Excessive daytime sleepiness in Parkinson's disease: characteristics and determinants

Eur Neurol. 2010;63(3):129-35. doi: 10.1159/000276402. Epub 2010 Jan 16.

Abstract

Background/aims: Excessive daytime sleepiness (EDS) is frequent in patients with Parkinson's disease (PD). Occasionally, EDS in PD exhibits narcolepsy-like features. We aimed to assess characteristics and determinants of EDS in consecutive patients with PD.

Methods: Thirty consecutive patients with PD underwent a detailed clinical examination. EDS was assessed using the Epworth Sleepiness Scale (ESS) and Multiple Sleep Latency Test (MSLT). Sleep was assessed using video-polysomnography. Cerebrospinal fluid (CSF) hypocretin-1 levels were obtained in 3 patients.

Results: ESS was >10 in 17 patients (57%). Mean sleep latency (MSL) on MSLT was <5 min in 11 patients (37%). There was a significant negative correlation between ESS and MSL. None of the 11 patients with MSL <5 min showed a sleep onset REM (SOREM) episode. Patients with EDS had higher dopamine agonists/levodopa equivalent doses, higher apnea/hypopnea index and exhibited wearing-off symptoms more often. Hypocretin-1 was normal in 3 patients tested.

Conclusion: EDS, which can sometimes be severe, is common in PD patients even in the absence of SOREM and detectable CSF-hypocretin deficiency. In PD, EDS is a multifaceted phenomenon, the determinants of which include severity of PD, wearing-off symptoms, dosage of antiparkinsonian drugs and sleep-disordered breathing.

MeSH terms

  • Aged
  • Aged, 80 and over
  • Antiparkinson Agents / therapeutic use
  • Disorders of Excessive Somnolence / complications*
  • Disorders of Excessive Somnolence / physiopathology*
  • Humans
  • Intracellular Signaling Peptides and Proteins / cerebrospinal fluid
  • Middle Aged
  • Neuropeptides / cerebrospinal fluid
  • Orexins
  • Parkinson Disease / complications*
  • Parkinson Disease / drug therapy
  • Parkinson Disease / physiopathology
  • Polysomnography
  • Time

Substances

  • Antiparkinson Agents
  • HCRT protein, human
  • Intracellular Signaling Peptides and Proteins
  • Neuropeptides
  • Orexins