Antiparkinsonian drugs as potent contributors to nocturnal sleep in patients with Parkinson's disease.
Antiparkinsonian drugs as potent contributors to nocturnal sleep in patients with Parkinson's disease.
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DOI：
10.1371/journal.pone.0255274
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发表时间：
2021
期刊：
影响因子：
3.7
通讯作者：
Doyu M
中科院分区：
文献类型：
--
作者：
Taguchi S;Koide H;Oiwa H;Hayashi M;Ogawa K;Ito C;Nakashima K;Yuasa T;Yasumoto A;Ando H;Fujikake A;Fukuoka T;Tokui K;Izumi M;Tsunoda Y;Kawagashira Y;Okada Y;Niwa JI;Doyu M
目的：阐明抗帕金森药物是否会导致帕金森病患者夜间睡眠障碍。虽然已经发现主要的抗帕金森药物左旋多巴和多巴胺激动剂（DAs）对睡眠有影响，但对特定药物对PD患者睡眠的影响知之甚少。研究参与者包括112名PD患者（中位年龄72.5岁[四分位数范围：IQR 65-79]；平均病程8.44年[标准差：7.33]；中位Hoehn和Yahr期3 [IQR 2-3.75]），服用三种非麦角缓释DAs（罗替戈汀32；普拉克索44；罗匹尼罗36）中的一种，伴或不伴左旋多巴（抗帕金森药物中位每日总剂量525.5 mg [IQR 376.25-658]左旋多巴当量剂量[LED]）。参与者使用PD睡眠量表-2 （PDSS-2）进行评估。在整个PD患者队列中，PDSS-2睡眠障碍域评分、评估睡眠质量的第1项评分和评估夜尿症的第8项评分与抗帕金森药物的日总剂量和左旋多巴的剂量呈正相关，而与DAs的剂量无关。根据DA治疗的亚分析显示，DA剂量与任何亚组的第1项和第8项评分均无相关性。罗替戈汀占抗帕金森药物总剂量的LED比值与第1项得分呈负相关。这些数据表明，抗帕金森药物，特别是左旋多巴，会对PD患者的夜间睡眠产生不利影响，尤其是在睡眠质量和夜尿方面。因此，调整抗帕金森药物的总剂量和左旋多巴的剂量比可能是缓解PD患者睡眠质量差的关键措施。在DAs中，我们发现罗替戈汀的剂量比与睡眠质量有明显的正相关。因此，用罗替戈汀替代部分左旋多巴可以改善PD患者的睡眠质量。
To clarify whether antiparkinsonian drugs contribute to nocturnal sleep disturbances in patients with Parkinson’s disease (PD). Although the major antiparkinsonian drugs L-dopa and dopamine agonists (DAs) have been found to affect sleep, little is known about the effects of specific drugs on sleep in PD patients. The study participants consisted of 112 PD patients (median age 72.5 years [inter-quartile range: IQR 65–79]; mean disease duration 8.44 years [standard deviation: 7.33]; median Hoehn and Yahr stage 3 [IQR 2–3.75]) taking one of three types of non-ergot extended-release DAs (rotigotine 32; pramipexole 44; ropinirole 36) with or without L-dopa (median daily total dosage of antiparkinsonian drugs 525.5 mg [IQR 376.25–658] levodopa equivalent dose [LED]). Participants were assessed using the PD Sleep Scale-2 (PDSS-2). For the whole PD patient cohort, the PDSS-2 sleep disturbance domain score and the scores for item 1 assessing sleep quality and item 8 assessing nocturia were positively correlated with daily total dosage of antiparkinsonian drugs and dosage of L-dopa, but not with the dosage of DAs. Sub-analysis according to DA treatment revealed that DA dosage was not correlated with item 1 or 8 score in any of the subgroups. The LED ratio of rotigotine to the total dosage of antiparkinsonian drugs was inversely correlated with the item 1 score. These data suggest that antiparkinsonian drugs, in particular L-dopa, adversely affect nocturnal sleep in PD patients, especially in terms of sleep quality and nocturia. Thus, adjusting both the total dosage of antiparkinsonian drugs and the dose-ratio of L-dopa might be key actions for alleviating poor sleep quality in patients with PD. Among DAs, we found a clear positive correlation between the dose-ratio of rotigotine and sleep quality. Thus, partial L-dopa replacement with rotigotine could improve sleep quality in patients with PD.
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8.6
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