Excessive daytime sleepiness in parkinsonism

Sleep Med Rev. 2005 Jun;9(3):185-200. doi: 10.1016/j.smrv.2005.01.001. Epub 2005 Apr 26.


Excessive daytime sleepiness (EDS) can affect 20-50% of patients with Parkinson's disease (PD), whereas sleep attacks (SA), which are sleep episodes without prodroma, seem infrequent. EDS is associated with more advanced disease, higher doses of levodopa-equivalent, and sometimes the use of dopamine agonists. Patients at risk for SA have higher Epworth sleepiness scores (ESS) (although an important subset of patients under-score on this scale) and a more frequent use of ergot or non-ergot dopamine agonists. Polysomnography is a valuable tool in patients with PD, because sleep apnea may occur in 20% of patients, whereas a specific narcolepsy-like phenotype, identified on multiple-sleep latency tests, occurs in patients with most severe EDS; this suggests a lesion in sleep-wake systems. Removal or replacement of a recently introduced dopamine agonist may offer some relief for EDS. If not, the adjunction of modafinil has a good benefit-risk ratio in patients with PD. EDS (and sometimes the narcolepsy-like phenotype) may also affect patients with atypical parkinsonism, such as dementia with Lewy bodies, multiple-system atrophy, and progressive supranuclear palsy.

Publication types

  • Review

MeSH terms

  • Antiparkinson Agents / adverse effects
  • Antiparkinson Agents / therapeutic use
  • Disorders of Excessive Somnolence / chemically induced
  • Disorders of Excessive Somnolence / diagnosis*
  • Dopamine Agonists / adverse effects
  • Dopamine Agonists / therapeutic use
  • Humans
  • Narcolepsy / chemically induced
  • Narcolepsy / diagnosis
  • Parkinson Disease / diagnosis*
  • Parkinson Disease / drug therapy
  • Parkinsonian Disorders / diagnosis*
  • Parkinsonian Disorders / drug therapy
  • Polysomnography / drug effects
  • Risk Factors
  • Sleep Apnea Syndromes / chemically induced
  • Sleep Apnea Syndromes / diagnosis


  • Antiparkinson Agents
  • Dopamine Agonists