Sleep attacks in patients taking dopamine agonists: review

doi:10.1136/bmj.324.7352.1483

BMJ 2002;324:1483-1487 ( 22 June )

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Sleep attacks in patients taking dopamine agonists: review

Carl Nikolaus Homann, consultant, ^a Karoline Wenzel, registrar, ^a Klaudia Suppan, registrar, ^a Gerd Ivanic, consultant, ^a Norbert Kriechbaum, associate professor, ^b Richard Crevenna, registrar, ^a Erwin Ott, head. ^a

^a Department of Neurology, Karl Franzens University Hospital, A-8036 Graz, Austria, ^b Department of Psychiatry, Karl Franzens University Hospital

Correspondence to: C N Homann nik.homann{at}kfunigraz.ac.at

Objectives: To assess the evidence for the existence andprevalence of sleep attacks in patients taking dopamine agonistsfor Parkinson's disease, the type of drugs implicated, and strategiesfor prevention andtreatment.
Design: Review of publications between July 1999 andMay 2001 in which sleep attacks or narcoleptic-like attacks werediscussed in patients with Parkinson'sdisease.
Results: 124 patients with sleep events were foundin 20 publications. Overall, 6.6% of patients taking dopamineagonists who attended movement disorder centres had sleep events.Men were over-represented. Sleep events occurred at both highand low doses of the drugs, with different durations of treatment(0-20 years), and with or without preceding signs of tiredness.Sleep attacks are a class effect, having been found in patientstaking the following dopamine agonists: levodopa (monotherapyin 8 patients), ergot agonists (apomorphine in 2 patients, bromocriptinein 13, cabergoline in 1, lisuride or piribedil in 23, pergolidein 5,) and non-ergot agonists (pramipexole in 32, ropinirole in38). Reports suggest two distinct types of events: those of suddenonset without warning and those of slow onset with prodromedrowsiness.
Conclusion: Insufficient data are available to provideeffective guidelines for prevention and treatment of sleep eventsin patients taking dopamine agonists for Parkinson's disease.Prospective population based studies are needed to provide thisinformation.

What is already known on this topic
Car crashes in patients with Parkinson's disease have been associated with sleep attacks caused by the dopamine agonists pramipexole and ropinirole

Whether sleep attacks exist, their connection with certain agonists, prevention or treatment, and the justification of legal actions are controversial

What this study adds
Sleep attacks as a phenomenon distinct from normal somnolence really do exist

They are a class effect of all dopamine drugs

Effective prevention and treatment strategies are lacking, although data are insufficient to justify a general driving ban

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Rapid Responses:

Read all Rapid Responses

Misperceptions about Unforewarned �Sleep Attacks� When Driving: James A Horne
bmj.com, 2 Jul 2002 [Full text]
Piribedil is a poor candidate for inducing sleep attacks: Peter A. Clarenbach
bmj.com, 28 Mar 2003 [Full text]