J Neurol (2008) 255:1032–1037 DOI 10.1007/s00415-008-0836-4 ORIGINAL COMMUNICATION JON 2836 Fabio Placidi Francesca Izzi Andrea Romigi Paolo Stanzione Maria Grazia Marciani Livia Brusa Francesca Sperli Salvatore Galati Patrizio Pasqualetti Mariangela Pierantozzi Sleep-wake cycle and effects of cabergoline monotherapy in de novo Parkinson’s disease patients An ambulatory polysomnographic study Introduction Patients affected by Parkinson’s disease (PD) frequently complain about sleep-wake cycle disturbances; several factors, indeed, may impair nocturnal sleep. Sleep ab- normalities can be due to PD-related motor phenomena such as nocturnal bradykinesia/akinesia and rigidity, resting tremor, dystonia/dyskinesias or nocturia, as well as concomitant sleep disorders such as restless leg syn- Received: 18 April 2007 Received in revised form: 15 November 2007 Accepted: 5 December 2007 Published online: 2 June 2008 F. Placidi, MD, PhD () · F. Izzi, MD · A. Romigi, MD · P. Stanzione, MD · M. G. Marciani, MD · F. Sperli, MD · S. Galati, MD · M. Pierantozzi, MD, PhD Neurology Clinic Dept. of Neuroscience University of Rome “Tor Vergata” Policlinico Tor Vergata Servizio di Neurofisiopatologia Centro di Medicina del Sonno V.le Oxford 81 Zip Code: 00133 Rome, Italy Tel.: +390620902107 Fax: +390620902106 E-Mail: fbplacidi@libero.it F. Placidi, MD, PhD · A. Romigi, MD · P. Stanzione, MD · M. G. Marciani, MD · M. Pierantozzi, MD, PhD IRCCS Santa Lucia Foundation Rome, Italy L. Brusa, MD, PhD Neurology Department S. Eugenio Hospital Rome, Italy P. Pasqualetti Associazione Fatebenefratelli per la Ricerca (AFaR) Rome, Italy This study was performed at the Sleep Disorder Center of Tor Vergata University of Rome. The authors have declared that no conflict of interest exists. ■ Abstract Objective To investi- gate the sleep-wake cycle and the effects of cabergoline monotherapy in a homogenous group of de novo Parkinson’s Disease (PD) patients without confounding comorbid factors. Design and participants Twelve de novo patients affected by idiopathic PD underwent two ambulatory polysomnographic (A- PSG) monitoring sessions. The first was performed at baseline, and the second recording one-month after stable treatment with cabergoline monotherapy. Subjective daytime sleepiness was evaluated by means of the Epworth Sleepiness Scale. Data obtained in PD patients at baseline were compared with those obtained in 12 age- and sex- matched healthy subjects. Results Diurnal sleep parameters did not show significant differences between controls and PD patients at baseline. In PD patients, no significant changes in diurnal sleep were observed between baseline and cabergoline treatment. Regard- ing nocturnal sleep, patients at baseline showed a significantly lower sleep efficiency and a signifi- cantly higher Wakefulness After Sleep Onset than controls. With respect to baseline, a significant increase in REM latency and a significant reduction in REM sleep were observed during cabergoline treatment. Conclusions In the early stage of PD, the neurodegenerative process does not seem to be di- rectly responsible for daytime somnolence, but it may be directly involved in the alteration of noc- turnal sleep. Cabergoline mono- therapy does not affect daytime sleep propensity and, despite clini- cal improvement, it may have nega- tive effects on REM sleep. ■ Key words sleep · daytime somnolence · Parkinson’s disease · cabergoline · polysomnography