title: Daytime sleepiness in Parkinson's disease: a reappraisal.
abstract: BACKGROUND
  Excessive daytime sleepiness is a frequent complaint in Parkinson's disease (PD); however the frequency and risk factors for objective sleepiness remain mostly unknown. We investigated both the frequency and determinants of self-reported and objective daytime sleepiness in patients with Parkinson's disease (PD) using a wide range of potential predictors.
  
  
  METHODS
  One hundred and thirty four consecutive patients with PD, without selection bias for sleep complaint, underwent a semi-structured clinical interview and a one night polysomnography followed by a multiple sleep latency test (MSLT). Demographic characteristics, medical history, PD course and severity, daytime sleepiness, depressive and insomnia symptoms, treatment intake, pain, restless legs syndrome, REM sleep behaviour disorder, and nighttime sleep measures were collected. Self-reported daytime sleepiness was defined by an Epworth Sleepiness Scale (ESS) score above 10. A mean sleep latency on MSLT below 8 minutes defined objective daytime sleepiness.
  
  
  RESULTS
  Of 134 patients with PD, 46.3% had subjective and only 13.4% had objective sleepiness with a weak negative correlation between ESS and MSLT latency. A high body mass index (BMI) was associated with both ESS and MSLT, a pain complaint with ESS, and a higher apnea/hypopnea index with MSLT. However, no associations were found between both objective and subjective sleepiness, and measures of motor disability, disease onset, medication (type and dose), depression, insomnia, restless legs syndrome, REM sleep behaviour disorder and nighttime sleep evaluation.
  
  
  CONCLUSIONS
  We found a high frequency of self-reported EDS in PD, a finding which is however not confirmed by the gold standard neurophysiological evaluation. Current treatment options for EDS in PD are very limited; it thus remains to be determined whether decreasing pain and BMI in association with the treatment of sleep apnea syndrome would decrease significantly daytime sleepiness in PD.
authors.affiliation: Unité des troubles du sommeil, Hôpital Gui de Chauliac, Montpellier, France; Service de Neurologie, Hôpital Gui de Chauliac, Montpellier, France.
authors.forename: Valérie
authors.initials: V
authors.lastname: Cochen De Cock
authors.affiliation: Unité des troubles du sommeil, Hôpital Gui de Chauliac, Montpellier, France.
authors.forename: Sophie
authors.initials: S
authors.lastname: Bayard
authors.affiliation: Inserm, U1061, Université Montpellier I, Montpellier, France.
authors.forename: Isabelle
authors.initials: I
authors.lastname: Jaussent
authors.affiliation: Service de Neurologie, Hôpital Gui de Chauliac, Montpellier, France.
authors.forename: Mahmoud
authors.initials: M
authors.lastname: Charif
authors.affiliation: Service de Neurologie, Hôpital Gui de Chauliac, Montpellier, France.
authors.forename: Magda
authors.initials: M
authors.lastname: Grini
authors.affiliation: Unité des troubles du sommeil, Hôpital Gui de Chauliac, Montpellier, France.
authors.forename: Muriel Croisier
authors.initials: MC
authors.lastname: Langenier
authors.affiliation: Department of Neurology, Shanghai Huashan Hospital, Shanghai Fudan University, Shanghai, China.
authors.forename: Huan
authors.initials: H
authors.lastname: Yu
authors.affiliation: Unité des troubles du sommeil, Hôpital Gui de Chauliac, Montpellier, France; Inserm, U1061, Université Montpellier I, Montpellier, France.
authors.forename: Regis
authors.initials: R
authors.lastname: Lopez
authors.affiliation: Service de Neurologie, Hôpital Gui de Chauliac, Montpellier, France.
authors.forename: Christian
authors.initials: C
authors.lastname: Geny
authors.affiliation: Unité des troubles du sommeil, Hôpital Gui de Chauliac, Montpellier, France; Service de Neurologie, Hôpital Gui de Chauliac, Montpellier, France.
authors.forename: Bertrand
authors.initials: B
authors.lastname: Carlander
authors.affiliation: Unité des troubles du sommeil, Hôpital Gui de Chauliac, Montpellier, France; Service de Neurologie, Hôpital Gui de Chauliac, Montpellier, France; Inserm, U1061, Université Montpellier I, Montpellier, France.
authors.forename: Yves
authors.initials: Y
authors.lastname: Dauvilliers
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D007866:Leg / Q000502:physiology; D008297:Male; D008875:Middle Aged; D009068:Movement; D010300:Parkinson Disease / Q000150:complications / Q000503:physiopathology*; D017286:Polysomnography; D012119:Respiration; D057566:Self Report; D012894:Sleep Stages; D012893:Sleep Wake Disorders / Q000150:complications; D012895:Sleep, REM