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Published in: BMC Neurology 1/2012

Open Access 01-12-2012 | Research article

Daytime sleepiness in Japanese patients with multiple system atrophy: prevalence and determinants

Authors: Takayoshi Shimohata, Hideaki Nakayama, Masahiko Tomita, Tetsutaro Ozawa, Masatoyo Nishizawa

Published in: BMC Neurology | Issue 1/2012

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Abstract

Background

The recent SLEEMSA study that evaluated excessive daytime sleepiness (EDS) in Caucasian patients with multiple system atrophy (MSA) demonstrated that EDS was more frequent in patients (28%) than in healthy subjects (2%). However, the prevalence and determinants of EDS in other ethnic populations have not been reported to date.

Methods

We performed a single-hospital prospective study on patients with probable MSA. To ascertain the prevalence and determinants of EDS in Japanese MSA patients, we assessed the patients’ degree of daytime sleepiness by using the Japanese version of the Epworth Sleepiness Scale (ESS). In addition, we investigated the effects of sleep-disordered breathing (SDB) and abnormal periodic leg movements in sleep (PLMS), which were measured by polysomnography, on the patients’ ESS scores.

Results

A total of 25 patients with probable MSA (21 patients with cerebellar MSA and 4 patients with parkinsonian MSA) were included in this study. All patients underwent standard polysomnography. The mean ESS score was 6.2 ± 0.9, and EDS was identified in 24% of the patients. SDB and abnormal PLMS were identified in 24 (96%) and 11 (44%) patients, respectively. The prevalences of EDS in patients with SDB and abnormal PLMS were 25% and 18%, respectively. No correlations were observed between ESS scores and the parameters of SDB or abnormal PLMS.

Conclusions

The frequency of EDS in Japanese patients with MSA was similar to that in Caucasian MSA patients. SDB and abnormal PLMS were frequently observed in MSA patients, although the severities of these factors were not correlated with EDS. Further investigations using objective sleep tests need to be performed.
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Literature
1.
go back to reference Roehrs T, Carskacon MA, Dement WC, Roth T: Daytime sleepiness and alertness. Principles and Practice of Sleep Medicine. Edited by: Kryger MH, Roth T, Dement WC. 2000, W.B. Saunders, Philadelphia, 43-52. 3d Roehrs T, Carskacon MA, Dement WC, Roth T: Daytime sleepiness and alertness. Principles and Practice of Sleep Medicine. Edited by: Kryger MH, Roth T, Dement WC. 2000, W.B. Saunders, Philadelphia, 43-52. 3d
2.
go back to reference Roberts RE, Shema SJ, Kaplan GA, Strawbridge WJ: Sleep complaints and depression in an aging cohort: A prospective perspective. Am J Psychiatry. 2000, 157 (1): 81-88.CrossRefPubMed Roberts RE, Shema SJ, Kaplan GA, Strawbridge WJ: Sleep complaints and depression in an aging cohort: A prospective perspective. Am J Psychiatry. 2000, 157 (1): 81-88.CrossRefPubMed
3.
go back to reference El-Ad B, Korczyn AD: Disorders of excessive daytime sleepiness–an update. J Neurol Sci. 1998, 153 (2): 192-202. 10.1016/S0022-510X(97)00291-8.CrossRefPubMed El-Ad B, Korczyn AD: Disorders of excessive daytime sleepiness–an update. J Neurol Sci. 1998, 153 (2): 192-202. 10.1016/S0022-510X(97)00291-8.CrossRefPubMed
4.
go back to reference Arnulf I: Excessive daytime sleepiness in parkinsonism. Sleep Med Rev. 2005, 9 (3): 185-200. 10.1016/j.smrv.2005.01.001.CrossRefPubMed Arnulf I: Excessive daytime sleepiness in parkinsonism. Sleep Med Rev. 2005, 9 (3): 185-200. 10.1016/j.smrv.2005.01.001.CrossRefPubMed
5.
go back to reference Chokroverty S, Sachdeo R, Masdeu J: Autonomic dysfunction and sleep apnea in olivopontocerebellar degeneration. Arch Neurol. 1984, 41 (9): 926-931. 10.1001/archneur.1984.04050200032014.CrossRefPubMed Chokroverty S, Sachdeo R, Masdeu J: Autonomic dysfunction and sleep apnea in olivopontocerebellar degeneration. Arch Neurol. 1984, 41 (9): 926-931. 10.1001/archneur.1984.04050200032014.CrossRefPubMed
6.
go back to reference Shimohata T, Shinoda H, Nakayama H, Ozawa T, Terajima K, Yoshizawa H, Matsuzawa Y, Onodera O, Naruse S, Tanaka K, et al: Daytime hypoxemia, sleep-disordered breathing, and laryngopharyngeal findings in multiple system atrophy. Arch Neurol. 2007, 64 (6): 856-861. 10.1001/archneur.64.6.856.CrossRefPubMed Shimohata T, Shinoda H, Nakayama H, Ozawa T, Terajima K, Yoshizawa H, Matsuzawa Y, Onodera O, Naruse S, Tanaka K, et al: Daytime hypoxemia, sleep-disordered breathing, and laryngopharyngeal findings in multiple system atrophy. Arch Neurol. 2007, 64 (6): 856-861. 10.1001/archneur.64.6.856.CrossRefPubMed
7.
go back to reference Silber MH, Levine S: Stridor and death in multiple system atrophy. Mov Disord. 2000, 15 (4): 699-704. 10.1002/1531-8257(200007)15:4<699::AID-MDS1015>3.0.CO;2-L.CrossRefPubMed Silber MH, Levine S: Stridor and death in multiple system atrophy. Mov Disord. 2000, 15 (4): 699-704. 10.1002/1531-8257(200007)15:4<699::AID-MDS1015>3.0.CO;2-L.CrossRefPubMed
8.
go back to reference Schmeichel AM, Buchhalter LC, Low PA, Parisi JE, Boeve BW, Sandroni P, Benarroch EE: Mesopontine cholinergic neuron involvement in Lewy body dementia and multiple system atrophy. Neurology. 2008, 70 (5): 368-373. 10.1212/01.wnl.0000298691.71637.96.CrossRefPubMed Schmeichel AM, Buchhalter LC, Low PA, Parisi JE, Boeve BW, Sandroni P, Benarroch EE: Mesopontine cholinergic neuron involvement in Lewy body dementia and multiple system atrophy. Neurology. 2008, 70 (5): 368-373. 10.1212/01.wnl.0000298691.71637.96.CrossRefPubMed
9.
go back to reference Benarroch EE, Schmeichel AM, Sandroni P, Parisi JE, Low PA: Rostral raphe involvement in Lewy body dementia and multiple system atrophy. Acta Neuropathol. 2007, 114 (3): 213-220. 10.1007/s00401-007-0260-3.CrossRefPubMed Benarroch EE, Schmeichel AM, Sandroni P, Parisi JE, Low PA: Rostral raphe involvement in Lewy body dementia and multiple system atrophy. Acta Neuropathol. 2007, 114 (3): 213-220. 10.1007/s00401-007-0260-3.CrossRefPubMed
10.
go back to reference Benarroch EE, Schmeichel AM, Sandroni P, Low PA, Parisi JE: Involvement of hypocretin neurons in multiple system atrophy. Acta Neuropathol. 2007, 113 (1): 75-80.CrossRefPubMed Benarroch EE, Schmeichel AM, Sandroni P, Low PA, Parisi JE: Involvement of hypocretin neurons in multiple system atrophy. Acta Neuropathol. 2007, 113 (1): 75-80.CrossRefPubMed
11.
go back to reference Benarroch EE, Schmeichel AM, Dugger BN, Sandroni P, Parisi JE, Low PA: Dopamine cell loss in the periaqueductal gray in multiple system atrophy and Lewy body dementia. Neurology. 2009, 73 (2): 106-112. 10.1212/WNL.0b013e3181ad53e7.CrossRefPubMedPubMedCentral Benarroch EE, Schmeichel AM, Dugger BN, Sandroni P, Parisi JE, Low PA: Dopamine cell loss in the periaqueductal gray in multiple system atrophy and Lewy body dementia. Neurology. 2009, 73 (2): 106-112. 10.1212/WNL.0b013e3181ad53e7.CrossRefPubMedPubMedCentral
12.
go back to reference Moreno-Lopez C, Santamaria J, Salamero M, Del Sorbo F, Albanese A, Pellecchia MT, Barone P, Overeem S, Bloem B, Aarden W, et al: Excessive daytime sleepiness in multiple system atrophy (SLEEMSA study). Arch Neurol. 2011, 68 (2): 223-230. 10.1001/archneurol.2010.359.CrossRefPubMed Moreno-Lopez C, Santamaria J, Salamero M, Del Sorbo F, Albanese A, Pellecchia MT, Barone P, Overeem S, Bloem B, Aarden W, et al: Excessive daytime sleepiness in multiple system atrophy (SLEEMSA study). Arch Neurol. 2011, 68 (2): 223-230. 10.1001/archneurol.2010.359.CrossRefPubMed
13.
go back to reference Vetrugno R, Provini F, Cortelli P, Plazzi G, Lotti EM, Pierangeli G, Canali C, Montagna P: Sleep disorders in multiple system atrophy: a correlative video-polysomnographic study. Sleep Med. 2004, 5 (1): 21-30. 10.1016/j.sleep.2003.07.002.CrossRefPubMed Vetrugno R, Provini F, Cortelli P, Plazzi G, Lotti EM, Pierangeli G, Canali C, Montagna P: Sleep disorders in multiple system atrophy: a correlative video-polysomnographic study. Sleep Med. 2004, 5 (1): 21-30. 10.1016/j.sleep.2003.07.002.CrossRefPubMed
14.
go back to reference Johns MW: A new method for measuring daytime sleepiness: the Epworth sleepiness scale. Sleep. 1991, 14 (6): 540-545.PubMed Johns MW: A new method for measuring daytime sleepiness: the Epworth sleepiness scale. Sleep. 1991, 14 (6): 540-545.PubMed
15.
go back to reference Gilman S, Low PA, Quinn N, Albanese A, Ben-Shlomo Y, Fowler CJ, Kaufmann H, Klockgether T, Lang AE, Lantos PL, et al: Consensus statement on the diagnosis of multiple system atrophy. J Neurol Sci. 1999, 163 (1): 94-98. 10.1016/S0022-510X(98)00304-9.CrossRefPubMed Gilman S, Low PA, Quinn N, Albanese A, Ben-Shlomo Y, Fowler CJ, Kaufmann H, Klockgether T, Lang AE, Lantos PL, et al: Consensus statement on the diagnosis of multiple system atrophy. J Neurol Sci. 1999, 163 (1): 94-98. 10.1016/S0022-510X(98)00304-9.CrossRefPubMed
16.
go back to reference Takegami M, Suzukamo Y, Wakita T, Noguchi H, Chin K, Kadotani H, Inoue Y, Oka Y, Nakamura T, Green J, et al: Development of a Japanese version of the Epworth Sleepiness Scale (JESS) based on item response theory. Sleep Med. 2009, 10 (5): 556-565. 10.1016/j.sleep.2008.04.015.CrossRefPubMed Takegami M, Suzukamo Y, Wakita T, Noguchi H, Chin K, Kadotani H, Inoue Y, Oka Y, Nakamura T, Green J, et al: Development of a Japanese version of the Epworth Sleepiness Scale (JESS) based on item response theory. Sleep Med. 2009, 10 (5): 556-565. 10.1016/j.sleep.2008.04.015.CrossRefPubMed
17.
go back to reference Johns MW: Sensitivity and specificity of the multiple sleep latency test (MSLT), the maintenance of wakefulness test and the epworth sleepiness scale: failure of the MSLT as a gold standard. J Sleep Res. 2000, 9 (1): 5-11. 10.1046/j.1365-2869.2000.00177.x.CrossRefPubMed Johns MW: Sensitivity and specificity of the multiple sleep latency test (MSLT), the maintenance of wakefulness test and the epworth sleepiness scale: failure of the MSLT as a gold standard. J Sleep Res. 2000, 9 (1): 5-11. 10.1046/j.1365-2869.2000.00177.x.CrossRefPubMed
18.
go back to reference Wenning GK, Tison F, Seppi K, Sampaio C, Diem A, Yekhlef F, Ghorayeb I, Ory F, Galitzky M, Scaravilli T, et al: Development and validation of the Unified Multiple System Atrophy Rating Scale (UMSARS). Mov Disord. 2004, 19 (12): 1391-1402. 10.1002/mds.20255.CrossRefPubMed Wenning GK, Tison F, Seppi K, Sampaio C, Diem A, Yekhlef F, Ghorayeb I, Ory F, Galitzky M, Scaravilli T, et al: Development and validation of the Unified Multiple System Atrophy Rating Scale (UMSARS). Mov Disord. 2004, 19 (12): 1391-1402. 10.1002/mds.20255.CrossRefPubMed
19.
go back to reference Folstein MF, Folstein SE, McHugh PR: “Mini-mental state”. A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res. 1975, 12 (3): 189-198. 10.1016/0022-3956(75)90026-6.CrossRefPubMed Folstein MF, Folstein SE, McHugh PR: “Mini-mental state”. A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res. 1975, 12 (3): 189-198. 10.1016/0022-3956(75)90026-6.CrossRefPubMed
20.
go back to reference Kugo A, Terada S, Ata T, Ido Y, Kado Y, Ishihara T, Hikiji M, Fujisawa Y, Sasaki K, Kuroda S: Japanese version of the Frontal Assessment Battery for dementia. Psychiatry Res. 2007, 153 (1): 69-75. 10.1016/j.psychres.2006.04.004.CrossRefPubMed Kugo A, Terada S, Ata T, Ido Y, Kado Y, Ishihara T, Hikiji M, Fujisawa Y, Sasaki K, Kuroda S: Japanese version of the Frontal Assessment Battery for dementia. Psychiatry Res. 2007, 153 (1): 69-75. 10.1016/j.psychres.2006.04.004.CrossRefPubMed
21.
go back to reference 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. 1999, 22 (5): 667-689. 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. 1999, 22 (5): 667-689.
22.
go back to reference Allen RP, Picchietti D, Hening WA, Trenkwalder C, Walters AS, Montplaisir J: Restless legs syndrome: diagnostic criteria, special considerations, and epidemiology. A report from the restless legs syndrome diagnosis and epidemiology workshop at the National Institutes of Health. Sleep Med. 2003, 4 (2): 101-119. 10.1016/S1389-9457(03)00010-8.CrossRefPubMed Allen RP, Picchietti D, Hening WA, Trenkwalder C, Walters AS, Montplaisir J: Restless legs syndrome: diagnostic criteria, special considerations, and epidemiology. A report from the restless legs syndrome diagnosis and epidemiology workshop at the National Institutes of Health. Sleep Med. 2003, 4 (2): 101-119. 10.1016/S1389-9457(03)00010-8.CrossRefPubMed
23.
go back to reference Goetz CG, Blasucci L, Stebbins GT: Switching dopamine agonists in advanced Parkinson's disease: is rapid titration preferable to slow?. Neurology. 1999, 52 (6): 1227-1229. 10.1212/WNL.52.6.1227.CrossRefPubMed Goetz CG, Blasucci L, Stebbins GT: Switching dopamine agonists in advanced Parkinson's disease: is rapid titration preferable to slow?. Neurology. 1999, 52 (6): 1227-1229. 10.1212/WNL.52.6.1227.CrossRefPubMed
24.
go back to reference Inzelberg R, Nisipeanu P, Rabey JM, Orlov E, Catz T, Kippervasser S, Schechtman E, Korczyn AD: Double-blind comparison of cabergoline and bromocriptine in Parkinson's disease patients with motor fluctuations. Neurology. 1996, 47 (3): 785-788. 10.1212/WNL.47.3.785.CrossRefPubMed Inzelberg R, Nisipeanu P, Rabey JM, Orlov E, Catz T, Kippervasser S, Schechtman E, Korczyn AD: Double-blind comparison of cabergoline and bromocriptine in Parkinson's disease patients with motor fluctuations. Neurology. 1996, 47 (3): 785-788. 10.1212/WNL.47.3.785.CrossRefPubMed
25.
go back to reference Lozano AM, Lang AE, Galvez-Jimenez N, Miyasaki J, Duff J, Hutchinson WD, Dostrovsky JO: Effect of GPi pallidotomy on motor function in Parkinson's disease. Lancet. 1995, 346 (8987): 1383-1387. 10.1016/S0140-6736(95)92404-3.CrossRefPubMed Lozano AM, Lang AE, Galvez-Jimenez N, Miyasaki J, Duff J, Hutchinson WD, Dostrovsky JO: Effect of GPi pallidotomy on motor function in Parkinson's disease. Lancet. 1995, 346 (8987): 1383-1387. 10.1016/S0140-6736(95)92404-3.CrossRefPubMed
26.
27.
go back to reference Carskadon MA, Dement WC: Normal human sleep: an overview. Principles and practice of sleep medicine. 2011, Elsevier Saunders, St. Louis, 16-26. 5CrossRef Carskadon MA, Dement WC: Normal human sleep: an overview. Principles and practice of sleep medicine. 2011, Elsevier Saunders, St. Louis, 16-26. 5CrossRef
28.
go back to reference Shimohata T, Tomita M, Nakayama H, Aizawa N, Ozawa T, Nishizawa M: Floppy epiglottis as a contraindication of CPAP in patients with multiple system atrophy. Neurology. 2011, 76 (21): 1841-1842. 10.1212/WNL.0b013e31821ccd07.CrossRefPubMed Shimohata T, Tomita M, Nakayama H, Aizawa N, Ozawa T, Nishizawa M: Floppy epiglottis as a contraindication of CPAP in patients with multiple system atrophy. Neurology. 2011, 76 (21): 1841-1842. 10.1212/WNL.0b013e31821ccd07.CrossRefPubMed
29.
go back to reference Uemura Y, Nomura T, Inoue Y, Yamawaki M, Yasui K, Nakashima K: Validation of the Parkinson's disease sleep scale in Japanese patients: a comparison study using the Pittsburgh Sleep Quality Index, the Epworth Sleepiness Scale and Polysomnography. J Neurol Sci. 2009, 287 (1–2): 36-40.CrossRefPubMed Uemura Y, Nomura T, Inoue Y, Yamawaki M, Yasui K, Nakashima K: Validation of the Parkinson's disease sleep scale in Japanese patients: a comparison study using the Pittsburgh Sleep Quality Index, the Epworth Sleepiness Scale and Polysomnography. J Neurol Sci. 2009, 287 (1–2): 36-40.CrossRefPubMed
30.
go back to reference Ozawa T, Tada M, Kakita A, Onodera O, Ishihara T, Morita T, Shimohata T, Wakabayashi K, Takahashi H, Nishizawa M: The phenotype spectrum of Japanese multiple system atrophy. J Neurol Neurosurg Psychiatry. 2010, 81 (11): 1253-1255. 10.1136/jnnp.2009.182576.CrossRefPubMed Ozawa T, Tada M, Kakita A, Onodera O, Ishihara T, Morita T, Shimohata T, Wakabayashi K, Takahashi H, Nishizawa M: The phenotype spectrum of Japanese multiple system atrophy. J Neurol Neurosurg Psychiatry. 2010, 81 (11): 1253-1255. 10.1136/jnnp.2009.182576.CrossRefPubMed
31.
go back to reference Kapur VK, Baldwin CM, Resnick HE, Gottlieb DJ, Nieto FJ: Sleepiness in patients with moderate to severe sleep-disordered breathing. Sleep. 2005, 28 (4): 472-477.PubMed Kapur VK, Baldwin CM, Resnick HE, Gottlieb DJ, Nieto FJ: Sleepiness in patients with moderate to severe sleep-disordered breathing. Sleep. 2005, 28 (4): 472-477.PubMed
32.
go back to reference Suzuki K, Miyamoto M, Miyamoto T, Iwanami M, Hirata K: Sleep disturbances associated with Parkinson's disease. Parkinsons Dis. 2011, 2011: 219056-PubMedPubMedCentral Suzuki K, Miyamoto M, Miyamoto T, Iwanami M, Hirata K: Sleep disturbances associated with Parkinson's disease. Parkinsons Dis. 2011, 2011: 219056-PubMedPubMedCentral
Metadata
Title
Daytime sleepiness in Japanese patients with multiple system atrophy: prevalence and determinants
Authors
Takayoshi Shimohata
Hideaki Nakayama
Masahiko Tomita
Tetsutaro Ozawa
Masatoyo Nishizawa
Publication date
01-12-2012
Publisher
BioMed Central
Published in
BMC Neurology / Issue 1/2012
Electronic ISSN: 1471-2377
DOI
https://doi.org/10.1186/1471-2377-12-130

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