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Contributions of Dopaminergic Drugs and Disease Severity to Daytime Sleepiness in Parkinson Disease
Padraig E. O'Suilleabhain, MB;
Richard B. Dewey, Jr, MD
Arch Neurol. 2002;59:986-989.
Background Excessive daytime somnolence is a common report among patients who have
Parkinson disease (PD). The relative contributions of disease severity and
of the various dopaminergic drugs are unclear.
Objective To separate and quantify the contributions of disease markers and drug
doses.
Methods Patients seen during a 7-month period at a center for movement disorders
completed the Epworth Sleepiness Scale. Treatment subgroups were compared.
The relationship to sedation of age; dopaminergic drug classes and doses;
Hoehn and Yahr stage; duration of disease; total score on the motor subsection
of the Unified Parkinson Disease Rating Scale; and the presence or absence
of dementia, depression, or hallucinations was calculated using simple and
multiple regression and t tests.
Results The Epworth Sleepiness Scale scores were higher among patients with
PD (mean [SD], 10.8 [5.3]; n = 368) compared with patients with other neurological
disorders (mean, 8.5 [5.1]; n = 243; P<.001).
A model containing the Hoehn and Yahr stage, levodopa dose, and use of a dopamine
agonist was the best at predicting the total score of Epworth Sleepiness Scale
in patients who have PD, but accounted for only 9% of the interindividual
variance. The parameter estimates (SE) corresponded to a 1.02 (0.03)–point
increase per Hoehn and Yahr stage, a 0.14 (0.06)–point increase per
100-mg increase in levodopa dose over 24 hours, and a 2.33 (0.57)-point increase
with use of an agonist. There was no statistically significant dose response
for agonists. No statistically significant difference in sedation among the
commonly used dopamine agonists was found.
Conclusions Somnolence in patients with PD, which is on average 25% higher than
in other neurological diseases, is related to PD stage, levodopa dose, and
the use of a dopamine agonist. However, most of the variability in sedation
levels in patients with PD as well as in controls is the result of, as yet,
unidentified factors.
From the Clinical Center for Movement Disorders, Department of Neurology,
University of Texas Southwestern Medical School, Dallas.
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