The nature of excessive sleepiness and sudden sleep onset in Parkinson׳s disease.
OBJECTIVE
Excessive daytime sleepiness (EDS) and sudden sleep onset (SOS) episodes are frequent in Parkinson׳s disease (PD). The objectives are to identify clinical characteristics and factors associated with EDS and SOS episodes.


METHODS
Clinical demographic data were recorded (N=100, mean age=65.0±10.4). EDS was identified by the Epworth Sleepiness Scale (ESS>10) and SOS episodes were registered. Disease severity was evaluated by the Unified Parkinson׳s Disease Rating Scale (UPDRS, I, II, and III), sleep disturbances by the Parkinson׳s Disease Sleep Scale (PDSS<100), depressive symptoms by the Beck Depression Inventory (BDI>10) and rapid eye movement (REM) sleep behavior disorder (RBD) by the REM sleep behavior scale. Levodopa equivalent dose was measured.


RESULTS
PD patients with EDS (67%) were predominately male (73.1%) and had worse disease severity (UPDRS II and III p= 0.005); SOS episodes (39%) were associated with disease duration, diabetes, sleep disturbances (PDSS Scale), disease severity (UPDRS I, II, III) and RBD symptoms (p<0.05). Stepwise regression analysis showed that EDS was independently associated with motor-symptoms severity (UPDRS III scale, p=0.003). SOS episodes were independently associated with disease duration (p=0.006) and sleep disturbances (PDSS scale, p=0.03): patients had more uncomfortable immobility at night, tremor on waking and snoring or difficult breathing.


CONCLUSIONS
EDS and or SOS episodes are frequent and manifest a differential pattern in PD. SOS episodes are associated with longer disease duration, diabetes, sleep disturbances and RBD symptoms indicating that these "sleep attacks" are of multifactorial origin and probably influenced by brain structural abnormalities.
Faculdade de Medicina, Universidade Federal do Ceara, Fortaleza, Brazil.
Daniel Gurgel Fernandes
DG
Távora
Faculdade de Medicina, Universidade Federal do Ceara, Fortaleza, Brazil.
Veralice Meireles Sales
VM
de Bruin
Faculdade de Medicina, Universidade Federal do Ceara, Fortaleza, Brazil.
Romulo
R
Lopes Gama
Faculdade de Medicina, Universidade Federal do Ceara, Fortaleza, Brazil.
Emily Mourão Soares
EM
Lopes
Faculdade de Medicina, Universidade Federal do Ceara, Fortaleza, Brazil.
Iago Farias
IF
Jorge
Faculdade de Medicina, Universidade Federal do Ceara, Fortaleza, Brazil.
Pedro Felipe Carvalhedo
PF
de Bruin
Diabetes; Parkinson’s disease; Sleep attacks; Sleepiness; Sudden sleep onset