Department of Systems Medicine, University of Rome "Tor Vergata", Via Montpellier 1, 00133, Rome, Italy.
Department of Systems Medicine, University of Rome "Tor Vergata", Via Montpellier 1, 00133, Rome, Italy; Parkinson's Disease Unit, University Hospital of Rome "Tor Vergata", Viale Oxford 81, 00133, Rome, Italy.
Parkinsonism Relat Disord. 2024 Oct;127:107103. doi: 10.1016/j.parkreldis.2024.107103. Epub 2024 Aug 13.
Sleep problems commonly occur in Parkinson's disease (PD) and significantly affect patients' quality of life. A possible effect on subjective sleep disturbances of monoamine oxidase-B inhibitors (MAOB-Is) has been described.
This prospective, observational, single-centre study involved 45 fluctuating PD patients complaining sleep problems as documented by the PD Sleep Scale -2nd version (PDSS-2 ≥18) starting rasagiline 1 mg/daily or safinamide 100 mg/daily, according to common clinical practice, and maintaining antiparkinsonian therapy unchanged. Polysomnography (PSG), sleep questionnaires (PDSS-2, Epworth Sleepiness Scale - ESS), and motor function were evaluated at baseline (T0) and after 4 months of treatment (T1).
Safinamide was prescribed in thirty patients and rasagiline in fifteen patients. Both drugs induced a significant improvement in Movement Disorder Society Unified PD Rating Scale III scores. Patients treated with rasagiline showed a significant increase in stage 1 (N1) Non-REM sleep compared to T0, with no significant effects on sleep scales. Patients treated with safinamide showed a significant increase in stage 3 of Non-REM sleep and sleep efficiency and a reduction in the rate of periodic limb movements, matching a significant reduction in PDSS-2 and ESS scales compared to T0.
This study showed that safinamide, in addition to having a significant effect on PD motor symptoms, like the other MAOB-Is, may exert a specific beneficial effect on subjective and objective sleep, probably driven by its dual mechanism of action, which involves both dopaminergic and glutamatergic neurotransmission.
睡眠问题在帕金森病（PD）中很常见，严重影响患者的生活质量。已经描述了单胺氧化酶-B 抑制剂（MAOB-Is）对主观睡眠障碍的可能影响。
这项前瞻性、观察性、单中心研究纳入了 45 例伴有睡眠问题的波动型 PD 患者，这些患者的睡眠问题已通过 PD 睡眠量表-第 2 版（PDSS-2≥18）记录下来，这些患者开始每天服用 1 毫克雷沙吉兰或 100 毫克沙芬酰胺，具体取决于常规临床实践，同时保持抗帕金森病治疗不变。在基线（T0）和治疗 4 个月后（T1）进行多导睡眠图（PSG）、睡眠问卷（PDSS-2、Epworth 嗜睡量表-EES）和运动功能评估。
在 30 例患者中开了沙芬酰胺，在 15 例患者中开了雷沙吉兰。两种药物均显著改善了运动障碍协会统一帕金森病评定量表第 3 部分评分。与 T0 相比，接受雷沙吉兰治疗的患者 N1 期非快速眼动睡眠（stage 1，N1）显著增加，但睡眠量表无显著变化。接受沙芬酰胺治疗的患者非快速眼动睡眠的第 3 期和睡眠效率显著增加，周期性肢体运动率降低，与 PDSS-2 和 EES 量表相比，T0 显著降低。
这项研究表明，沙芬酰胺除了像其他 MAOB-Is 一样对 PD 运动症状有显著作用外，可能对主观和客观睡眠有特定的有益作用，这可能是其双重作用机制的结果，该机制涉及多巴胺能和谷氨酸能神经传递。
