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Sleep. 2014 Jan 1;37(1):177-85. doi: 10.5665/sleep.3332.

Continuous positive airway pressure improves sleep and daytime sleepiness in patients with Parkinson disease and sleep apnea.

Author information

1
San Diego State University and University of California, San Diego Joint Doctoral Program in Clinical Psychology, San Diego, CA.
2
Department of Psychiatry, University of California San Diego, San Diego, CA.
3
Department of Family and Preventive Medicine, University of California San Diego, San Diego, CA.
4
Department of Neurosciences, University of California San Diego, San Diego, CA.
5
San Diego State University and University of California, San Diego Joint Doctoral Program in Clinical Psychology, San Diego, CA ; Department of Psychiatry, University of California San Diego, San Diego, CA ; Veterans Medical Research Foundation, San Diego, CA.
6
Department of Medicine, University of California San Diego, San Diego, CA.
7
San Diego State University and University of California, San Diego Joint Doctoral Program in Clinical Psychology, San Diego, CA ; Department of Psychiatry, University of California San Diego, San Diego, CA ; Department of Medicine, University of California San Diego, San Diego, CA ; Veterans Affairs Center of Excellence for Stress and Mental Health, San Diego, CA.

Abstract

STUDY OBJECTIVES:

Obstructive sleep apnea (OSA), common in Parkinson disease (PD), contributes to sleep disturbances and daytime sleepiness. We assessed the effect of continuous positive airway pressure (CPAP) on OSA, sleep, and daytime sleepiness in patients with PD.

DESIGN:

This was a randomized placebo-controlled, crossover design. Patients with PD and OSA were randomized into 6 w of therapeutic treatment or 3 w of placebo followed by 3 w of therapeutic treatment. Patients were evaluated by polysomnography (PSG) and multiple sleep latency test (MSLT) pretreatment (baseline), after 3 w, and after 6 w of CPAP treatment. Analyses included mixed models, paired analysis, and within-group analyses comparing 3 w to 6 w of treatment.

SETTING:

Sleep laboratory.

PARTICIPANTS:

Thirty-eight patients with PD (mean age = 67.2 ± 9.2 y; 12 females).

INTERVENTION:

Continuous positive airway pressure.

MEASUREMENTS:

PSG OUTCOME MEASURES: sleep efficiency, %sleep stages (N1, N2, N3, R), arousal index, apnea-hypopnea index (AHI), and % time oxygen saturation < 90% (%time SaO2 < 90%). MSLT outcome measures: mean sleep-onset latency (MSL).

RESULTS:

There were significant group-by-time interactions for AHI (P < 0.001), % time SaO2 < 90% (P = 0.02), %N2 (P = 0.015) and %N3 (P = 0.014). Subjects receiving therapeutic CPAP showed significant decrease in AHI, %time SaO2 < 90%, %N2, and significant increase in %N3 indicating effectiveness of CPAP in the treatment of OSA, improvement in nighttime oxygenation, and in deepening sleep. The paired sample analyses revealed that 3 w of therapeutic treatment resulted in significant decreases in arousal index (t = 3.4, P = 0.002). All improvements after 3 w were maintained at 6 w. Finally, 3 w of therapeutic CPAP also resulted in overall decreases in daytime sleepiness (P = 0.011).

CONCLUSIONS:

Therapeutic continuous positive airway pressure versus placebo was effective in reducing apnea events, improving oxygen saturation, and deepening sleep in patients with Parkinson disease and obstructive sleep apnea. Additionally, arousal index was reduced and effects were maintained at 6 weeks. Finally, 3 weeks of continuous positive airway pressure treatment resulted in reduced daytime sleepiness measured by multiple sleep latency test. These results emphasize the importance of identifying and treating obstructive sleep apnea in patients with Parkinson disease.

KEYWORDS:

Continuous positive airway pressure; Parkinson disease; daytime sleepiness; obstructive sleep apnea; sleep disorders; sleep quality

PMID:
24470706
PMCID:
PMC3902881
DOI:
10.5665/sleep.3332
[Indexed for MEDLINE]
Free PMC Article
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