[The factors impact on the urgent daytime sleepiness degree in the Parkinson's disease].

Unlabelled: One of the main manifestations of excessive daytime sleepiness (EDS) among patients with Parkinson's disease is sudden-onset sleep (SOS). The SOS episodes could dramatically increase the traumatic ratio among those patients. The factors of SOS among PD patients are not well understood.

Objective: Describe the clinical and physiological features of patients with different types of SOS for detection of influencing factors of urgent EDS.

Material And Methods: 32 patients SOS positive (17 female) were included. The median age was 66.5±7.8; the median PD duration was 9.2±4.3 years (2.66±0.5 Hoehn-Yahr). The patients received the levodopa - dopamine receptors agonist combined medications. Moreover, the Unified Parkinson's disease rating scale (UPDRS parts II, III in an «on» state of dopaminergic medication), the diary of the assessment of the waking period, the Epworth Sleepiness Scale, the Parkinson Disease Sleep Scale I (PDSS I), the Scales for Outcomes of Parkinson's disease-Cognition (SCOPA-Cog), the Beck Depression Inventory, the State-Trait Anxiety Inventory, the Apathy Scale, the Stroop test, objective sleep-wake assessment: standard nocturnal video-polysomnography (PSG), multiple sleep latency tests (MSLT) were used. Besides, we compare patients' clinical and neuropsychological characteristics (especially EDS sense) before the SOS.

Results: 36% of patients describe the SOS without preexisting sleepiness (group 1). The short-time period of sleepiness notes approximately 64% SOS patients before the sleeping period (group 2). Group 1 has the less prominent activity of daily living compared to group 2. Moreover, group 1 patients have significantly lower subjective and objective severity of night sleep disorders (higher total score value of SOS BP, longer 3rd stage of sleep duration), lesser severity of the Epworth and apathy scale (<0.05). The group 2 patients with a low ability to resist the onset of SOS (less than 5 minutes) differed from patients with greater resistance. Firstly, by a greater degree of disturbances in daily activities (ASOBP, section 2), shorter latent periods 1, 3 stages, shorter duration of 1 stage of night sleep; more prominent anxiety, depression and impaired attention (<0.05). The narcoleptic-like falling asleep syndrome was diagnosed in 9 (28%) cases with SOS, without significant difference between the groups.

Conclusion: SOS among patients without EDS are an independent manifestation of PD. The degree of SOS urgency is affected by the severity of the activity of daily living, anxiety, depression, and attention disorders.