• Claudia Moreno-López, Joan Santamaría, Manuel Salamero, Francesca Del Sorbo, Alberto Albanese, Maria Teresa Pellecchia, Paolo Barone, Sebastiaan Overeem, Bastiaan Bloem, Willemijn Aarden, Margherita Canesi, Angelo Antonini, Susanne Duerr, Gregor K Wenning, Werner Poewe, Alfonso Rubino, Giuseppe Meco, Susanne A Schneider, Kailash P Bhatia, Ruth Djaldetti, Miguel Coelho, Cristina Sampaio, Valerie Cochen, Helge Hellriegel, Günther Deuschl, Carlo Colosimo, Luca Marsili, Thomas Gasser, and Eduardo Tolosa.
• Movement Disorders Unit, Department of Neurology, Hospital Clinic of Barcelona, University of Barcelona Medical School and Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas, 08036 Barcelona, Spain.
• Arch. Neurol. 2011 Feb 1; 68 (2): 223-30.

BackgroundSleep disorders are common in multiple system atrophy (MSA), but the prevalence of excessive daytime sleepiness (EDS) is not well known.ObjectiveTo assess the frequency and associations of EDS in MSA.DesignSurvey of EDS in consecutive patients with MSA and comparison with patients with Parkinson disease (PD) and individuals without known neurologic disease.SettingTwelve tertiary referral centers.ParticipantsEighty-six consecutive patients with MSA; 86 patients with PD matched for age, sex, and Hoehn and Yahr stage; and 86 healthy subject individuals matched for age and sex.Main Outcome MeasuresEpworth Sleepiness Scale (ESS), modified ESS, Sudden Onset of Sleep Scale, Tandberg Sleepiness Scale, Pittsburgh Sleep Quality Index, disease severity, dopaminergic treatment amount, and presence of restless legs syndrome.ResultsMean (SD) ESS scores were comparable in MSA (7.72 [5.05]) and PD (8.23 [4.62]) but were higher than in healthy subjects (4.52 [2.98]) (P < .001). Excessive daytime sleepiness (ESS score >10) was present in 28% of patients with MSA, 29% of patients with PD, and 2% of healthy subjects (P < .001). In MSA, in contrast to PD, the amount of dopaminergic treatment was not correlated with EDS. Disease severity was weakly correlated with EDS in MSA and PD. Restless legs syndrome occurred in 28% of patients with MSA, 14% of patients with PD, and 7% of healthy subjects (P < .001). Multiple regression analysis (with 95% confidence intervals obtained using nonparametric bootstrapping) showed that sleep-disordered breathing and sleep efficiency predicted EDS in MSA and amount of dopaminergic treatment and presence of restless legs syndrome in PD.ConclusionsMore than one-quarter of patients with MSA experience EDS, a frequency similar to that encountered in PD. In these 2 conditions, EDS seems to be associated with different causes.

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