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

Background: Neurodegeneration and dopaminergic medications are known to be the main reasons of EDS in PD. However, complexity and diversity of PD symptoms can lead to development of EDS due to other factors.

Method: PD patients [N=90 (50M); 65,0±8,4 years old; 4,6±3,1 (0.3-12) years motor disease duration, HY range 1-3, mean MoCA score 25.8±1.9 (21-30)] underwent clinical evaluation including MDS-UPDRS, Epworth Sleepiness Scale (ESS), PD sleep scale – 2 (PDSS-2). EDS was diagnosed according to ESS, with cutoff of 10. 40 patients with EDS underwent polysomnography and multiple sleep latency test (MSLT).

Results: Out of the 90 patients, 53,3% had EDS (PD-EDS). PD-EDS patients more frequently were males (32/48 versus 15/42, p=0,017), had prominent axial and gait impairment (8,4±4,5 versus 5,8±4,9, p=0,016), hallucinations (21% versus 4,5%, p=0,04), longer disease duration (5,0±2,9 versus 3,7±3,1, p=0,04) and higher levodopa equivalent dose (LED)  (600,5±324,4 mg versus 415,4±273,1 mg, p=0,04). According to results of MSLT, patients with EDS were divided into groups: patients with hypersomnia (sleep latency (SL) ≤ 8 min) and subjective EDS (SL > 10 min). Main reasons of hypersomnia were defined: 1 – due to use of dopamine agonists – 42,5% (n=17), 2 –due to moderate and severe obstructive sleep apnea syndrome (OSAS) – 17,5% (n=7), narcolepsy-like phenotype – 7,5% (n=3). Subjective EDS was resulted from orthostatic hypotension (OH) and postprandial hypotension (PH) in 20% (n=8) and mood disorders (depression and anxiety) in 12,5% (n=5). Orthostatic probe can help diagnose subjective EDS due to autonomic dysfunction because of difference of OH frequency in comparison with other patients (80% versus 3%, p<0,0001). Regression analysis found factors associated with EDS development: circadian disorders, extracampine hallucinations, PH (R2=0,38, p=0,00027).

Conclusion: EDS is found in 53,3% of patients and can be divided into hypersomnia and subjective EDS. Subjective EDS occurs in 32,5% patients. OH and PH are main contributing factors and orthostatic probe can distinguish such patients. Use of dopamine agonists, OSAS and narcolepsy-like phenotype are main reasons of hypersomnia in PD patients. Male sex, disease duration and LED, axial and gait impairment, circadian disorders, hallucinations and PH are risk factors for EDS in PD patients.

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