title: Serial macro-architectural alterations with levodopa in Parkinson's disease: Polysomnography (PSG)-based analysis.
abstract: OBJECTIVE
  We studied the sleep macroarchitecture with polysomnography (PSG) in drug naïve patients with Parkinson's disease (PD) and reassessed them following treatment with levodopa.
  
  
  METHODS
  This prospective hospital-based study included 15 patients with PD (age: 59 ± 11.2 years, duration of PD: 11.8 ± 12.3 months; and male: female (M:F) = 11:4). They were assessed for demography, phenotype, modified Hoehn and Yahr staging (H & Y); Schwab and England and Activities of Daily Living (S and E ADL) Scale; and Unified PDRating Scale (UPDRS). Sleep was assessed using Epworth Sleepiness Scale (ESS), Pittsburgh Sleep Quality Index (PSQI), and National Institute of Mental Health and Neurosciences (NIMHANS) comprehensive sleep disorder questionnaire. They underwent overnight PSG at baseline and after13.3 ± 5.7 months of levodopa (440 mg/day).
  
  
  RESULTS
  Patients with PD had responded to levodopa as indicated by the significant improvement in UPDRS motor score in ON state compared to OFF state. Nocturnal sleep quality indices did not vary significantly, but the excessive daytime somnolence improved (P = 0.04) with levodopa. Sleep efficiency (P = 0.65), latency to sleep onset (P = 0.19), latency to stage 1 (P = 0.12), and duration of stage 1 (P = 0.55) had increased. Duration of 'awake in bed' (P = 0.24), slow wave sleep (P = 0.29), and rapid eye movement (REM) sleep (P = 0.24) decreased with treatment. Periodic leg movements (PLMs) had reduced (P = 0.68) and mean oxygen saturation during sleep improved (P = 0.002). Surprisingly, snore index (P < 0.03) during sleep had increased with levodopa.
  
  
  CONCLUSIONS
  Sleep alterations in PD occur even in early stages due to the disease process. There was improvement in most of the parameters of sleep macroarchitecture with levodopa.
authors.affiliation: Department of Neurology, National Institute of Mental health and Neurosciences, Bangalore, Karnataka, India.
authors.forename: Sanju P
authors.initials: SP
authors.lastname: Joy
authors.affiliation: Department of Neurology, National Institute of Mental health and Neurosciences, Bangalore, Karnataka, India.
authors.forename: Sanjib
authors.initials: S
authors.lastname: Sinha
authors.affiliation: Department of Neurology, National Institute of Mental health and Neurosciences, Bangalore, Karnataka, India.
authors.forename: Pramod Kumar
authors.initials: PK
authors.lastname: Pal
authors.affiliation: Department of Neurology, National Institute of Mental health and Neurosciences, Bangalore, Karnataka, India.
authors.forename: Samhita
authors.initials: S
authors.lastname: Panda
authors.affiliation: Department of Biostatistics, National Institute of Mental health and Neurosciences, Bangalore, Karnataka, India.
authors.forename: M
authors.initials: M
authors.lastname: Philip
authors.affiliation: Department of Neurology, National Institute of Mental health and Neurosciences, Bangalore, Karnataka, India.
authors.forename: Arun B
authors.initials: AB
authors.lastname: Taly
keywords: Levodopa; Parkinson's disease; polysomnography; sleep