Parkinson's disease (PD) is associated with sleep complaints as excessive daytime sleepiness (EDS) and several factors have been implicated in the genesis of these complaints. Objective. To correlate the subjective perception of EDS with variables as the severity of the motor symptoms, medications, and the presence of depressive symptoms. Materials and Methods. A cross-sectional study, using specific scales as Epworth sleepiness scale (ESS), Beck depression inventory (iBeck) and Hoehn and Yahr (HY), in 42 patients with PD. Results. The patients had a mean age of years and mean disease duration of years. The mean ESS was and 28.6% of patients reached a score of abnormally high value ( ). There was no association with gender, disease duration, and dopamine agonists. Patients with EDS used larger amounts of levodopa ( versus ?mg, ), but those who had an iBeck reached lower values of ESS than the others ( versus , ). Conclusions. EDS was common in PD patients, being related to levodopa intake. Presence of depressed mood may influence the final results of self-assessment scales for sleep disorders. 1. Introduction Parkinson’s disease (PD) is a leading progressive neurodegenerative disease, with prevalence estimated 1-2% of the population above 55 years. Sleep-related complaints are frequent in this population and, in some cases, may be the initial manifestation of the disease. Around 60 to 90% of PD patients affected by sleep disorders suffer negative impact on their quality of life [1]. A population study, which evaluated 245 patients with Parkinson’s disease, showed that more than two-thirds of them had complaints about sleep disturbances and complaints of the same type are found in 46% of diabetic patients and 33% of control patients [2]. Excessive daytime sleepiness (EDS) has an estimated prevalence from 15.5 to 74% of PD patients [1]. Clinical evidence support the hypothesis of EDS being a particular symptom of PD and its potential association with disease progression [2–4]. However, there are studies that contradict this association [5–7]. The EDS can also arise as a secondary symptom nighttime sleep deprivation or other sleep disorders such as sleep apnea (present in 20–30% of PD patients). Patients with REM sleep behavior disorders did not show greater EDS, even if REM sleep is interrupted by violent dreams [8]. Finally, the association between the dopamine replacement therapy and the EDS has been described [1]. Although there are reports that the dopamine agonists cause drowsiness as a class effect [9], in many studies, the main predictive factor is
References
[1]
A. Iranzo, “Parkinson's disease and sleepiness,” Sleep Medicine Clinics, vol. 1, no. 1, pp. 127–137, 2006.
[2]
E. Tandberg, J. P. Larsen, and K. Karlsen, “A community-based study of sleep disorders in patients with Parkinson's disease,” Movement Disorders, vol. 13, no. 6, pp. 895–899, 1998.
[3]
M. D. Gjerstad, D. Aarsland, and J. P. Larsen, “Development of daytime somnolence over time in Parkinson's disease,” Neurology, vol. 58, no. 10, pp. 1544–1546, 2002.
[4]
D. E. Hobson, A. E. Lang, W. R. Wayne Martin, A. Razmy, J. Rivest, and J. Fleming, “Excessive daytime sleepiness and sudden-onset sleep in Parkinson disease: a survey by the Canadian Movement Disorders Group,” Journal of the American Medical Association, vol. 287, no. 4, pp. 455–463, 2002.
[5]
I. Arnulf, E. Konofal, M. Merino-Andreu et al., “Parkinson's disease and sleepiness: an integral part of PD,” Neurology, vol. 58, no. 7, pp. 1019–1024, 2002.
[6]
M. A. Brodsky, J. Godbold, T. Roth, and C. W. Olanow, “Sleepiness in Parkinson's disease: a controlled study,” Movement Disorders, vol. 18, no. 6, pp. 668–672, 2003.
[7]
P. Braga-Neto, F. Pereira Da Silva-Júnior, F. Sueli Monte, P. F. C. de Bruin, and V. M. S. de Bruin, “Snoring and excessive daytime sleepiness in Parkinson's disease,” Journal of the Neurological Sciences, vol. 217, no. 1, pp. 41–45, 2004.
[8]
V. C. De Cock, M. Vidailhet, S. Leu et al., “Restoration of normal motor control in Parkinson's disease during REM sleep,” Brain, vol. 130, no. 2, pp. 450–456, 2007.
[9]
I. Schlesinger and P. D. Ravin, “Dopamine agonists induce episodes of irresistible daytime sleepiness,” European Neurology, vol. 49, no. 1, pp. 30–33, 2003.
[10]
S. Stevens, C. L. Comella, and E. J. Stepanski, “Daytime sleepiness and alertness in patients with Parkinson disease,” Sleep, vol. 27, no. 5, pp. 967–972, 2004.
[11]
A. Razmy, A. E. Lang, and C. M. Shapiro, “Predictors of impaired daytime sleep and wakefulness in patients with Parkinson disease treated with older (Ergot) vs newer (Nonergot) dopamine agonists,” Archives of Neurology, vol. 61, no. 1, pp. 97–102, 2004.
[12]
M. W. Johns, “A new method for measuring daytime sleepiness: the Epworth sleepiness scale,” Sleep, vol. 14, no. 6, pp. 540–545, 1991.
[13]
R. Poryazova, D. Benninger, D. Waldvogel, and C. L. Bassetti, “Excessive daytime sleepiness in parkinson's disease: characteristics and determinants,” European Neurology, vol. 63, no. 3, pp. 129–135, 2010.
[14]
I. Shpirer, A. Miniovitz, C. Klein et al., “Excessive daytime sleepiness in patients with parkinson's disease: a polysomnography study,” Movement Disorders, vol. 21, no. 9, pp. 1432–1438, 2006.
[15]
J. Bu?ková, J. Klempí?, V. Majerová, et al., “Sleep disturbances in untreated Parkinson’s disease,” Journal of Neurology, vol. 258, no. 12, pp. 2254–2259, 2011.
[16]
B. H?gl, I. Arnulf, C. Comella et al., “Scales to assess sleep impairment in Parkinson's disease: critique and recommendations,” Movement Disorders, vol. 25, no. 16, pp. 2704–2716, 2010.
[17]
M. Menza, R. D. Dobkin, H. Marin, and K. Bienfait, “Sleep disturbances in Parkinson's disease,” Movement Disorders, vol. 25, supplement 1, pp. S117–S122, 2010.
[18]
D. E. Hobson, A. E. Lang, W. R. Wayne Martin, A. Razmy, J. Rivest, and J. Fleming, “Excessive daytime sleepiness and sudden-onset sleep in Parkinson disease: a survey by the Canadian Movement Disorders Group,” Journal of the American Medical Association, vol. 287, no. 4, pp. 455–463, 2002.
[19]
S. Kumar, M. Bhatia, and M. Behari, “Excessive daytime sleepiness in Parkinson's disease as assessed by Epworth Sleepiness Scale (ESS),” Sleep Medicine, vol. 4, no. 4, pp. 339–342, 2003.
[20]
W. G. Ondo, K. D. Vuong, H. Khan, F. Atassi, C. Kwak, and J. Jankovic, “Daytime sleepiness and other sleep disorders in Parkinson's disease,” Neurology, vol. 57, no. 8, pp. 1392–1396, 2001.
[21]
R. Margis, K. Donis, S. V. Sch?nwald, et al., “Psychometric properties of the Parkinson’s Disease Scale—Brazilian version,” Parkinsonism & Related Disorders, vol. 15, pp. 495–499, 2008.
[22]
J. Santamaria, “How to evaluate excessive daytime sleepiness in Parkinson's disease,” Neurology, vol. 63, no. 8, supplement 3, pp. S21–S23, 2004.
[23]
R. P. Lesser, S. Fahn, and S. R. Snider, “Analysis of the clinical problems in parkinsonism and the complications of long-term levodopa therapy,” Neurology, vol. 29, no. 9, pp. 1253–1260, 1979.
[24]
G. Fabbrini, P. Barbanti, C. Aurilia, C. Pauletti, N. Vanacore, and G. Meco, “Excessive daytime somnolence in Parkinson's disease. Follow-up after 1 year of treatment,” Neurological Sciences, vol. 24, no. 3, pp. 178–179, 2003.
[25]
D. Kaynak, G. Kiziltan, H. Kaynak, G. Benbir, and O. Uysal, “Sleep and sleepiness in patients with Parkinson's disease before and after dopaminergic treatment,” European Journal of Neurology, vol. 12, no. 3, pp. 199–207, 2005.
[26]
R. G. Holloway, I. Shoulson, S. Fahn, et al., “Pramipexole vs levodopa as initial treatment for Parkinson Disease: a 4-year randomized controlled trial,” Archives of Neurology, vol. 61, no. 7, pp. 1044–1053, 2004.
[27]
M. Merino-Andreu, I. Arnulf, E. Konofal, J. P. Derenne, and Y. Agid, “Unawareness of naps in Parkinson's disease and in disorders with excessive daytime sleepiness,” Neurology, vol. 60, no. 9, pp. 1553–1554, 2003.
[28]
C. D. Silberman, J. Laks, C. F. Capit?o, C. S. Rodrigues, I. Moreira, and E. Engelhardt, “Recognizing depression in patients with Parkinson’s Disease,” Arquives of Neuropsiquiatry, vol. 64, no. 2, pp. 407–411, 2006.
[29]
J. S. A. M. Reijnders, U. Ehrt, W. E. J. Weber, D. Aarsland, and A. F. G. Leentjens, “A systematic review of prevalence studies of depression in Parkinson's disease,” Movement Disorders, vol. 23, no. 2, pp. 183–189, 2007.
[30]
U. Ehrt, K. Br?nnick, A. F. G. Leentjens, J. P. Larsen, and D. Aarsland, “Depressive symptom profile in Parkinson's disease: a comparison with depression in elderly patients without Parkinson's disease,” International Journal of Geriatric Psychiatry, vol. 21, no. 3, pp. 252–258, 2006.