Excessive Daytime Sleepiness

  • David E. Hardesty
  • Daryl Victor
  • Steven J. Frucht
Part of the Current Clinical Neurology book series (CCNEU)

Abstract

Excessive daytime sleepiness (EDS) is common in patients with Parkinson’s disease (PD) and can lead to serious medical consequences, including depression, cognitive impairment, and death or injury from sleeprelated accidents. It can also have a deleterious impact on social functions such as work and marriage. To successfully prevent or remedy such negative outcomes, it is important to periodically screen PD patients for EDS. The Epworth Sleepiness Scale (ESS), which can be completed in about 5 minutes, is a reasonable screening tool when used in conjunction with a focused history. When EDS is present, assessment of safety is a priority, and recommendations should be clearly stated to the patient. Next, an underlying cause of EDS can often be identified. Obstructive sleep apnea (OSA) is a common and treatable cause of EDS in the general population. Patients with PD are also at increased risk for other sleep disorders that cause EDS, such as rapid eye movement (REM), sleep behavioral disorder, and insomnia. PD symptoms can directly cause EDS by dramatically reducing sleep quality. PD treatment can cause EDS directly, or cause hallucinations and dyskinesias that similarly interfere with sleep. Furthermore, medications that reduce these side effects also cause somnolence. Finally, the underlying pathophysiology of PD also appears to directly cause EDS. Polysomnography may be needed to clarify the etiology of EDS, but often history and physical examination can lead to correct diagnosis and specific treatment. When no cause can be found, or treatment is unsuccessful, it may be appropriate to treat patients with wakefulness-promoting agents. Our goal is to provide the clinician with a rational, flexible, and cost-effective approach to evaluate and manage EDS in patients with PD. Sleep attacks and driving are additional issues that we discuss at the end of this chapter

Key Words

Parkinson’s disease (PD) excessive daytime sleepiness (EDS) somnolence hypersomnolence Epworth Sleepiness Scale polysomnography sleep attacks 

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Copyright information

© Humana Press Inc., Totowa, NJ 2005

Authors and Affiliations

  • David E. Hardesty
    • 1
  • Daryl Victor
    • 1
  • Steven J. Frucht
    • 1
  1. 1.Department of NeurologyColumbia UniversityNew York

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