Excessive Daytime Sleepiness as a Risk Factor for Impulse Control Disorders in Parkinson’s Disease

Xiaohui Tang,1,2 Qian Liang,1 Tao Li,1 Yetong Ouyang,1 Zhe Xue Huang,1 Xiaoshun Tang,1 Jiayi Jin,1 Lijia Yu,1 Xijin Wang1 1Department of Neurology, Shanghai Tongji Hospital, School of Medicine, Tongji University, Shanghai, People’s Republic of China; 2Department of Neurology, Zhabei Central Hospital, Shanghai, People’s Republic of ChinaCorrespondence: Xijin Wang, Department of Neurology, Shanghai Tongji Hospital, School of Medicine, Tongji University, 389 Xincun Road, Putuo District, Shanghai, 200065, People’s Republic of China, Tel +8613651627382, Email [email protected]: Impulse control disorders (ICDs) and excessive daytime sleepiness (EDS) are common symptoms in Parkinson’s disease (PD). Few longitudinal studies have focused on the association between EDS and ICDs. This longitudinal study aimed at assessing association between EDS and ICDs in PD.Patients and Methods: Patients without ICDs were incorporated from the Parkinson’s Progression Markers Initiative. All patients were followed until the onset of ICDs or the end of 4 years. A total of 260 PD patients were included. Univariable and multivariable logistic regression were used to explore association between EDS and ICDs.Results: The overall frequency of ICDs at the end of follow-up was 23.8% (62 patients). The mean duration from dopamine replacement therapy to develop ICDs was 3.30 ± 2.42 years. Patients with ICDs had significantly higher Epworth Sleepiness Scale (ESS) score (P = 0.002) and higher proportion of EDS (P = 0.030) when compared to patients without ICDs. The multivariable logistic regression analysis indicated that high ESS (OR = 2.01, 95% CI 1.01– 4.04, p = 0.049) score, high dopamine agonist equivalent daily dose (OR = 2.54, 95% CI 1.37– 4.71, p = 0.003), high Geriatric Depression Scale (OR = 2.33, 95% CI 1.27– 4.28, p = 0.006) score and postural instability (OR = 3.03, 95% CI 1.26– 7.29, p = 0.013) were associated with ICDs occurrence.Conclusion: Our results indicated that EDS acts as a risk for ICDs occurrence in PD. Clinicians should pay attention to EDS in clinical practice. This may be a promising new approach to better understand and therapy ICDs.Keywords: excessive daytime sleepiness, impulse control disorders, Parkinson’s disease, risk factors