Objective: To examine reasons and associated clinical features of excessive daytime sleepiness (EDS) in patients with Parkinson’s disease (PD).

Background: Patients with EDS can divided into clinical subgroups depend on its origin. These subgroups are associated with combinations of PD symptoms, which can help to distinguish them and find out the reason of EDS.

Methods: PD patients [N=61 (34M); 63,9±6,4 years old; 4,5±3,2 (0.3-12) years motor disease duration, HY range 1-3, mean MoCA score 25.6±1.8 (22-29)] underwent clinical evaluation including the Hoehn and Yahr scale, the MDS-UPDRS, the scale of autonomic dysfunction in PD (Levin, 2003), the Epworth Sleepiness Scale (ESS), the Parkinson’s disease sleep scale – 2 (PDSS-2). 31 patients with EDS underwent one-night video-polysomnography study and the multiple sleep latency test (MSLT).

Results: Out of the 61 patients, 67,2% had EDS (PD-EDS). There were male predominance (28M versus 13M, p=0,016), longer therapy duration (4,1±3,3 versus 2,1±2,7 years, p=0,01) and higher levodopa equivalent dose (LED) (623,8±323,4 versus 452,0±199,7 mg, p=0,03) in PD-EDS. EDS was associated with extracampine hallucinations (p=0,02), circadian disorders (p<0,05) and postprandial hypotension (PH) (p<0,05). PD-EDS was divided into three groups by results of sleep investigation: 1 – pure EDS (n=15), 2 – moderate and severe obstructive sleep apnea syndrome (OSAS) (n=8), 3 – patients with negative MSLT and subjective sleepiness due to orthostatic hypotension (OH) and/or PH (n=8). The highest ESS scores were in group 2 (14,2±3,7) in comparison with group 1 (10,4±4,1, p=0,02) and group 3 (10,4±3,9, p>0,05). Patients in group 2 had the highest BMI – 33,7±5,3 kg/m2 in comparison with group 1 – 27,1±3,3 kg/m2 and group 3 – 23,1±2,3 kg/m2 (p<0,05). Group 3 had more prominent autonomic dysfunction in comparison with group 1 (p=0,0003), OH was more frequent in this group (p<0,025).

Conclusions: EDS was found in 67% of patients. Risk factors for EDS were male sex, longer therapy duration, high LED, extracampine hallucinations, high BMI and PH. Pure EDS was found in 48%, OSAS lead to EDS in 26%. Complaints about EDS were related with autonomic cardiovascular dysfunction in 26%. High ESS score and high BMI were strongly associated with OSAS. OH, high score of the scale of autonomic dysfunction, low BMI were prognostic factors for subjective sleepiness.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/clinical-heterogeneity-of-excessive-daytime-sleepiness-in-parkinsons-disease/