Clinical long-term nocturnal sleeping disturbances and excessive daytime sleepiness in Parkinson's disease

PLoS One. 2021 Dec 1;16(12):e0259935. doi: 10.1371/journal.pone.0259935. eCollection 2021.


Objective: To prospectively evaluate nocturnal sleep problems and excessive daytime sleepiness (EDS) in Parkinson's disease (PD) patients, and analyze the influence of motor symptoms, treatment, and sex differences on sleep problems in PD.

Methods: Sleep disturbances of 103 PD patients were assessed with Parkinson's Disease Sleep Scale (PDSS) and the Epworth Sleepiness Scale (ESS). Student's t-test for related samples, one-way ANOVA with Tukey's HSD post hoc test were used to assess group differences. Bivariate correlations and mixed-effects linear regression models were used to analyze the association between clinical aspects and sleep disturbances over time.

Results: At baseline, 48.5% of PD patients presented nocturnal problems and 40% of patients presented EDS. The PDSS and ESS total score slightly improve over time. Nocturnal problems were associated with age and motor impartment, explaining the 51% of the variance of the PDSS model. Males presented less nocturnal disturbances and more EDS than females. Higher motor impairment and combined treatment (L-dopa and agonist) were related to more EDS, while disease duration and L-dopa in monotherapy were related to lower scores, explaining the 59% of the model.

Conclusions: Sleep disturbances changed over time and age, diseases duration, motor impairment, treatment and sex were associated with nocturnal sleep problems and EDS. Agonist treatment alone or in combination with L-dopa might predict worse daytime sleepiness, while L-dopa in monotherapy is related to lower EDS, which significantly affects the quality of life of PD patients.

MeSH terms

  • Age Factors
  • Antiparkinson Agents / administration & dosage
  • Antiparkinson Agents / therapeutic use
  • Female
  • Humans
  • Levodopa / administration & dosage
  • Levodopa / therapeutic use
  • Male
  • Middle Aged
  • Parkinson Disease / complications*
  • Parkinson Disease / drug therapy
  • Photoperiod
  • Sex Factors
  • Sleep Wake Disorders / epidemiology*
  • Sleep Wake Disorders / etiology


  • Antiparkinson Agents
  • Levodopa

Grants and funding

The authors received no specific funding for this work.