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Sleep attacks, daytime sleepiness, and dopamine agonists in Parkinson's disease.
Mov Disord. 2003 Jun; 18(6):659-67.MD

Abstract

To study the putative association of dopamine agonists with sleep attacks in patients with Parkinson's disease (PD) and their relation to daytime sleepiness, we performed a survey of 2,952 PD patients in two German counties. In 177 patients, sudden, unexpected, and irresistible sleep episodes while engaged in some activity were identified in a structured telephone interview. Ninety-one of these patients denied the occurrence of appropriate warning signs. A total of 133 patients (75%) had an Epworth Sleepiness Scale (ESS) score >10; 65 (37%) >15. Thirty-one patients (18%) had an ESS score < or =10 and yet experienced sleep attacks without warning signs. Thus, although a significant proportion of patients at risk for sleep attacks might be identified using the ESS, roughly 1% of the PD patient population seems to be at risk for sleep attacks without appropriate warning signs and without accompanying daytime sleepiness. Sleep attacks occurred with all dopamine agonists marketed in Germany (alpha-dihydroergocryptine, bromocriptine, cabergoline, lisuride, pergolide, pramipexole, ropinirole), and no significant difference between ergot and nonergot drugs was evident. Levodopa (L-dopa) monotherapy carried the lowest risk for sleep attacks (2.9%; 95% confidence interval [CI], 1.7-4.0%) followed by dopamine agonist monotherapy (5.3%; 95% CI, 1.5-9.2%) and combination of L-dopa and a dopamine agonist (7.3%; 95% CI, 6.1-8.5%). Neither selegeline nor amantadine or entacapone appeared to influence the occurrence of sleep attacks. A high ESS score, intake of dopamine agonists, and duration of PD were the main influencing factors for the occurrence of sleep attacks. The odds ratio for dopamine agonist therapy was 2.9 compared to 1.9 with L-dopa therapy and 1.05 for a 1-year-longer disease duration.

Authors+Show Affiliations

Department of Neurology, University of Bonn, Bonn, Germany. spaus@uni-bonn.deNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

12784269

Citation

Paus, Sebastian, et al. "Sleep Attacks, Daytime Sleepiness, and Dopamine Agonists in Parkinson's Disease." Movement Disorders : Official Journal of the Movement Disorder Society, vol. 18, no. 6, 2003, pp. 659-67.
Paus S, Brecht HM, Köster J, et al. Sleep attacks, daytime sleepiness, and dopamine agonists in Parkinson's disease. Mov Disord. 2003;18(6):659-67.
Paus, S., Brecht, H. M., Köster, J., Seeger, G., Klockgether, T., & Wüllner, U. (2003). Sleep attacks, daytime sleepiness, and dopamine agonists in Parkinson's disease. Movement Disorders : Official Journal of the Movement Disorder Society, 18(6), 659-67.
Paus S, et al. Sleep Attacks, Daytime Sleepiness, and Dopamine Agonists in Parkinson's Disease. Mov Disord. 2003;18(6):659-67. PubMed PMID: 12784269.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Sleep attacks, daytime sleepiness, and dopamine agonists in Parkinson's disease. AU - Paus,Sebastian, AU - Brecht,Hans Michael, AU - Köster,Jürgen, AU - Seeger,Gert, AU - Klockgether,Thomas, AU - Wüllner,Ullrich, PY - 2003/6/5/pubmed PY - 2003/10/3/medline PY - 2003/6/5/entrez SP - 659 EP - 67 JF - Movement disorders : official journal of the Movement Disorder Society JO - Mov Disord VL - 18 IS - 6 N2 - To study the putative association of dopamine agonists with sleep attacks in patients with Parkinson's disease (PD) and their relation to daytime sleepiness, we performed a survey of 2,952 PD patients in two German counties. In 177 patients, sudden, unexpected, and irresistible sleep episodes while engaged in some activity were identified in a structured telephone interview. Ninety-one of these patients denied the occurrence of appropriate warning signs. A total of 133 patients (75%) had an Epworth Sleepiness Scale (ESS) score >10; 65 (37%) >15. Thirty-one patients (18%) had an ESS score < or =10 and yet experienced sleep attacks without warning signs. Thus, although a significant proportion of patients at risk for sleep attacks might be identified using the ESS, roughly 1% of the PD patient population seems to be at risk for sleep attacks without appropriate warning signs and without accompanying daytime sleepiness. Sleep attacks occurred with all dopamine agonists marketed in Germany (alpha-dihydroergocryptine, bromocriptine, cabergoline, lisuride, pergolide, pramipexole, ropinirole), and no significant difference between ergot and nonergot drugs was evident. Levodopa (L-dopa) monotherapy carried the lowest risk for sleep attacks (2.9%; 95% confidence interval [CI], 1.7-4.0%) followed by dopamine agonist monotherapy (5.3%; 95% CI, 1.5-9.2%) and combination of L-dopa and a dopamine agonist (7.3%; 95% CI, 6.1-8.5%). Neither selegeline nor amantadine or entacapone appeared to influence the occurrence of sleep attacks. A high ESS score, intake of dopamine agonists, and duration of PD were the main influencing factors for the occurrence of sleep attacks. The odds ratio for dopamine agonist therapy was 2.9 compared to 1.9 with L-dopa therapy and 1.05 for a 1-year-longer disease duration. SN - 0885-3185 UR - https://www.unboundmedicine.com/medline/citation/12784269/Sleep_attacks_daytime_sleepiness_and_dopamine_agonists_in_Parkinson's_disease_ L2 - https://doi.org/10.1002/mds.10417 DB - PRIME DP - Unbound Medicine ER -