Paus Sebastian, Brecht Hans Michael, Köster Jürgen, Seeger Gert, Klockgether Thomas, Wüllner Ullrich
Department of Neurology, University of Bonn, Bonn, Germany.
Mov Disord. 2003 Jun;18(6):659-67. doi: 10.1002/mds.10417.
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.
为研究多巴胺激动剂与帕金森病（PD）患者睡眠发作的假定关联及其与日间嗜睡的关系，我们在德国两个县对2952例PD患者进行了一项调查。在177例患者中，通过结构化电话访谈确定了在从事某些活动时出现的突然、意外且无法抗拒的睡眠发作。其中91例患者否认出现过适当的预警信号。共有133例患者（75%）的爱泼沃斯思睡量表（ESS）评分>10；65例（37%）>15。31例患者（18%）的ESS评分≤10，但仍经历了无预警信号的睡眠发作。因此，尽管使用ESS可能识别出很大一部分有睡眠发作风险的患者，但约1%的PD患者群体似乎有在无适当预警信号且无伴随日间嗜睡的情况下出现睡眠发作的风险。睡眠发作在德国市场上销售的所有多巴胺激动剂（α-二氢麦角隐亭、溴隐亭、卡麦角林、利苏瑞、培高利特、普拉克索、罗匹尼罗）使用过程中均有发生，麦角类药物和非麦角类药物之间无明显差异。左旋多巴（L-多巴）单药治疗发生睡眠发作的风险最低（2.9%；95%置信区间[CI]，1.7 - 4.0%），其次是多巴胺激动剂单药治疗（5.3%；95%CI，1.5 - 9.2%）以及L-多巴与多巴胺激动剂联合治疗（7.3%；95%CI，6.1 - 8.5%）。司来吉兰、金刚烷胺或恩他卡朋似乎均未影响睡眠发作的发生。ESS评分高、多巴胺激动剂的使用以及PD病程是睡眠发作发生的主要影响因素。与L-多巴治疗相比，多巴胺激动剂治疗的比值比为2.9，而病程每延长1年的比值比为1.05，L-多巴治疗的比值比为1.9。
