Sleep Disorders Unit and Inserm UMR 975, Pitié-Salpêtrière Hospital, Assistance Publique Hôpitaux de Paris, Paris 6 University, Paris, France.
Parkinsonism Relat Disord. 2009 Dec;15 Suppl 3:S101-4. doi: 10.1016/S1353-8020(09)70792-8.
Excessive daytime sleepiness is a disabling and vital problem in patients with PD. It affects around 33% patients and culminates in sleep attacks (without prodroma) in 1 to 4% of the patients. When monitored, short, narcolepsy-like naps with abnormal intrusion of REM sleep during daytime (and hypnagogic hallucinations as wakeful dreams) are observed in 33-41% patients, while other patients display naps with non REM sleep. Although insomnia, sleep apnea and periodic leg movements are common in these patients, there is no clear link between the night events and the level of sleepiness. Patients treated with dopamine agonists are two to three fold more exposed to sleep attacks than those on levodopa, with large variability between patients. Sleepiness may exist, to a lesser degree, before the onset of parkinsonism and before the use of dopamine agents, suggesting that other, disease-dependant factors contribute to the sleepiness. Most arousal systems are indeed damaged in PD brains, including the locus coeruleus (noradrenalin), the pedunculo-pontine nucleus and the basal forebrain (acetylcholine), the median raphe (serotonin), and the lateral hypothalamus (orexin), while histamine dopamine arousal system are normal. Treating patients with stimulants such as modafinil is only partially efficacious, while trials of anti-H3 drugs and sodium oxybate seem more active. Eventually, the recent stimulation of the pedunculopontine nucleus has stimulant or sedative effects in patients, depending on the frequency of stimulation. These results provide new insights into the mechanisms of arousal in PD.
白天过度嗜睡是 PD 患者致残和严重的问题。它影响约 33%的患者，最终导致 1%至 4%的患者出现睡眠发作（无前驱症状）。当监测到白天发生短暂、类似发作性睡病的小睡时，伴有 REM 睡眠异常侵入（催眠幻觉作为觉醒梦），在 33%至 41%的患者中观察到，而其他患者则表现为非 REM 睡眠的小睡。尽管这些患者中失眠、睡眠呼吸暂停和周期性肢体运动很常见，但夜间事件与嗜睡程度之间没有明确的联系。与接受左旋多巴治疗的患者相比，接受多巴胺激动剂治疗的患者发生睡眠发作的风险高 2 至 3 倍，且患者之间的差异很大。在帕金森病发病前和使用多巴胺药物之前，可能存在较轻程度的嗜睡，这表明其他与疾病相关的因素导致了嗜睡。大多数觉醒系统在 PD 大脑中确实受损，包括蓝斑（去甲肾上腺素）、脑桥被盖核和基底前脑（乙酰胆碱）、中缝核（血清素）和外侧下丘脑（食欲素），而组胺多巴胺觉醒系统正常。使用莫达非尼等兴奋剂治疗患者仅部分有效，而抗 H3 药物和羟丁酸钠的试验似乎更有效。最终，最近刺激脑桥被盖核会根据刺激频率对患者产生兴奋或镇静作用。这些结果为 PD 中的觉醒机制提供了新的见解。
