Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Observational Study
. 2017 Aug;88(8):653-662.
doi: 10.1136/jnnp-2016-315023. Epub 2017 May 29.

Longitudinal assessment of excessive daytime sleepiness in early Parkinson's disease

Amy W Amara  1 , Lama M Chahine  2 , Chelsea Caspell-Garcia  3 , Jeffrey D Long  3 , Christopher Coffey  3 , Birgit Högl  4 , Aleksandar Videnovic  5 , Alex Iranzo  6 , Geert Mayer  7 , Nancy Foldvary-Schaefer  8 , Ron Postuma  9 , Wolfgang Oertel  10   11 , Shirley Lasch  12 , Ken Marek  12 , Tanya Simuni  13 ; Parkinson’s Progression Markers Initiative
Affiliations
Observational Study

Longitudinal assessment of excessive daytime sleepiness in early Parkinson's disease

Amy W Amara et al. J Neurol Neurosurg Psychiatry. 2017 Aug.

Abstract

Background: Excessive daytime sleepiness (EDS) is common and disabling in Parkinson's disease (PD). Predictors of EDS are unclear, and data on biological correlates of EDS in PD are limited. We investigated clinical, imaging and biological variables associated with longitudinal changes in sleepiness in early PD.

Methods: The Parkinson's Progression Markers Initiative is a prospective cohort study evaluating progression markers in participants with PD who are unmedicated at baseline (n=423) and healthy controls (HC; n=196). EDS was measured with the Epworth Sleepiness Scale (ESS). Clinical, biological and imaging variables were assessed for associations with EDS for up to 3 years. A machine learning approach (random survival forests) was used to investigate baseline predictors of incident EDS.

Results: ESS increased in PD from baseline to year 3 (mean±SD 5.8±3.5 to 7.55±4.6, p<0.0001), with no change in HC. Longitudinally, EDS in PD was associated with non-tremor dominant phenotype, autonomic dysfunction, depression, anxiety and probable behaviour disorder, but not cognitive dysfunction or motor severity. Dopaminergic therapy was associated with EDS at years 2 and 3, as dose increased. EDS was also associated with presynaptic dopaminergic dysfunction, whereas biofluid markers at year 1 showed no significant associations with EDS. A predictive index for EDS was generated, which included seven baseline characteristics, including non-motor symptoms and cerebrospinal fluid phosphorylated-tau/total-tau ratio.

Conclusions: In early PD, EDS increases significantly over time and is associated with several clinical variables. The influence of dopaminergic therapy on EDS is dose dependent. Further longitudinal analyses will better characterise associations with imaging and biomarkers.

Keywords: Biomarkers; Excessive daytime sleepiness; Non-motor symptoms; Parkinson’s disease; Sleep.

PubMed Disclaimer

Conflict of interest statement

Competing interests: AWA is an investigator for studies sponsored by the Michael J. Fox Foundation for Parkinson’s Research and Abbvie. JDL has a consulting agreement with NeuroPhage and is a paid consultant for Roche Pharma and Azevan Pharmaceuticals. BH received honoraria as a consultant, for advisory board and/or for speaking for UCB, Otsuka, Lundbeck, Lilly, Axovant and Mundipharma, and Travel Support from Habel Medizintechnik and Vivisol, Austria. GM is an investigator for studies sponsored by UCB Pharma Brussels, Novartis, Michael J. Fox Foundation for Parkinson’s Research, Paul Ehrlich Institute Langen/Germany, Jazz Pharma/USA and Bioprojet; serves on speaker’s bureau for UCB Pharma Brussels; and is on the advisory board of UCB Pharma. RP receives speaker fees from Boehringer, Novartis Canada and Teva Neurosciences. SL is employed by Molecular NeuroImaging, LLC. KM has ownership in inviCRO, LLC and a consultant for Pfizer, GE Healthcare, Lilly, BMS, Piramal, Biogen, Prothena, Roche, Neuropore, US WorldMeds, Neurophage, UCB, Oxford Biomedica and Lysosomal Therapetic, Inc. TS has received consulting honoraria from National Parkinson Foundation, Teva Pharmaceuticals, Pfizer, Harbor, UCB, IMPAX, Acadia, Lundbeck, Eli Lilly and Company, Allergan, Merz Inc and US WorldMeds.

Figures

Figure 1
Figure 1
EDS survival curves by risk group defined by quartile cutoffs of the linear combination of predictors. EDS, excessive daytime sleepiness.
See this image and copyright information in PMC

References

    1. Martinez-Martin P, Rodriguez-Blazquez C, Kurtis MM, et al. The impact of non-motor symptoms on health-related quality of life of patients with Parkinson’s disease. Mov Disord 2011;26:399–406. - PubMed
    1. Simuni T, Caspell-Garcia C, Coffey C, et al. Correlates of excessive daytime sleepiness in de novo Parkinson’s disease: A case control study. Mov Disord 2015;30:1371–81. - PMC - PubMed
    1. Knipe MD, Wickremaratchi MM, Wyatt-Haines E, et al. Quality of life in young-compared with late-onset Parkinson’s disease. Mov Disord 2011. 26 2011 8. - PubMed
    1. Chahine LM, Amara AW, Videnovic A. A systematic review of the literature on disorders of sleep and wakefulness in Parkinson’s disease from 2005 to 2015. Sleep Med Rev 2016;. - PMC - PubMed
    1. Meindorfner C, Körner Y, Möller JC, et al. Driving in Parkinson’s disease: mobility, accidents, and sudden onset of sleep at the wheel. Mov Disord 2005;20:832–42. - PubMed

Publication types

MeSH terms

Substances