Journal of Neurology

, 254:1037 | Cite as

Association of daytime sleepiness with nigrostriatal dopaminergic degeneration in early Parkinson's disease

  • Svenja Happe
  • Paul Christian Baier
  • Kathrin Helmschmied
  • Johannes Meller
  • Klaus Tatsch
  • Walter Paulus



Many patients with Parkinson's disease (PD) report daytime sleepiness. Its etiology, however, is still not fully understood. The aim of this study was to examine if the amount of nigrostriatal dopaminergic degeneration is associated with subjective daytime sleepiness in patients with PD.

Patients and methods

We investigated 21 patients with PD clinically and by means of [123I] FP-CIT-SPECT (DaTSCANR). Each patient filled in the Epworth sleepiness scale (ESS), the Parkinson's Disease Sleep Scale (PDSS), and the self-rating depression scale according to Zung (SDS) to assess sleepiness, sleep quality, and depressive symptoms.


The mean specific dopamine transporter binding in the 21 PD patients (60.8 ± 10.4 years, nine females, median Hoehn and Yahr stage 2.0) was decreased. Nine patients were in Hoehn and Yahr stage 1 (58.7 ± 6.6 years, four females; ESS score 7.4 ± 4.5; PDSS score 105.1 ± 30.9), the other 12 patients were in Hoehn and Yahr stage 2 (62.4 ± 12.6 years, five females; ESS score 6.7 ± 4.7, PDSS score 97.1 ± 25.6). Age, gender, ESS, and PDSS scores were not significantly different in both groups. However, ESS scores showed an inverse correlation with mean DAT binding in the striatum (r = -0.627, p = 0.03), the caudate nucleus (r = -0.708, p = 0.01), and the putamen (r = -0.599, p = 0.04) in patients with Hoehn and Yahr stage 2. There was no correlation of the ESS score with age, disease duration, UPDRS motor score, PDSS score, or depression score.


Subjective daytime sleepiness seems to be associated with dopaminergic nigrostriatal degeneration in early PD.

Key words

Parkinson's disease sleepiness Epworth sleepiness scale (ESS) SPECT dopamine transporter 


  1. 1.
    Lees AJ, Blackburn NA, Campbell VL (1988) The nighttime problems of Parkinson's disease. Clin Neuropharmacol 11:512–19CrossRefPubMedGoogle Scholar
  2. 2.
    Abbott RD, Ross GW, White LR, Tanner CM, Masaki KH, Nelson JS, Curb JD, Petrovich H (2005) Excessive daytime sleepiness and subsequent development of Parkinson's disease. Neurology 65:1442–446CrossRefPubMedGoogle Scholar
  3. 3.
    Frucht S, Rogers JD, Greene PE, Gordon MF, Fahn S (1999) Falling asleep at the wheel: motor vehicle mishaps in persons taking pramipexole and ropinirole. Neurology 52:1908–910PubMedGoogle Scholar
  4. 4.
    Happe S, Trenkwalder C (2005) Sleep disorders in Parkinson's disease. In: Ebadi M, Pfeiffer R (eds) Parkinson's disease. CRC Press LLC, Boca Raton, USA, pp 217–27Google Scholar
  5. 5.
    Ryan M, Slevin JD, Wells A (2000) Non-ergot dopamine agonist-induced sleep attacks. Pharmacotherapy 20:724–26CrossRefPubMedGoogle Scholar
  6. 6.
    Happe S, Berger K (2001) The association of dopamine agonists with daytime sleepiness, sleep problems and quality of life in patients with Parkinson's disease. a prospective study. J Neurol 248:1062–067CrossRefPubMedGoogle Scholar
  7. 7.
    Pal S, Bhattacharya KF, Agapito C, Chaudhuri KR (2001) A study of excessive daytime sleepiness and its clinical significance in three groups of Parkinson's disease patients taking pramipexole, cabergoline and levodopa mono and combination therapy. J Neural Transm 108:71–7CrossRefPubMedGoogle Scholar
  8. 8.
    Arnulf I, Konofal E, Merino-Andreu M, Houeto JL, Mesnage V, Welter ML, Lacomblez L, Golmard JL, Derenne JP, Agid Y (2002) Parkinson's disease and sleepiness: an integral part of PD. Neurology 58:1019–024PubMedGoogle Scholar
  9. 9.
    Braak H, Rüb U, Gai WP, Del Tredici K (2003) Idiopathic Parkinson's disease: possible routes by which vulnerable neuronal types may be subject to neuroinvasion by an unknown pathogen. J Neural Transm 110:517–36CrossRefPubMedGoogle Scholar
  10. 10.
    Del Tredici K, Rüb U, De Vos RA, Bohl JR, Braak H (2002) Where does Parkinson's disease pathology begin in the brain? Neuropathol Exp Neurol 61:413–26Google Scholar
  11. 11.
    Johns MW (1991) A new method for measuring daytime sleepiness: the Epworth sleepiness scale. Sleep 14:540–45PubMedGoogle Scholar
  12. 12.
    Gibb WR, Lees AJ (1988) The relevance of Lewy body to the pathogenesis of idiopathic Parkinson's disease. J Neurol Neurosurg Psychiatry 51:745–52CrossRefPubMedGoogle Scholar
  13. 13.
    Hughes AJ, Daniel SE, Kilford L, Lees AJ (1992) Accuracy of clinical diagnosis of idiopathic Parkinson's disease: a clinico-pathological study of 100 cases. J Neurol Neurosurg Psychiatry 55:181–84CrossRefPubMedGoogle Scholar
  14. 14.
    Hughes AJ, Daniel SE, Lees AJ (2001) Improved accuracy of clinical diagnosis of Lewy body Parkinson's disease. Neurology 57:1497–499PubMedGoogle Scholar
  15. 15.
    Hoehn MM, Yahr MD (1967) Parkinsonism; onset, progression and mortality. Neurology 17:427–67PubMedGoogle Scholar
  16. 16.
    Fahn S, Elton RL and members of the UPDRS development committee (1987) Unified Parkinson's disease rating scale. In: Fahn S, Marsden CD, Calne DB, Lieberman A (eds) Recent developments in Parkinson's disease. Florham Park, NJ: MacMillan Health Care Information, pp 153–63Google Scholar
  17. 17.
    Koch W, Radau PE, Hamann C, Tatsch K (2005) Clinical testing of an optimized software solution for an automated, observer-independent evaluation of dopamine transporter SPECT studies. J Nucl Med 46:1109–118PubMedGoogle Scholar
  18. 18.
    Chaudhuri KR, Pal S, DiMarco A, Whately-Smith C, Bridgman K, Mathew R, Pezzela FR, Forbes A, Högl B, Trenkwalder C (2002) The Parkinson's disease sleep scale: a new instrument for assessing sleep and nocturnal disability in Parkinson's disease. J Neurol Neurosurg Psychiatry 73:629–33CrossRefPubMedGoogle Scholar
  19. 19.
    Zung WWK (1972) The depression status inventory: an adjunct to the selfrating depression scale. J Clin Psychol 28:539–43CrossRefPubMedGoogle Scholar
  20. 20.
    Klawans HL, Goetz C, Nausieda PA, Weiner WJ (1977) Levodopa-induced dopamine receptor hypersensitivity. Trans Am Neurol Assoc 102:80–3PubMedGoogle Scholar
  21. 21.
    Kaasinen V, Aalto S, Någren K, Hietala J, Sonninen P, Rinne JO (2003) Extrastriatal dopamine D2 receptors in Parkinson's disease: a longitudinal study. J Neural Transm 110:591–01CrossRefPubMedGoogle Scholar
  22. 22.
    Kaasinen V, Någren K, Hietala J, Oikonen V, Vilkman H, Farde L, Halldin C, Rinne JO (2000) Extrastriatal dopamine D2 and D3 receptors in early and advanced Parkinson's disease. Neurology 54:1482–484PubMedGoogle Scholar
  23. 23.
    Baier PC, Branisa P, Koch R, Schindehütte J, Paulus W, Trenkwalder S (2006) Circadian distribution of motoractivity in unilaterally 6-hydroxydopamine lesioned rats. Exp Brain Res 169:283–88CrossRefPubMedGoogle Scholar
  24. 24.
    Eisensehr I, Linke R, Noachtar S, Schwarz J, Gildehaus FJ, Tatsch K (2000) Reduced striatal dopamine transporters in idiopathic rapid eye movement sleep behavior disorder. Comparison with Parkinson's disease and controls. Brain 123:1155–160CrossRefPubMedGoogle Scholar
  25. 25.
    Eisensehr I, Linke R, Tatsch K, Kharraz B, Gildehaus JF, Wetter CT, Trenkwalder C, Schwarz J, Noachtar S (2003) Increased muscle activity during rapid eye movement sleep correlates with decrease of striatal presynaptic dopamine transporters. IPT and IBZM SPECT imaging in subclinical and clinically manifest idiopathic REM sleep behavior disorder, Parkinson's disease, and controls. Sleep 26:507–12PubMedGoogle Scholar
  26. 26.
    Benamer HT, Patterson J, Wyper DJ, Hadley DM, Macphee GJ, Grosset DG (2000) Correlation of Parkinson's disease severity and duration with 123IFP-CIT SPECT striatal uptake. Mov Disord 15:692–98CrossRefPubMedGoogle Scholar
  27. 27.
    Tatsch K, Schwarz J, Mozley PD, Linke R, Pogarell O, Oertel WH, Fieber RS, Hahn K, Kung HF (1997) Relationship between clinical features of Parkinson's disease and presynaptic dopamine transporter binding assessed with [123I]IPT and single-photon emission tomography. Eur J Nucl Med 24:415–21PubMedGoogle Scholar
  28. 28.
    Rye DB (2006) Excessive daytime sleepiness and unintended sleep in Parkinson's disease. Curr Neurol Neurosci Rep 6:169–76CrossRefPubMedGoogle Scholar
  29. 29.
    Romiti A, Brusa L, Marciani MG, Pierantozzi M, Placidi F, Izzi F, Sperli F, Testa F, Stanzione P (2005) Sleep episodes and daytime somnolence as result of individual susceptibility to different dopaminergic drugs in a PD patient: a polysomnographic study. J Neurol Sci 228:7–0CrossRefGoogle Scholar

Copyright information

© Steinkopff-Verlag 2007

Authors and Affiliations

  • Svenja Happe
    • 1
    • 2
  • Paul Christian Baier
    • 1
  • Kathrin Helmschmied
    • 1
  • Johannes Meller
    • 3
  • Klaus Tatsch
    • 4
  • Walter Paulus
    • 1
  1. 1.Dept. of Clinical NeurophysiologyUniversity of GöttingenGöttingenGermany
  2. 2.Dept. of Clinical NeurophysiologyKlinikum Bremen-Ost, University of GöttingenBremenGermany
  3. 3.Dept. of Nuclear MedicineUniversity of GöttingenGöttingenGermany
  4. 4.Dept. of Nuclear MedicineLudwig-Maximilians-UniversityMunichGermany

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