Excessive Daytime Sleepiness and Sudden-Onset Sleep in Parkinson Disease

Abstract

Excessive daytime sleepiness is common even in patients with PD who are independent and do not have dementia. Sudden-onset sleep without warning is infrequent. The Epworth score has adequate sensitivity for predicting prior episodes of falling asleep while driving and its specificity can be increased by use of the Inappropriate Sleep Composite Score. It is unknown if routinely performing these assessments could be more effective in predicting future risk for these rare sleep attacks. Patients should be warned not to drive if they doze in unusual circumstances.

Sleep disturbances in Taiwanese patients with Parkinson's disease

“…In a study of 638 Canadian patients with PD with H&Y stage of 2.2 ± 0.68, Hobson et al. (2002) reported that 51% had EDS; however, in our study, only 26.3% of patients with a similar H&Y stage had EDS. In our patient cohort and that investigated in Switzerland by Poryazova et al., the mean age (65.7 ± 8.88 vs. 65 ± 10 years) and disease duration (8.2 ± 5.2 vs. 8.2 ± 6.6 years) were similar; however, 57% of the patients studied by Poryazova et al.…”

“…The occurrence of EDS among patients with PD was lower in Asian than in Caucasian populations in the literature. Studies from Asia using the ESS have reported that the prevalence of EDS ranged from 15.1% to 32.3%; however, prevalence ranging from 40.6% to 57% was reported for Europe and North America (Brodsky et al., 2003; Chen et al., 2015; Goldman et al., 2013; Hobson et al., 2002; Louter et al., 2012; Poryazova et al., 2010; Ratti et al., 2015; Setthawatcharawanich et al., 2014; Tan et al., 2002; Yu et al., 2015; Zhu et al., 2016) (Table 3). Disease severity, disease duration, dopaminergic therapy, and hypnotic medication have been suggested to contribute to EDS; however, neither of them could fully explain this discrepancy.…”

“…Intriguingly, although the reported percentages of poor sleepers in Asian patients are equal to or slightly higher than those among Western populations, the prevalence of EDS is lower in Asian than in Caucasian patients. In the Western countries, such as France, the Netherlands, Switzerland, Canada, and the United States, the percentage of poor sleepers ranged from 58.8% to 63% and EDS ranged from 40.6% to 57% (Brodsky, Godbold, Roth, & Olanow, 2003; Hobson et al., 2002; Louter, Munneke, Bloem, & Overeem, 2012; Poryazova, Benninger, Waldvogel, & Bassetti, 2010; Ratti et al., 2015; Zhu, van Hilten, & Marinus, 2016). In Asia, EDS was found to be considerably less prevalent among patients with PD.…”

Levodopa Challenge Neuroimaging of Levodopa-Related Mood Fluctuations in Parkinson's Disease

“…Each of the following regimens was used by one motor fluctuator control: venlafaxine (225 mg/day) and trazodone (50 mg/day); paroxetine (20 mg/day) and imipramine (50 mg/day); sertraline 100 mg/day; trazodone (175 mg/day); amitriptyline (50 mg/day). d Equivalent dose of levodopa or dopamine agonists using the method of Hobson et al (2002). Other medications included amantadine (one mood, three motor), selegiline (zero mood, two motor), and benztropine (zero mood, one motor).…”

“…route (the intermediatedose protocol in Black et al, 2003). By way of comparison, the average usual morning dose of antiparkinsonian medication in these patients was equivalent to about 250 mg levodopa using the formula of Hobson et al (2002), with no group difference (t-test, p40.30). Seven subjects in each group received levodopa i.v.…”