Schaeffer Eva, Vaterrodt Thomas, Zaunbrecher Laura, Liepelt-Scarfone Inga, Emmert Kirsten, Roeben Benjamin, Elshehabi Morad, Hansen Clint, Becker Sara, Nussbaum Susanne, Busch Jan-Hinrich, Synofzik Matthis, Berg Daniela, Maetzler Walter
Department of Neurology, Christian-Albrecht-University Kiel, Arnold-Heller-Straße 3, Kiel, Germany.
Department for Neurology, SHG-Kliniken Sonnenberg, Saarbrücken, Germany.
J Neurol. 2021 Jul;268(7):2506-2514. doi: 10.1007/s00415-021-10419-7. Epub 2021 Feb 5.
Sleep disturbances are common in Parkinson's Disease (PD), with nocturnal akinesia being one of the most burdensome. Levodopa is frequently used in clinical routine to improve nocturnal akinesia, although evidence is not well proven.
We assessed associations of Levodopa intake with quality of sleep and perception of nocturnal akinesia in three PD cohorts, using the Parkinson's Disease Sleep Scale (PDSS-2) in two cohorts and a question on nocturnal immobility in one cohort. In one cohort also objective assessment of mobility during sleep was performed, using mobile health technology.
In an independent analysis of all three cohorts (in total n = 1124 PD patients), patients taking Levodopa CR reported a significantly higher burden by nocturnal akinesia than patients without Levodopa. Higher Levodopa intake and MDS-UPDRS part IV scores (indicating motor fluctuations) predicted worse PDSS-2 and higher subjective nocturnal immobility scores, while disease duration and severity were not predictive. Levodopa intake was not associated with objectively changed mobility during sleep.
Our results showed an association of higher Levodopa intake with perception of worse quality of sleep and nocturnal immobility in PD, indicating that Levodopa alone might not be suitable to improve subjective feeling of nocturnal akinesia in PD. In contrast, Levodopa intake was not relevantly associated with objectively measured mobility during sleep. PD patients with motor fluctuations may be particularly affected by subjective perception of nocturnal mobility. This study should motivate further pathophysiological and clinical investigations on the cause of perception of immobility during sleep in PD.
睡眠障碍在帕金森病（PD）中很常见，夜间运动不能是最具负担的症状之一。左旋多巴在临床常规中经常用于改善夜间运动不能，尽管证据并不充分。
我们在三个PD队列中评估了左旋多巴摄入量与睡眠质量及夜间运动不能感知之间的关联，在两个队列中使用帕金森病睡眠量表（PDSS - 2），在一个队列中使用关于夜间不动的问题。在一个队列中还使用移动健康技术对睡眠期间的运动进行了客观评估。
在对所有三个队列（总共n = 1124名PD患者）的独立分析中，服用控释左旋多巴的患者报告夜间运动不能的负担明显高于未服用左旋多巴的患者。更高的左旋多巴摄入量和MDS - UPDRS第四部分评分（表明运动波动）预示着更差的PDSS - 2评分和更高的主观夜间不动评分，而病程和疾病严重程度无预测作用。左旋多巴摄入量与睡眠期间客观的运动变化无关。
我们的结果表明，较高的左旋多巴摄入量与PD患者睡眠质量较差和夜间不动的感知相关，表明单独使用左旋多巴可能不适于改善PD患者夜间运动不能的主观感受。相比之下，左旋多巴摄入量与睡眠期间客观测量的运动无显著关联。有运动波动的PD患者可能特别受夜间运动主观感知的影响。本研究应推动对PD患者睡眠期间不动感知原因的进一步病理生理学和临床研究。
