Daytime sleepiness and other sleep disorders in Parkinson’s disease
Abstract
Background: PD is associated with a variety of sleep problems. The dopamine agonists (DA) pramipexole and ropinirole were recently implicated in causing “sleep attacks” and motor vehicle accidents.
Methods: In order to determine the overall rate of subjective sleep problems in PD and to determine if any factors, including specific medications, correlate with sleep pathology, the authors surveyed consecutive patients with PD seen over a 3-month period in a Movement Disorders Clinic. The authors collected demographic and medication data, and the patients completed the Epworth Sleepiness Scale (ESS), questions assessing the presence of restless legs syndrome (RLS), a modified National Sleep Foundation sleep survey, and specific questions regarding falling asleep while driving.
Results: A total of 320 patients completed the questionnaire. The authors eliminated 17, six for incomplete data and 11 for having a primary diagnosis other than PD. The mean age of the remaining 303 patients was 67.1 ± 10.7 years, and the mean duration of PD was 9.1 ± 5.7 years. The ESS scores averaged 11.1 ± 5.9, and in 50.2% of patients the score was abnormally high (>10). Stepwise regression analysis found that sleepiness correlated with longer duration of PD (p < 0.001), more advanced PD (p < 0.004), male sex (p < 0.001), and the use of any DA (p < 0.003). The soporific effects of the three most common DA (pramipexole, ropinirole, and pergolide) were similar. Falling asleep while driving was reported by 63/279 (22.6%) of current drivers and correlated with higher ESS scores (p < 0.05). Other sleep disorders, including RLS, were also frequently reported.
Conclusion: Daytime sleepiness is common in PD and correlates with more advanced and longer duration of PD, and male sex. The DA were also independently associated with daytime sleepiness, but in this group, no single DA was more culpable than the others.
Get full access to this article
View all available purchase options and get full access to this article.
References
1.
Schapira AH. Sleep attacks (sleep episodes) with pergolide. Lancet . 2000; 355: 1332–1333. Letter.
2.
Frucht S, Rogers JD, Greene PE, Gordon MF, Fahn S. Falling asleep at the wheel: motor vehicle mishaps in persons taking pramipexole and ropinirole. Neurology . 1999; 52: 1908–1910.
3.
Frucht SJ, Greene P, Fahn S. Sleep episodes in Parkinson’s disease: a wake-up call. Mov Disord . 2000; 15: 601–603.
4.
Hauser RA, Gauger L, Anderson WM, Zesiewicz TA. Pramipexole-induced somnolence and episodes of daytime sleep. Mov Disord . 2000; 15: 658–663.
5.
Olanow CW, Schapira AHV, Roth T. Waking up to sleep episodes in Parkinson’s disease. Mov Disord . 2000; 15: 212–215.
6.
Johns MW. A new method for measuring daytime sleepiness: the Epworth sleepiness scale. Sleep . 1991; 14: 540–545.
7.
National Sleep Foundation. Omnibus Sleep in America Poll. National Sleep Foundation Publication, 1999.
8.
Walters AS. Toward a better definition of the restless legs syndrome. The International Restless Legs Syndrome Study Group. Mov Disord . 1995; 10: 634–642.
9.
Hosmer DW, Lemeshow S. Applied logistic regression. New York: Wiley, 1989.
10.
Lai EC, Jankovic J, Krauss JK, et al. Long term efficacy of posteroventral pallidotomy in the treatment of Parkinson’s disease. Neurology . 2000; 55: 1218–1222.
11.
El-Ad B, Korczyn AD. Disorders of excessive daytime sleepiness–an update. J Neurol Sci . 1998; 153: 192–202.
12.
Factor SA, McAlarney T, Sanchez–Ramos JR, Weiner WJ. Sleep disorders and sleep effect in Parkinson’s disease. Mov Disord . 1990; 5: 280–285.
13.
Dowling GA. Sleep in older women with Parkinson’s disease. J Neurosci Nurs . 1995; 27: 355–357.
14.
Horiguchi J, Inami Y, Nishimatsu O, Innami T, Kakimoto Y. Sleep-wake complaints in Parkinson’s disease. Rinsho Shinkeigaku . 1990; 30: 214–216.
15.
van Hilten JJ, Weggeman M, van der Velde EA, Kerkhof GA, van Dijk JG, Roos RA. Sleep, excessive daytime sleepiness and fatigue in Parkinson’s disease. J Neural Transm Park Dis Dement Sect . 1993; 5: 235–244.
16.
Tandberg E, Larsen JP, Karlsen K. Excessive daytime sleepiness and sleep benefit in Parkinson’s disease: a community-based study. Mov Disord . 1999; 14: 922–927.
17.
Hanna PA, Ratkos L, Ondo WG, Jankovic J. Switching from pergolide to pramipexole in patients with Parkinson’s disease. J Neural Transm . 2000; 1: 1–2.
18.
Lees AJ, Blackburn NA, Campbell VL. The nighttime problems of Parkinson’s disease. Clin Neuropharmacol . 1988; 11: 512–519.
19.
Currie LJ, Harrison MB, Trugman JM, Bennett JP Jr, Wooten GF. Early morning dystonia in Parkinson’s disease. Neurology . 1998; 51: 283–285.
20.
Comella CL, Nardine TM, Diederich NJ, Stebbins GT. Sleep-related violence, injury, and REM sleep behavior disorder in Parkinson’s disease. Neurology . 1998; 51: 526–529.
21.
Partinen M. Sleep disorder related to Parkinson’s disease. J Neurol . 1997; 244: S3–6.
22.
Razmy A, Shapiro CM. Interactions of sleep and Parkinson’s disease. Semin Clin Neuropsychiatry . 2000; 5: 20–32.
23.
Wetter TC, Collado–Seidel V, Pollmacher T, Yassourdis A. Sleep and periodic leg movement patterns in drug-free patients with Parkinson’s disease and multiple systems atrophy. Sleep . 2000; 23: 361–367.
24.
Askenasy JJ, Weitzman ED, Yahr MD. Are periodic movements in sleep a basal ganglia dysfunction? J Neural Transm . 1987; 70: 337–347.
25.
Andreu N, Chale JJ, Senard JM, Thalamas C, Montastruc JL, Rascol O. L-Dopa-induced sedation: a double-blind cross-over controlled study versus triazolam and placebo in healthy volunteers. Clin Neuropharmacol . 1999; 22: 15–23.
26.
Askenasy JJ, Yahr MD. Reversal of sleep disturbance in Parkinson’s disease by antiparkinsonian therapy: a preliminary study. Neurology . 1985; 35: 527–532.
27.
Stocchi F, Barbato L, Nordera G, Berardelli A, Ruggieri S. Sleep disorders in Parkinson’s disease. J Neurol . 1998; 245 (suppl 1): S15–18.
28.
Cianchetti C, Masala C, Mangoni A, Gessa GL. Suppression of REM and delta sleep by apomorphine in man: a dopamine mimetic effect. Psychopharmacology (Berl) . 1980; 67: 61–65.
29.
van Hilten B, Hoff JI, Middelkoop HA, et al. Sleep disruption in Parkinson’s disease. Assessment by continuous activity monitoring. Arch Neurol . 1994; 51: 922–928.
30.
Nicholson AN, Pascoe PA. Dopaminergic transmission and the sleep-wakefulness continuum in man. Neuropharmacology . 1990; 29: 411–417.
31.
Kales A, Ansel RD, Markham CH, Scharf MB, Tan TL. Sleep in patients with Parkinson’s disease and normal subjects prior to and following levodopa administration. Clin Pharmacol Ther . 1971; 12: 397–406.
32.
Trampus M, Ferri N, Monopoli A, Ongini E. The dopamine D1 receptor is involved in the regulation of REM sleep in the rat. Eur J Pharmacol . 1991; 194: 189–194.
33.
Monti JM, Jantos H, Fernandez M. Effects of the selective dopamine D-2 receptor agonist, quinpirole on sleep and wakefulness in the rat. Eur J Pharmacol . 1989; 169: 61–66.
34.
Fertl E, Auff E, Doppelbauer A, Waldhauser F. Circadian secretion pattern of melatonin in de novo parkinsonian patients: evidence for phase-shifting properties of l-dopa. J Neural Transm Park Dis Dement Sect . 1993; 5: 227–234.
35.
Reid MS, Tafti M, Nishino S, Sampathkumaran R, Siegel JM, Mignot E. Local administration of dopaminergic drugs into the ventral tegmental area modulates cataplexy in the narcoleptic canine. Brain Res . 1996; 733: 83–100.
36.
Honda K, Riehl J, Mignot E, Nishino S. Dopamine D3 agonists into the substantia nigra aggravate cataplexy but do not modify sleep. Neuroreport . 1999; 10: 3111–3118.
37.
Bagetta G, De Sarro G, Priolo E, Nistico G. Ventral tegmental area: site through which dopamine D2-receptor agonists evoke behavioural and electrocortical sleep in rats. Br J Pharmacol . 1988; 95: 860–866.
38.
Horne JA, Reyner LA. Sleep related vehicle accidents. BMJ . 1995; 310: 565–567.
39.
Hakkanen J, Summala H. Sleepiness at work among commercial truck drivers. Sleep . 2000; 23: 49–57.
40.
Maycock G. Sleepiness and driving: the experience of UK car drivers. J Sleep Res . 1996; 5: 229–237.
41.
Maycock G. Sleepiness and driving: the experience of heavy goods vehicle drivers in the UK. J Sleep Res . 1997; 6: 238–244.
42.
Aldrich MS. Automobile accidents in patients with sleep disorders. Sleep . 1989; 12: 487–494.
Information & Authors
Information
Published In
Copyright
© 2001.
Publication History
Received: August 24, 2000
Accepted: June 22, 2001
Published online: October 23, 2001
Published in print: October 23, 2001
Authors
Metrics & Citations
Metrics
Citations
Download Citations
If you have the appropriate software installed, you can download article citation data to the citation manager of your choice. Select your manager software from the list below and click Download.
Cited By
- Parkinson’s disease psychosis associated with accelerated multidomain cognitive decline, BMJ Mental Health, 27, 1, (e301062), (2024).https://doi.org/10.1136/bmjment-2024-301062
- Sleep quality, excessive daytime sleepiness, and depression in Parkinson’s disease: implications for improved patient outcomes, Neurological Research, 46, 4, (297-303), (2024).https://doi.org/10.1080/01616412.2024.2301878
- Sex-dependent effects of monomeric α-synuclein on calcium and cell death of lateral hypothalamic mouse neurons are altered by orexin, Molecular and Cellular Neuroscience, 129, (103934), (2024).https://doi.org/10.1016/j.mcn.2024.103934
- Setting the clinical context to non-motor symptoms reflected by Park-pain, Park-sleep, and Park-autonomic subtypes of Parkinson’s disease, Translational Approaches to Unravelling Non-Motor Symptoms of Parkinson's Disease, (1-58), (2024).https://doi.org/10.1016/bs.irn.2023.08.012
- Pathophysiology and Management Approaches for Parkinson’s Disease, Drug Delivery Strategies in Neurological Disorders: Challenges and Opportunities, (103-153), (2024).https://doi.org/10.1007/978-981-99-6807-7_5
- Parkinson's Disease and Driving Fitness: A Systematic Review of the Existing Guidelines, Movement Disorders Clinical Practice, 11, 3, (198-208), (2024).https://doi.org/10.1002/mdc3.13942
- Bidirectional association between Parkinson’s disease and obstructive sleep apnea: a cohort study, Journal of Clinical Sleep Medicine, 19, 9, (1615-1623), (2023).https://doi.org/10.5664/jcsm.10596
- Awareness of medical issues in health sciences and in scientific technological education, IP Journal of Nutrition, Metabolism and Health Science, 6, 3, (106-109), (2023).https://doi.org/10.18231/j.ijnmhs.2023.018
- Clinical Manifestations of Subjective Sleep Disorders in Chinese Patients with Parkinson’s Disease and Their Relationship with Dopaminergic Drugs, European Neurology, 86, 6, (377-386), (2023).https://doi.org/10.1159/000533905
- Excessive daytime sleepiness in a model of Parkinson’s disease improved by low-frequency stimulation of the pedunculopontine nucleus, npj Parkinson's Disease, 9, 1, (2023).https://doi.org/10.1038/s41531-023-00455-7
- See more
Loading...
View Options
Get Access
Login options
Check if you have access through your login credentials or your institution to get full access on this article.
Personal login Institutional LoginPurchase Options
The neurology.org payment platform is currently offline. Our technical team is working as quickly as possible to restore service.
If you need immediate support or to place an order, please call or email customer service:
- 1-800-638-3030 for U.S. customers - 8:30 - 7 pm ET (M-F)
- 1-301-223-2300 for customers outside the U.S. - 8:30 - 7 pm ET (M-F)
- [email protected]
We appreciate your patience during this time and apologize for any inconvenience.
We appreciate the comments of Homann et al. and generally agree with their suppositions. The frequency with which our PD patients admitted to falling asleep while driving is higher than other major series. [3, 4, 5, 6] Since their letter was submitted the sleep survey of the Canadian Movement Disorders Group was published as a full paper. [7] We attribute our high rate of driving sleepiness to our patient demographics. First, patients were told that the data would be confidential. Second, our clinic serves as a tertiary referral center for the southern United States and, therefore, our patients tend to have more advanced disease, a longer duration of disease, and older age, all of which can correlate with sleep problems. Third, many of our patients live in rural areas and are forced to drive much longer distances than would be required in more densely populated areas, such as Europe. Likewise, there is very little public transportation, whereas gasoline is relatively inexpensive. Fourth, the state of Texas has particularly liberal driving laws. Even patients with active epilepsy are not legally prevented from driving. In short, we suspect that patients in our catchment area drive more than in most areas of the world, and are therefore more prone fall asleep while driving. We referenced a study that reported a higher incidence of falling asleep in long-haul truck drivers, compared to our PD population, suggesting that baseline driving characteristics greatly influence these figures. [8] We do not feel that driving should be legislatively limited for patients with PD who take dopaminergic medications, however, we do counsel them regarding this potential problem. Further studies are needed to determine the mechanisms of excessive drowsiness and to define the predictors of altered daytime alertness and tendency to fall asleep while driving [9].
References
1. Ondo WG, Dat Vuong K, Kahn H, Atassi F, Kwak C, Jankovic J. Daytime sleepiness and other sleep disorders in Parkinson's disease. Neurology 2001;57:1392-1396.
2. Frucht SJ, Greene PE, Fahn S. Sleep episodes in Parkinson's disease: a wake-up call. Mov Disord 2000;15:601-603.
3. Lang AE, Hobson DE, Martin W, J Rives J. Excessive daytime sleepiness and sudden onset sleep in Parkinson's disease: A survey from 18 Canadian movement disorders clinics. Neurology 2001;56:S40.001(Abstract)
4. Gimenez-Roldan S, Dobato JL, Mateo D. Vehicle drivers with Parkinson disease: behavior schedules of a patient sample from the Community of Madrid. Neurologia. 1998;13:13-21.
5. Homann CN, Trummer M, Wenzel K, et al. Sleep attacks and severe road accidents in patients with parkinson's disease - an unfrequent finding! Mov Disord 2001;16:44-44.(Abstract)
6. Tan EK, Lum SY, Fook-Chong SMC et al. Evaluation of somnolence in Parkinson's disease: Comparison with age and sex matched controls. Neurology 2002;58:465-468.
7. Hobson DE, Lang AE, Martin WRA, et al. Excessive daytime sleepiness and sudden-onset sleep in Parkinson disease. A survey by the Canadian Movement Disorders Group. JAMA 2002;287:455-463.
8. Hakkanen J, Summala H. Sleepiness at work among commercial truck drivers. Sleep 2000;23:49-57.
9. Rye DB, Jankovic J. Emerging views of dopamine in modulating sleep/wake state from an unlikely source: PD. Neurology 2002;58:341-346.