title: Obstructive sleep apnea in Parkinson's disease patients: effect of Sinemet CR taken at bedtime.
abstract: OBJECTIVE
  Obstructive sleep apnea (OSA) results from upper airway (UA) obstruction. In Parkinson's disease (PD), levodopa improves UA obstruction during wakefulness. We hypothesized that bedtime controlled-release levodopa (Sinemet CR) is associated with less severe OSA (lower apnea-hypopnea index [AHI]) in PD patients.
  
  
  METHODS
  Idiopathic PD subjects underwent nocturnal polysomnography (PSG) and were divided into those taking bedtime Sinemet CR (SinCR+) and those not taking Sinemet CR (SinCR-). Outcomes were compared between groups for PSG recordings analyzed in whole and split at their mid-point with each half analyzed separately, using linear regression.
  
  
  RESULTS
  Fifty-seven subjects were studied, eight SinCR+, and 49 SinCR-. They were 65 % male, aged 64.4 ± 10.3 years (mean ± SD), with body mass index 27.26 ± 3.98 kg/m(2). The whole night AHI was 15.6 ± 13.3 and 29.1 ± 20.8 in SinCR+ and SinCR-, respectively (p = 0.07 unadjusted, p = 0.11 adjusted for confounders). A similar trend was observed in the first half of the night. In the second half, the SinCR+ group had significantly lower AHI (beta = -18.8; p = 0.01 adjusted) and respiratory arousal index (beta = -14.2; p = 0.02 adjusted) than the SinCR- group.
  
  
  CONCLUSIONS
  Bedtime Sinemet CR appears to reduce OSA in PD patients. There were no significant differences between groups in the first half of the night likely because of residual effects of short-acting levodopa in both groups, while Sinemet CR had residual effect in the second half. These results possibly provide an alternative to help manage OSA and improve sleep quality in PD patients.
authors.affiliation: Respiratory Division & Sleep Laboratory, McGill University Health Centre, 1001 Decarie Blvd, Montreal, Quebec, H4A 3J1, Canada. priti.gros@mail.mcgill.ca.
authors.forename: Priti
authors.initials: P
authors.lastname: Gros
authors.affiliation: Neurology Department, Clinica Alemana de Santiago, Santiago, Chile.
authors.forename: Victoria P
authors.initials: VP
authors.lastname: Mery
authors.affiliation: Montreal Neurological Hospital, McGill University Health Centre, Montreal, QC, Canada.
authors.forename: Anne-Louise
authors.initials: AL
authors.lastname: Lafontaine
authors.affiliation: Respiratory Division & Sleep Laboratory, McGill University Health Centre, 1001 Decarie Blvd, Montreal, Quebec, H4A 3J1, Canada.
authors.forename: Ann
authors.initials: A
authors.lastname: Robinson
authors.affiliation: Department of Medicine and Department of Epidemiology, Biostatistics & Occupational Health, McGill University Health Centre, Montreal, QC, Canada.|Respiratory & Epidemiology and Clinical Research Unit, McGill University Health Centre, Montreal, QC, Canada.
authors.forename: Andrea
authors.initials: A
authors.lastname: Benedetti
authors.affiliation: Respiratory Division & Sleep Laboratory, McGill University Health Centre, 1001 Decarie Blvd, Montreal, Quebec, H4A 3J1, Canada.
authors.forename: R John
authors.initials: RJ
authors.lastname: Kimoff
authors.affiliation: Respiratory Division & Sleep Laboratory, McGill University Health Centre, 1001 Decarie Blvd, Montreal, Quebec, H4A 3J1, Canada.|Respiratory & Epidemiology and Clinical Research Unit, McGill University Health Centre, Montreal, QC, Canada.
authors.forename: Marta
authors.initials: M
authors.lastname: Kaminska
mesh_terms: D000368:Aged; D001143:Arousal / Q000187:drug effects; D002230:Carbidopa / Q000008:administration & dosage*; D004334:Drug Administration Schedule; D004338:Drug Combinations; D005260:Female; D006801:Humans; D007980:Levodopa / Q000008:administration & dosage*; D008297:Male; D008875:Middle Aged; D010300:Parkinson Disease / Q000188:drug therapy*; D017286:Polysomnography / Q000187:drug effects*; D020181:Sleep Apnea, Obstructive / Q000188:drug therapy*; D014851:Wakefulness / Q000187:drug effects
chemical_list: D004338:Drug Combinations; C009265:carbidopa, levodopa drug combination; D007980:Levodopa; D002230:Carbidopa
keywords: Long-acting levodopa; Obstructive sleep apnea; Parkinson’s disease; Sinemet CR; Sleep disorders