Re: Research Abstract: Sudden Onset of Daytime Sleepiness

[Guest guest]

,

Although I use CPAP for diagnosed Obstructive Sleep

Apnea and take no medications, I still experience this

sudden onset daytime sleepiness once every week or

two. I can best equate it to the situation where a

marathoner hits their endurance wall. As you have

mentioned the only thing to do when it hits is to take

the earliest possible opportunity to take a nap and

avoid driving if at all possible. On the topic of

driving, when my wife and I take a trip these days, it

seems that two hours is the absolute max I can do at

the wheel and sometimes I can sense that I am risking

it even then. So I add my weight to other people's

calls regarding safe driving. Don't risk your life,

those of your loved ones or other motorists. So many

people on this list or their loved ones are fighting

desparately to survive against the odds with their

illness, so lets be equally active in preserving life

in areas we have more control over.

Sorry for the sermon, all the best to everyone.

Regards Sowter

--- " B. Fisher " jfisher@...> wrote: >

Greetings!

>

> The following abstract is from a report titled:

>

> Excessive daytime sleepiness and sudden-onset

> sleep in Parkinson disease: a survey by the

> Canadian Movement Disorders Group.

>

> The link to the abstract is:

>

>

>

http://www.websciences.org/cftemplate/NAPS/indiv.cfm?ID=20005615

>

> Conclusion: Not only is reaction time an issue, but

> sudden daytime

> sleepiness is not a good thing when driving.

>

> I've had this happen (but not when driving). It is

> alarming to be suddenly

> overwhelmed by sleepiness. When it happens, I MUST

> get some rest.

>

>

> Regards,

> =jbf=

>

> B. Fisher

>

>

>

> JAMA 2002;287(4):455-63.

>

> Excessive daytime sleepiness and sudden-onset sleep

> in Parkinson disease: a

> survey by the Canadian Movement Disorders Group.

> HOBSON DE, LANG AE, MARTIN WR, RAZMY A, RIVEST J,

> FLEMING J.

>

> Department of Medicine, University of Maitoba,

> Winnipeg.

> dhobson@...

>

> CONTEXT: Somnolence is a recognized adverse effect

> of dopamine agonists. Two

> new dopamine agonists, pramipexole and ropinirole,

> have been reported to

> cause sudden-onset sleep spells in patients with

> Parkinson disease (PD)

> while they were driving. The frequency of these

> spells and whether driving

> should be restricted has yet to be established.

> OBJECTIVE: To determine the

> frequency of and predictors for sudden-onset sleep

> and, particularly,

> episodes of falling asleep while driving among

> patients with PD. DESIGN,

> SETTING, AND PARTICIPANTS: Prospective survey

> conducted between January and

> April 2000 in 18 clinics directed by members of the

> Canadian Movement

> Disorders Group; 638 consecutive highly functional

> PD patients without

> dementia were enrolled, of whom 420 were currently

> drivers. MAIN OUTCOME

> MEASURES: Excessive daytime sleepiness and

> sudden-onset sleep as assessed by

> the Epworth Sleepiness Scale and the Inappropriate

> Sleep Composite Score.

> The latter score, designed for this study, addressed

> falling asleep in

> unusual circumstances. The 2 scales were combined in

> 3 separate formats:

> dozing off, sudden unexpected sleep, and sudden

> blank spells. RESULTS:

> Excessive daytime sleepiness was present overall in

> 327 (51%) of the 638

> patients and in 213 (51%) of the 420 drivers.

> Patients taking a variety of

> different dopamine agonists had no differences in

> Epworth sleepiness scores,

> in the composite score, or in the risk of falling

> asleep while driving.

> Sixteen patients (3.8%) had experienced at least 1

> episode of sudden onset

> of sleep while driving (after the diagnosis of PD);

> in 3 (0.7%), it occurred

> without warning. The 2 risk factors associated with

> falling asleep at the

> wheel were the Epworth Sleepiness Scale score (odds

> ratio [OR], 1.14; 95%

> confidence interval [CI], 1.06-1.24) and the

> Inappropriate Sleep Composite

> Score (OR, 2.54; 95% CI, 1.76-3.66). A standard

> Epworth Sleepiness Scale

> score of 7 or higher predicted 75% of episodes of

> sleep behind the wheel at

> a specificity of 50% (exclusion of the question

> related to driving provided

> 70% sensitivity and 52% specificity), whereas a

> score of 1 on the

> Inappropriate Sleep Composite Score generated a

> sensitivity of 52% and

> specificity of 82%. CONCLUSIONS: Excessive daytime

> sleepiness is common even

> in patients with PD who are independent and do not

> have dementia.

> Sudden-onset sleep without warning is infrequent.

> The Epworth score has

> adequate sensitivity for predicting prior episodes

> of falling asleep while

> driving and its specificity can be increased by use

> of the Inappropriate

> Sleep Composite Score. It is unknown if routinely

> performing these

> assessments could be more effective in predicting

> future risk for these rare

> sleep attacks. Patients should be warned not to

> drive if they doze in

> unusual circumstances.

>

>

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