Sleepiness and Sleepiness Perception in Patients with Parkinson's Disease: A Clinical and Electrophysiological Study.
Bargiotas P, Lachenmayer ML, Schreier DR, Mathis J, Bassetti CL.
Sleep. 2019 Jan 12. doi: 10.1093/sleep/zsz004. [Epub ahead of print]
PMID: 30649557

The main objective of the study was to assess the prevalence, the severity and the daytime course of excessive daytime sleepiness (EDS) in advanced Parkinson's disease (PD) and to explore how PD patients perceive the degree and onset of their sleepiness during objective sleepiness tests. In addition, the occurrence of early-onset REM periods (SOREMPs) in PD was assessed.
We analyzed data from 46 PD patients (26 males, mean age 63.5 years, mean UPDRS-III-OFF 34.7). The sleep-wake assessment included Epworth (ESS) and Karolinska (KSS) sleepiness scales and objective (polysomnography, MSLT, MWT) measures.
Subjective (ESS≥10) and objective (mean sleep latency, MSL<5 minutes in MSLT) EDS were present in 43% and 41% of patients respectively. The MSL in MSLT and MWT remained unchanged throughout the day and significantly correlated with KSS during the trial but not with KSS shortly before it. In MWT, about one-fourth of patients failed to signal their sleepiness before falling asleep. SOREMPs, usually (83%) arising from NREM1 or wake, were recorded in 24% of the patients. Patients with SOREMPs had significantly lower MSL in MSLT and MWT and higher AHI compared to those without SOREMPs.
PD patients exhibit daylong increased EDS but they underestimate its degree and often fail to signal its onset. SOREMPs in PD have a "narcoleptic" character in sleep stage sequencing and are associated with the presence of sleep-disturbed breathing. These results add to our understanding of sleepiness and sleepiness perception in PD and have important implications for its diagnosis and management.
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