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Obstructive sleep apnea in Parkinson’s disease patients: effect of Sinemet CR taken at bedtime

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Abstract

Purpose

Obstructive sleep apnea (OSA) results from upper airway (UA) obstruction. In Parkinson’s disease (PD), levodopa improves UA obstruction during wakefulness. We hypothesized that bedtime controlled-release levodopa (Sinemet CR) is associated with less severe OSA (lower apnea-hypopnea index [AHI]) in PD patients.

Methods

Idiopathic PD subjects underwent nocturnal polysomnography (PSG) and were divided into those taking bedtime Sinemet CR (SinCR+) and those not taking Sinemet CR (SinCR−). Outcomes were compared between groups for PSG recordings analyzed in whole and split at their mid-point with each half analyzed separately, using linear regression.

Results

Fifty-seven subjects were studied, eight SinCR+, and 49 SinCR−. They were 65 % male, aged 64.4 ± 10.3 years (mean ± SD), with body mass index 27.26 ± 3.98 kg/m2. The whole night AHI was 15.6 ± 13.3 and 29.1 ± 20.8 in SinCR+ and SinCR−, respectively (p = 0.07 unadjusted, p = 0.11 adjusted for confounders). A similar trend was observed in the first half of the night. In the second half, the SinCR+ group had significantly lower AHI (beta = −18.8; p = 0.01 adjusted) and respiratory arousal index (beta = −14.2; p = 0.02 adjusted) than the SinCR− group.

Conclusions

Bedtime Sinemet CR appears to reduce OSA in PD patients. There were no significant differences between groups in the first half of the night likely because of residual effects of short-acting levodopa in both groups, while Sinemet CR had residual effect in the second half. These results possibly provide an alternative to help manage OSA and improve sleep quality in PD patients.

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References

  1. Barone P, Antonini A, Colosimo C, Marconi R, Morgante L, Avarello TP, Bottacchi E, Cannas A, Ceravolo G, Ceravolo R, Cicarelli G, Gaglio RM, Giglia RM, Iemolo F, Manfredi M, Meco G, Nicoletti A, Pederzoli M, Petrone A, Pisani A, Pontieri FE, Quatrale R, Ramat S, Scala R, Volpe G, Zappulla S, Bentivoglio AR, Stocchi F, Trianni G, Dotto PD (2009) The PRIAMO study: a multicenter assessment of nonmotor symptoms and their impact on quality of life in Parkinson’s disease. Mov Disord : Off J Mov Disord Soc 24(11):1641–1649. doi:10.1002/mds.22643

    Article  Google Scholar 

  2. Neikrug AB, Liu L, Avanzino JA, Maglione JE, Natarajan L, Bradley L, Maugeri A, Corey-Bloom J, Palmer BW, Loredo JS, Ancoli-Israel S (2014) Continuous positive airway pressure improves sleep and daytime sleepiness in patients with Parkinson disease and sleep apnea. Sleep 37(1):177–185. doi:10.5665/sleep.3332

    PubMed  PubMed Central  Google Scholar 

  3. Cochen De Cock V, Abouda M, Leu S, Oudiette D, Roze E, Vidailhet M, Similowski T, Arnulf I (2010) Is obstructive sleep apnea a problem in Parkinson’s disease? Sleep Med 11(3):247–252. doi:10.1016/j.sleep.2009.05.008

    Article  PubMed  Google Scholar 

  4. Maria B, Sophia S, Michalis M, Charalampos L, Andreas P, John ME, Nikolaos SM (2003) Sleep breathing disorders in patients with idiopathic Parkinson’s disease. Respir Med 97(10):1151–1157

    Article  PubMed  Google Scholar 

  5. Chotinaiwattarakul W, Dayalu P, Chervin RD, Albin RL (2011) Risk of sleep-disordered breathing in Parkinson’s disease. Sleep breathing = Schlaf & Atmung 15(3):471–478. doi:10.1007/s11325-010-0362-3

    Article  Google Scholar 

  6. Trotti LM, Bliwise DL (2010) No increased risk of obstructive sleep apnea in Parkinson’s disease. Mov Disord Off J Mov Disord Soc 25(13):2246–2249. doi:10.1002/mds.23231

    Article  Google Scholar 

  7. Kendzerska T, Mollayeva T, Gershon AS, Leung RS, Hawker G, Tomlinson G (2014) Untreated obstructive sleep apnea and the risk for serious long-term adverse outcomes: a systematic review. Sleep Med Rev 18(1):49–59. doi:10.1016/j.smrv.2013.01.003

    Article  PubMed  Google Scholar 

  8. Mery VP, Lafontaine AL, Robinson A, Pinto L, Benedetti A, Kimoff RJ, Kaminska M (2013) Impact of sleep disordered breathing on non-motor symptoms of patients with Parkinson’s disease. Am J Respir Crit Care Med 187:A2037

    Google Scholar 

  9. Gaudette E. KRJ (2010) Pathophysiology of OSA. In: McNicholas W.T. BMR (ed) European Respiratory Monograph 50 : Sleep Apnoea, vol 50. European Respiratory Society, U.K

  10. Sabate M, Gonzalez I, Ruperez F, Rodriguez M (1996) Obstructive and restrictive pulmonary dysfunctions in Parkinson’s disease. J Neurol Sci 138(1-2):114–119

    Article  CAS  PubMed  Google Scholar 

  11. Vincken WG, Darauay CM, Cosio MG (1989) Reversibility of upper airway obstruction after levodopa therapy in Parkinson’s disease. Chest 96(1):210–212

    Article  CAS  PubMed  Google Scholar 

  12. Herer B, Arnulf I, Housset B (2001) Effects of levodopa on pulmonary function in Parkinson’s disease. Chest 119(2):387–393

    Article  CAS  PubMed  Google Scholar 

  13. Goetz CG, Tanner CM, Shannon KM, Carroll VS, Klawans HL, Carvey PM, Gilley D (1988) Controlled-release carbidopa/levodopa (CR4-Sinemet) in Parkinson’s disease patients with and without motor fluctuations. Neurology 38(7):1143–1146

    Article  CAS  PubMed  Google Scholar 

  14. Sinemet CR - Monographie de produit (2008) Accessed on December 10th 2014. http://www.bmscanada.ca/static/products/fr/pm_pdf/Sinemet_CR_FR_PM.pdf

  15. Sage JI, Mark MH (1994) Pharmacokinetics of continuous-release carbidopa/levodopa. Clin Neuropharmacol 17(Suppl 2):S1–S6

    PubMed  Google Scholar 

  16. Stocchi F, Barbato L, Nordera G, Berardelli A, Ruggieri S (1998) Sleep disorders in Parkinson’s disease. J Neurol 245(Suppl 1):S15–S18

    Article  PubMed  Google Scholar 

  17. 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(3):181–184

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  18. Reichmann H (2010) Clinical criteria for the diagnosis of Parkinson’s disease. Neurodegener Dis 7(5):284–290. doi:10.1159/000314478

    Article  PubMed  Google Scholar 

  19. Scaglione C, Vignatelli L, Plazzi G, Marchese R, Negrotti A, Rizzo G, Lopane G, Bassein L, Maestri M, Bernardini S, Martinelli P, Abbruzzese G, Calzetti S, Bonuccelli U, Provini F, Coccagna G (2005) REM sleep behaviour disorder in Parkinson’s disease: a questionnaire-based study. Neurol Sci Off J Ital Neurol Soc Ital Soc Clin Neurophysiol 25(6):316–321. doi:10.1007/s10072-004-0364-7

    CAS  Google Scholar 

  20. Allen RP, Burchell BJ, MacDonald B, Hening WA, Earley CJ (2009) Validation of the self-completed Cambridge-Hopkins questionnaire (CH-RLSq) for ascertainment of restless legs syndrome (RLS) in a population survey. Sleep Med 10(10):1097–1100. doi:10.1016/j.sleep.2008.10.007

    Article  PubMed  Google Scholar 

  21. Goetz CG, Tilley BC, Shaftman SR, Stebbins GT, Fahn S, Martinez-Martin P, Poewe W, Sampaio C, Stern MB, Dodel R, Dubois B, Holloway R, Jankovic J, Kulisevsky J, Lang AE, Lees A, Leurgans S, LeWitt PA, Nyenhuis D, Olanow CW, Rascol O, Schrag A, Teresi JA, van Hilten JJ, LaPelle N (2008) Movement Disorder Society-sponsored revision of the Unified Parkinson’s Disease Rating Scale (MDS-UPDRS): scale presentation and clinimetric testing results. Mov Disord Off J Mov Disord Soc 23(15):2129–2170. doi:10.1002/mds.22340

    Article  Google Scholar 

  22. Miller MR, Crapo R, Hankinson J, Brusasco V, Burgos F, Casaburi R, Coates A, Enright P, van der Grinten CP, Gustafsson P, Jensen R, Johnson DC, MacIntyre N, McKay R, Navajas D, Pedersen OF, Pellegrino R, Viegi G, Wanger J (2005) General considerations for lung function testing. Eur Respir J 26(1):153–161. doi:10.1183/09031936.05.00034505

    Article  CAS  PubMed  Google Scholar 

  23. Iber C, Ancoli-Israel S, Chesson A, Quan SF, American Academy of Sleep Medicine (2007) The AASM Manual for the Scoring of Sleep and Associated Events: rules, terminology and technical specifications, 1st edn. American Academy of Sleep Medicine, Westchester, Illinois

    Google Scholar 

  24. (1999) Sleep-related breathing disorders in adults: recommendations for syndrome definition and measurement techniques in clinical research. The Report of an American Academy of Sleep Medicine Task Force. Sleep 22 (5):667-689

  25. Tomlinson CL, Stowe R, Patel S, Rick C, Gray R, Clarke CE (2010) Systematic review of levodopa dose equivalency reporting in Parkinson’s disease. Mov Disord Off J Mov Disord Soc 25(15):2649–2653. doi:10.1002/mds.23429

    Article  Google Scholar 

  26. LeWitt PA (1992) Clinical studies with and pharmacokinetic considerations of sustained-release levodopa. Neurology 42(1 Suppl 1):29–32, discussion 57-60

    CAS  PubMed  Google Scholar 

  27. Breen DP, Vuono R, Nawarathna U, Fisher K, Shneerson JM, Reddy AB, Barker RA (2014) Sleep and circadian rhythm regulation in early Parkinson disease. JAMA Neurol 71(5):589–595. doi:10.1001/jamaneurol.2014.65

    Article  PubMed  PubMed Central  Google Scholar 

  28. Coelho M, Ferreira JJ (2012) Late-stage Parkinson disease. Nat Rev Neurol 8(8):435–442. doi:10.1038/nrneurol.2012.126

    CAS  PubMed  Google Scholar 

  29. Gillman A, Roebuck T, Ho S, van Braak E, Naughton MT (2012) Comparison of supine-only and REM-only obstructive sleep apnoea. Sleep Med 13(7):875–878. doi:10.1016/j.sleep.2012.01.016

    Article  PubMed  Google Scholar 

  30. Young T, Palta M, Dempsey J, Skatrud J, Weber S, Badr S (1993) The occurrence of sleep-disordered breathing among middle-aged adults. N Engl J Med 328(17):1230–1235. doi:10.1056/nejm199304293281704

    Article  CAS  PubMed  Google Scholar 

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Funding sources

This study was funded by an internal grant from the Research Institute of the McGill University Health Centre. Other funding sources were the VitalAire Inc., Philips Respironics, American Academy of Neurology, and American Thoracic Society Foundation.

Compliance with ethical standards

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. This was a secondary analysis of an observational cohort study. All persons gave their informed consent prior to their inclusion in the study. No details revealed in this article disclose the identity of the subjects.

Conflict of interest

Anne-Louise Lafontaine has served in the advisory boards for Abbvie and has received honoraria from Teva, Allergan, Merz, and Norvatis. Marta Kaminska was a consultant and member of advisory board at Biron Laboratoires du sommeil.

Author information

Authors and Affiliations

  1. Respiratory Division & Sleep Laboratory, McGill University Health Centre, 1001 Decarie Blvd, Montreal, Quebec, H4A 3J1, Canada

    Priti Gros, Ann Robinson, R. John Kimoff & Marta Kaminska

  2. Neurology Department, Clinica Alemana de Santiago, Santiago, Chile

    Victoria P. Mery

  3. Montreal Neurological Hospital, McGill University Health Centre, Montreal, QC, Canada

    Anne-Louise Lafontaine

  4. Department of Medicine and Department of Epidemiology, Biostatistics & Occupational Health, McGill University Health Centre, Montreal, QC, Canada

    Andrea Benedetti

  5. Respiratory & Epidemiology and Clinical Research Unit, McGill University Health Centre, Montreal, QC, Canada

    Andrea Benedetti & Marta Kaminska

Authors
  1. Priti Gros
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  2. Victoria P. Mery
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Correspondence to Priti Gros.

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Gros, P., Mery, V.P., Lafontaine, AL. et al. Obstructive sleep apnea in Parkinson’s disease patients: effect of Sinemet CR taken at bedtime. Sleep Breath 20, 205–212 (2016). https://doi.org/10.1007/s11325-015-1208-9

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  • DOI: https://doi.org/10.1007/s11325-015-1208-9

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