Correlates of excessive daytime sleepiness in de novo Parkinson's disease: A case control study

Tanya Simuni*, Chelsea Caspell-Garcia, Christopher Coffey, Lama M. Chahine, Shirley Lasch, Wolfgang H. Oertel, Geert Mayer, Birgit Högl, Ron Postuma, Aleksandar Videnovic, Amy Willis Amara, Ken Marek, David Russell, Stewart Factor, Penelope Hogarth, David Standaert, Robert Hauser, Joseph Jankovic, Matthew Stern, Lama ChahineJames Leverenz, Samuel Frank, Irene Richard, Klaus Seppi, Holly Shill, Hubert Fernandez, Daniela Berg, Isabel Wurster, Douglas Galasko, Zoltan Mari, David Brooks, Nicola Pavese, Paolo Barone, Stuart Isaacson, Alberto Espay, Dominic Rowe, Melanie Brandabur, James Tetrud, Grace Liang, Alex Iranzo, Eduardo Tolosa, Laura Leary, Cheryl Riordan, Linda Rees, Alicia Portillo, Art Lenahan, Karen Williams, Stephanie Guthrie, Ashlee Rawlins, Sherry Harlan, Christine Hunter, Baochan Tran, Abigail Darin, Carly Linder, Marne Baca, Heli Venkov, Cathi Ann Thomas, Raymond James, Cheryl Deeley, Courtney Bishop, Fabienne Sprenger, Diana Willeke, Sanja Obradov, Jennifer Mule, Nancy Monahan, Katharina Gauss, Deborah Fontaine, Christina Gigliotti, McCoy Arita McCoy, Becky Dunlop, Bina Shah, Susan Ainscough, Angela James, Rebecca Silverstein, Kristy Espay, Madelaine Ranola, Claudia Trenkwalder, Alastair D. Reith, Arie Struyk, Bradley Boeve, Brian Harvey, Cindy Comella, David Tattersall, Madeline Kelly, Nancy Foldvary, Chelsea Caspell, Liz Uribe, Eric Foster, Katherine Gloer, Jon Yankey, Karl Kieburtz, Renee Wilson, Alice Rudolph, Cynthia Casaceli, Sherer Todd Sherer, Sohini Chowdhury, Mark Frasier, Catherine Kopil, Vanessa Arnedo, Norbert Schuff, Paola Casalin, Giulia Malferrari, John Trojanowski, Les Shaw, Andrew Singleton, Keith A. Hawkins, PPMI Sleep Working group on behalf of the PPMI Investigators

*Corresponding author for this work

    Research output: Contribution to journalArticlepeer-review

    74 Citations (Scopus)


    Objective: This study was undertaken to determine the frequency and correlates of excessive daytime sleepiness in de novo, untreated Parkinson's disease (PD) patients compared with the matched healthy controls. Methods: Data were obtained from the Parkinson's Progression Markers Initiative, an international study of de novo, untreated PD patients and healthy controls. At baseline, participants were assessed with a wide range of motor and nonmotor scales, including the Movement Disorder Society Unified Parkinson's Disease Rating Scale (MDS-UPDRS). Excessive daytime sleepiness was assessed based on the Epworth Sleepiness scale (ESS), with a cutoff of 10. Results: Four hundred twenty-three PD subjects and 196 healthy controls were recruited into the study. Mean ESS (min, max) score was 5.8 (0, 20) for the PD subjects and 5.6 (0, 19) for healthy controls (P=0.54). Sixty-six (15.6%) PD subjects and 24 (12%) healthy controls had ESS of at least 10 (P=0.28). No difference was seen in demographic characteristics, age of onset, disease duration, PD subtype, cognitive status, or utilization of sedatives between the PD sleepiness-positive versus the negative group. The sleepiness-positive group had higher MDS-UPDRS Part I and II but not III scores, and higher depression and autonomic dysfunction scores. Sleepiness was associated with a marginal reduction of A-beta (P=0.05) but not alpha-synuclein spinal fluid levels in PD. Conclusions: This largest case control study demonstrates no difference in prevalence of excessive sleepiness in subjects with de novo untreated PD compared with healthy controls. The only clinical correlates of sleepiness were mood and autonomic dysfunction. Ongoing longitudinal analyses will be essential to further examine clinical and biological correlates of sleepiness in PD and specifically the role of dopaminergic therapy.

    Original languageEnglish
    Pages (from-to)1371-1381
    Number of pages11
    JournalMovement Disorders
    Issue number10
    Publication statusPublished - 1 Sept 2015


    • Biomarkers
    • Daytime somnolence
    • Parkinson's disease


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