Excessive daytime sleepiness and sudden-onset sleep in Parkinson disease - A survey by the Canadian Movement Disorders Group
Excessive daytime sleepiness and sudden-onset sleep in Parkinson disease - A survey by the Canadian Movement Disorders Group
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DOI：
10.1001/jama.287.4.455
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发表时间：
2002-01-23
影响因子：
120.7
通讯作者：
Fleming, J
中科院分区：
文献类型：
--
作者：
Hobson, DE;Lang, AE;Fleming, J
背景嗜睡是多巴胺受体激动剂的一种公认的不良反应。据报道，两种新的多巴胺激动剂，普拉克索和罗匹尼罗，可导致帕金森病（PD）患者在驾驶时突然发作睡眠。这些法术的频率和驾驶是否应该被restricted.Objective确定的频率和预测突然发作的睡眠，特别是，发作的睡着了，而驾驶的患者之间的PD.Design，设置，和参与者前瞻性调查1月和2000年4月在18个诊所由加拿大运动障碍组的成员指导; 638连续高功能PD患者无痴呆症，其中420人目前drivers.Main结果措施过度白天嗜睡和突然发作的睡眠评估的埃普沃思嗜睡量表和不适当的睡眠综合评分。后一个分数是为这项研究设计的，涉及在不寻常的情况下入睡。这2个尺度结合在3个独立的格式打瞌睡，突然意外的睡眠，突然空白spells.Results过度白天嗜睡总体上存在于327（51%）的638名患者和213（51%）的420名司机。服用不同多巴胺受体激动剂的患者在埃普沃思嗜睡评分、综合评分或驾驶时无法入睡的风险方面没有差异。16例患者（3.8%）在驾驶时至少发生1次突然睡眠发作（诊断为PD后）; 3例患者（0.7%）在无警告的情况下发生。与开车时无法入睡相关的2个风险因素是埃普沃思嗜睡量表评分（比值比[OR]，1.14; 95%置信区间[CI]，1.06-1.24）和不适当睡眠综合评分（OR，2.54; 95% CI，1.76-3.66）。标准的埃普沃思嗜睡量表评分为7分或更高，预测75%的车轮后睡眠事件，特异性为50%（排除与驾驶相关的问题提供了70%的灵敏度和52%的特异性），而不适当睡眠综合评分为1分时，敏感性为52%，特异性为82%，结论即使在独立生活且未患痴呆的PD患者中，白天过度嗜睡也很常见。突然发作的睡眠没有警告是罕见的。埃普沃思评分对于预测驾驶时入睡障碍的既往发作具有足够的灵敏度，并且其特异性可以通过使用不适当睡眠综合评分来增加。目前尚不清楚常规进行这些评估是否可以更有效地预测这些罕见睡眠发作的未来风险。应警告患者在异常情况下打瞌睡时不要开车。
Context Somnolence is a recognized adverse effect of dopamine agonists. Two new dopamine agonists, pramipexole and ropinirole, have been reported to cause sudden-onset sleep spells in patients with Parkinson disease (PD) while they were driving. The frequency of these spells and whether driving should be restricted has yet to be established.Objective To determine the frequency of and predictors for sudden-onset sleep and, particularly, episodes of falling asleep while driving among patients with PD.Design, Setting, and Participants Prospective survey conducted between January and April 2000 in 18 clinics directed by members of the Canadian Movement Disorders Group; 638 consecutive highly functional PD patients without dementia were enrolled, of whom 420 were currently drivers.Main Outcome Measures Excessive daytime sleepiness and sudden-onset sleep as assessed by the Epworth Sleepiness Scale and the Inappropriate Sleep Composite Score. The latter score, designed for this study, addressed falling asleep in unusual circumstances. The 2 scales were combined in 3 separate formats dozing off, sudden unexpected sleep, and sudden blank spells.Results Excessive daytime sleepiness was present overall in 327 (51 %) of the 638 patients and in 213 (51%) of the 420 drivers. Patients taking a variety of different dopamine agonists had no differences in Epworth sleepiness scores, in the composite score, or in the risk of failing asleep while driving. Sixteen patients (3.8%) had experienced at least 1 episode of sudden onset of sleep while driving (after the diagnosis of PD); in 3 (0.7%), it occurred without warning. The 2 risk factors associated with failing asleep at the wheel were the Epworth Sleepiness Scale score (odds ratio [OR], 1.14; 95% confidence interval [CI], 1.06-1.24) and the Inappropriate Sleep Composite Score (OR, 2.54; 95% CI, 1.76-3.66). A standard Epworth Sleepiness Scale score of 7 or higher predicted 75% of episodes of sleep behind the wheel at a specificity of 50% (exclusion of the question related to driving provided 70% sensitivity and 52% specificity), whereas a score of 1 on the Inappropriate Sleep Composite Score generated a sensitivity of 52% and specificity of 82%.Conclusions Excessive daytime sleepiness is common even in patients with PD who are independent and do not have dementia. Sudden-onset sleep without warning is infrequent. The Epworth score has adequate sensitivity for predicting prior episodes of failing asleep while driving and its specificity can be increased by use of the Inappropriate Sleep Composite Score. It is unknown if routinely performing these assessments could be more effective in predicting future risk for these rare sleep attacks. Patients should be warned not to drive if they doze in unusual circumstances.