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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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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.

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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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