Manni Raffaele, Terzaghi Michele, Sartori Ivana, Mancini Francesca, Pacchetti Claudio
Unit of Sleep Medicine and Epilepsy, IRCCS C. Mondino Institute of Neurology, Pavia, Italy.
Sleep Med. 2004 Mar;5(2):189-93. doi: 10.1016/j.sleep.2003.01.001.
This study is aimed at evaluating daytime sleepiness in a series of Parkinson's disease (PD) patients chronically treated with dopamine agonists (DAs) alone or in combination with L-Dopa.
A preliminary series of 22 non-demented, adult PD patients (mean age 68.9, 13 men and 9 women) were evaluated by means of structured sleep interview, Epworth sleepiness scale (ESS) and 24-h ambulatory polysomnography (A-PSG).
Sleep attacks (SAs) were reported by 32% of the patients, in three of them (43%) after DA treatment was initiated (alone or in addition to L-Dopa). In two patients, both with chronic use of ropinirole, we documented NREM SAs during a continuous ambulatory polysomnography (A-PSG) performed in the patients' real-life settings. The subjects experiencing SAs showed a higher degree of daytime sleep propensity than those without SA, having higher ESS scores and a higher proportion of microsleeps and intentional naps on A-PSG. Interestingly, we found that nocturnal total sleep time is higher in PD patients with SAs than in the others.
All in all, our data indicate that SAs are an extreme manifestation of increased daytime sleepiness. The occurrence of SAs in our series of PD patients is unlikely to depend simply on the demands of homeostatic mechanisms.
本研究旨在评估一系列长期单独使用多巴胺激动剂（DAs）或与左旋多巴联合使用治疗的帕金森病（PD）患者的日间嗜睡情况。
通过结构化睡眠访谈、爱泼华嗜睡量表（ESS）和24小时动态多导睡眠图（A - PSG）对初步选取的22例非痴呆成年PD患者（平均年龄68.9岁，13名男性和9名女性）进行评估。
32%的患者报告有睡眠发作（SAs），其中3例（43%）在开始使用DA治疗后（单独使用或联合左旋多巴）出现。在2例长期使用罗匹尼罗的患者中，我们在患者实际生活环境中进行的连续动态多导睡眠图（A - PSG）记录中发现了非快速眼动睡眠发作。经历睡眠发作的受试者比未经历睡眠发作的受试者表现出更高程度的日间睡眠倾向，ESS评分更高，A - PSG上微睡眠和有意小睡的比例更高。有趣的是，我们发现有睡眠发作的PD患者夜间总睡眠时间比其他患者更长。
总体而言，我们的数据表明睡眠发作是日间嗜睡增加的一种极端表现。我们这组PD患者中睡眠发作的发生不太可能仅仅取决于内稳态机制的需求。
