family and Preventive Medicine, University of California San Diego, San Diego, CA.
Loki
L
Natarajan
Department of Psychiatry, University of California San Diego, San Diego, CA.
Lenette
L
Bradley
Department of Psychiatry, University of California San Diego, San Diego, CA.
Alex
A
Maugeri
Department of Neurosciences, University of California San Diego, San Diego, CA.
Jody
J
Corey-Bloom
San Diego State University and University of California, San Diego Joint Doctoral Program in Clinical Psychology, San Diego, CA ; Department of Psychiatry, University of California San Diego, San Diego, CA ; Veterans Medical Research Foundation, San Diego, CA.
Barton W
BW
Palmer
Department of Medicine, University of California San Diego, San Diego, CA.
Jose S
JS
Loredo
San Diego State University and University of California, San Diego Joint Doctoral Program in Clinical Psychology, San Diego, CA ; Department of Psychiatry, University of California San Diego, San Diego, CA ; Department of Medicine, University of California San Diego, San Diego, CA ; Veterans Affairs Center of Excellence for Stress and Mental Health, San Diego, CA.
Sonia
S
Ancoli-Israel
D000368:Aged; D045422:Continuous Positive Airway Pressure; D018592:Cross-Over Studies; D005260:Female; D006801:Humans; D008297:Male; D010300:Parkinson Disease / Q000150:complications* / Q000503:physiopathology*; D010919:Placebos; D017286:Polysomnography; D012890:Sleep / Q000502:physiology*; D020181:Sleep Apnea, Obstructive / Q000150:complications / Q000503:physiopathology* / Q000628:therapy*; D012894:Sleep Stages / Q000502:physiology; D016896:Treatment Outcome
D010919:Placebos
Continuous positive airway pressure; Parkinson disease; daytime sleepiness; obstructive sleep apnea; sleep disorders; sleep quality