Daytime alertness in Parkinson's disease: potentially dose-dependent, divergent effects by drug class.
Daytime alertness in Parkinson's disease: potentially dose-dependent, divergent effects by drug class.
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DOI：
10.1002/mds.25082
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发表时间：
2012-08
影响因子：
8.6
通讯作者：
Rye, David B.
中科院分区：
文献类型：
--
作者：
Bliwise, Donald L.;Trotti, Lynn Marie;Wilson, Anthony G.;Greer, Sophia A.;Wood-Siverio, Cathy;Juncos, Jorge J.;Factor, Stewart A.;Freeman, Alan;Rye, David B.
许多特发性帕金森氏症患者难以保持白天的警觉。关于这是否反映了抗帕金森药物、疾病本身或其他因素（如夜间睡眠障碍）的影响，存在争议。在这项研究中，我们通过客观的多导睡眠图测量夜间睡眠和白天警觉性来评估接受药物治疗和未接受药物治疗的帕金森病患者，从而检验了这一现象。患者（n = 63）接受了一项48小时的实验室研究，包括连续2晚的夜间多导睡眠仪和2天的保持清醒测试。我们研究了警觉性个体差异的相关因素，包括人口统计学、临床特征、夜间睡眠变量以及抗帕金森药物的种类和剂量。结果表明：1)相对于未介导的患者，所有类型的多巴胺能药物均与白天警觉性降低相关，且这种作用不受疾病持续时间或疾病严重程度的介导；2)多巴胺激动剂剂量增加与白天警觉性降低相关，而左旋多巴剂量增加与白天警觉性升高相关。与维持清醒测试定义的白天警觉性无关的变量包括年龄、性别、诊断年份、运动损伤评分和大多数夜间睡眠变量。帕金森病患者在客观评估的白天警觉性方面的缺陷似乎是疾病和药物及其剂量的作用。不同药物作用下睡眠/觉醒周期的基础科学研究预测了帕金森病药物类别明显不同的剂量依赖效应。
Many patients with idiopathic Parkinson’s disease experience difficulties maintaining daytime alertness. Controversy exists regarding whether this reflects effects of anti-Parkinsonian medications, the disease itself or other factors such as nocturnal sleep disturbances. In this study we examined the phenomenon by evaluating medicated and unmedicated Parkinson’s patients with objective polysomnographic measurements of nocturnal sleep and daytime alertness. Patients (n = 63) underwent a 48-hour laboratory-based study incorporating 2 consecutive nights of overnight polysomnography and 2 days of Maintenance of Wakefulness Testing. We examined correlates of individual differences in alertness, including demographics, clinical features, nocturnal sleep variables and class and dosage of anti-Parkinson’s medications. Results indicated that: 1) relative to unmediated patients, all classes of dopaminergic medications were associated with reduced daytime alertness and this effect was not mediated by disease duration or disease severity; 2) increasing dosages of dopamine agonists were associated with less daytime alertness, whereas higher levels of levodopa were associated with higher levels of alertness. Variables unrelated to Maintenance of Wakefulness Test defined daytime alertness included age, sex, years with diagnosis, motor impairment score and most nocturnal sleep variables. Deficits in objectively assessed daytime alertness in Parkinson’s disease appear to be a function of both the disease and the medications and their doses utilized. The apparent divergent dose-dependent effects of drug class in Parkinson’s disease are anticipated by basic science studies of the sleep/wake cycle under different pharmacological agents.
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影响因子：
9.9
作者：
Ferreira, JJ;Galitzky, M;Rascol, O
通讯作者：
Rascol, O
影响因子：
4.4
作者：
Havlikova, Eva;van Dijk, Jitse P.;Groothoff, Johan W.
通讯作者：
Groothoff, Johan W.
影响因子：
168.9
作者：
Ferreira, JJ;Galitzky, M;Rascol, O
通讯作者：
Rascol, O
影响因子：
6
作者：
Baumann, C;Ferini-Strambi, L;Bassetti, CL
通讯作者：
Bassetti, CL
影响因子：
120.7
作者：
Hobson, DE;Lang, AE;Fleming, J
通讯作者：
Fleming, J