Sleep attacks, daytime sleepiness, and dopamine agonists in Parkinson's disease
Sleep attacks, daytime sleepiness, and dopamine agonists in Parkinson's disease
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DOI：
10.1002/mds.10417
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发表时间：
2003-06-01
影响因子：
8.6
通讯作者：
Wüllner, U
中科院分区：
文献类型：
--
作者：
Paus, S;Brecht, HM;Wüllner, U
为了研究多巴胺激动剂与帕金森氏病(PD)患者睡眠发作的可能关联及其与日间嗜睡的关系，我们对德国两个县的2952名PD患者进行了调查。在177名患者中，在从事某些活动时突然、意外和不可抗拒的睡眠发作在结构化的电话采访中被识别出来。其中91名患者否认出现了适当的警告迹象。共有133名患者(75%)的Epworth嗜睡量表(ESS)评分为10；65(37%)>；15。31名患者(18%)的ESS评分小于或等于10，但经历过无征兆的睡眠发作。因此，尽管使用ESS可以确定有睡眠发作风险的患者的很大比例，但大约1%的PD患者群体似乎在没有适当的警告信号和没有伴随日间嗜睡的情况下面临睡眠发作的风险。所有在德国销售的多巴胺激动剂(α-二氢麦角隐亭、溴隐亭、卡麦角林、利尿胺、培高利特、普拉克索、罗匹罗尔)都会发生睡眠发作，麦角类和非麦角类药物之间没有明显差异。左旋多巴(L-多巴)单一治疗的睡眠发作风险最低(2.9%；95%可信区间为1.7-4.0%)，其次是多巴胺激动剂单一治疗(5.3%；95%CI，1.5-9.2%)和L-多巴与多巴胺激动剂的联合治疗(7.3%；95%CI，6.1-8.5%)。选择线、金刚烷胺或恩塔卡彭似乎都不会影响睡眠发作的发生。ESS评分高、多巴胺激动剂摄入量、帕金森病持续时间是睡眠发作的主要影响因素。多巴胺激动剂治疗的优势比为2.9，而L多巴治疗的优势比为1.9，病程延长一年的优势比为1.05。(C)2003年行动障碍会。
To study the putative association of dopamine agonists with sleep attacks in patients with Parkinson's disease (PD) and their relation to daytime sleepiness, we performed a survey of 2,952 PD patients in two German counties. In 177 patients, sudden, unexpected, and irresistible sleep episodes while engaged in some activity were identified in a structured telephone interview. Ninety-one of these patients denied the occurrence of appropriate warning signs. A total of 133 patients (75%) had an Epworth Sleepiness Scale (ESS) score >10; 65 (37%) >15. Thirty-one patients (18%) had an ESS score less than or equal to10 and yet experienced sleep attacks without warning signs. Thus, although a significant proportion of patients at risk for sleep attacks might be identified using the ESS, roughly 1% of the PD patient population seems to be at risk for sleep attacks without appropriate warning signs and without accompanying daytime sleepiness. Sleep attacks occurred with all dopamine agonists marketed in Germany (alpha-dihydroergocryptine, bro-mocriptine, cabergoline, lisuride, pergolide, pramipexole, ropimrole), and no significant difference between ergot and nonergot drugs was evident. Levodopa (L-dopa) monotherapy carried the lowest risk for sleep attacks (2.9%; 95% confidence interval [CI], 1.7-4.0%) followed by dopamine agonist monotherapy (5.3%; 95% Cl, 1.5-9.2%) and combination Of L-dopa and a dopamine agonist (7.3%; 95% Cl, 6.1-8.5%). Neither selege-line nor amantadine or entacapone appeared to influence the occurrence of sleep attacks. A high ESS score, intake of dopamine agonists, and duration of PD were the main influencing factors for the occurrence of sleep attacks. The odds ratio for dopamine agonist therapy was 2.9 compared to 1.9 with L-dopa therapy and 1.05 for a 1-year-longer disease duration. (C) 2003 Movement Disorder Society.