Sleep quality in caregivers of patients with Alzheimer's disease and Parkinson's disease and its relationship to quality of life

ABSTRACT Background: Knowledge about sleep complaints of caregivers of patients with Alzheimer's disease (AD) and Parkinson's disease (PD) is limited, and we lack information about the relationship between caregivers' sleep problems and their quality of life (QoL). Methods: We evaluated subjective sleep quality and its relationship to QoL in a group of 80 caregivers of patients with AD (ADCG, n = 40) and PD (PDCG, n = 40), and in 150 controls. Information about night-time complaints was collected using the Pittsburgh Sleep Quality Index (PSQI). QoL was measured using the McGill QoL Questionnaire. Results: Eighteen ADCG (45%), 22 PDCG (55%), and 45 (30%) controls reported poor sleep quality. Mean global PSQI score of PDCG (6.25 ± 3.9) was not significantly different from that of ADCG (5.8 ± 3.5; p = 0.67). However, both PDCG and ADCG scored significantly higher than control group (4.3 ± 3.1; p < 0.01). ADCG frequently reported difficulties falling asleep (72.5%) and disturbed sleep (100%). PDCG reported reduced subjective sleep quality (80%) and increased sleep disturbances (100%). Poor sleep quality was associated with depressive symptoms and correlated with QoL in caregivers of both groups, particularly the psychological symptoms domain. Conclusions: Among caregivers of patients with AD and PD, poor sleep quality is frequent and significantly linked to QoL and depressive symptoms. Identifying the nature of sleep disturbances not only in patients but also in their caregivers is important as appropriate treatment may lead to a better management of the needs of families coping with these patients.     

Effect of CPAP treatment on mood states in patients with sleep apnea.

Sleep apnea can lead to marked psychological distress including some mood symptoms. Previous studies on continuous positive airway pressure (CPAP) treatment usually reported significant improvement in mood symptoms in patients with sleep apnea, but most of them did not consider the placebo effect of CPAP. We examined the effect of CPAP treatment on mood states by employing both CPAP treatment and placebo CPAP. Twenty five men and nine women with sleep apnea underwent two successive nights of polysomnography (PSG) during hospitalization. The Profile of Mood States (POMS) was administered to measure mood states. Patients were randomly assigned to either CPAP treatment group or placebo CPAP group. After 7 days of CPAP use at home, all patients were re-hospitalized to undergo one more night of nocturnal PSG with their assigned treatment (CPAP treatment or placebo CPAP). They also had a repeat evaluation of mood by completing the POMS. Only patients on CPAP treatment improved significantly in apnea index, respiratory disturbance index, and mean oxygen saturation. However, both CPAP treatment group and placebo CPAP group showed significant improvement in mood states. In conclusion, the effect of CPAP treatment on mood symptoms in apneic patients could be a placebo effect. CPAP treatment may be effective in improving mood states only in patients who have severe depressive symptoms secondary to sleep apnea.     

Long-term adherence to continuous positive airway pressure therapy in non-sleepy sleep apnea patients

ObjectiveThe effectiveness of continuous positive airway pressure (CPAP) therapy greatly depends on consistent use. However, data regarding adherence in non-sleepy obstructive sleep apnea (OSA) patients are scarce. The aim of this study was to assess long-term adherence and predictors of CPAP compliance in a large sample of non-sleepy OSA patients.MethodsWe conducted a prospective, multicenter study comprising 357 non-sleepy patients (Epworth Sleepiness Scale score <11) with moderate-to-severe OSA (apnea–hypopnea index [AHI] of ≥20) who began CPAP therapy between May 2004 and May 2006; follow-up ended in May 2009. Non-compliance was scored as CPAP dropout or average cumulative CPAP use of <4 hours per night. Multivariate Cox regression analysis was performed to identify independent predictors of poor CPAP adherence.ResultsPatients were followed up for a median of four years (interquartile range [IQR] = 3.0–4.4). At the end of the study period, 230 patients (64.4%) fulfilled the criteria for good CPAP compliance, whereas 127 patients (35.6%) were considered non-compliant. The median CPAP use was five hours per night (interquartile range = 2.18–6.25). Multivariate analysis showed that interactions between the AHI and the percentage of nighttime spent with an O₂ saturation of <90% (TC90) (p = 0.010) and between the AHI and hypertension at baseline (p = 0.029) predicted long-term compliance with CPAP.ConclusionThis study demonstrates that CPAP treatment is feasible in non-sleepy, moderate-to-severe OSA patients. Good CPAP adherence was predicted by greater OSA severity as measured by both the AHI and TC90 and by the presence of hypertension at baseline in patients with higher AHI levels.     

CPAP therapy in patients with mild OSA: implementation and treatment outcome

Objectives: To determine continuous positive airway pressure (CPAP) treatment compliance and reversal of excessive daytime sleepiness in patients with mild OSA.Background: CPAP therapy is the most widely accepted and used intervention in patients with a diagnosis of obstructive sleep apnea (OSA). There are, however, no widely accepted protocols to help guide the rational use of CPAP therapy. Patients with mild OSA (respiratory event index (REI) >5 or 相似文献   

Open-label adjunctive zonisamide in the treatment of bipolar disorders: a prospective trial

BACKGROUND: The response of 62 outpatients with DSM-IV bipolar disorders to open-label adjunctive zonisamide was evaluated in a prospective 8-week acute trial, followed by a 48-week continuation trial, conducted from June 2001 through May 2002. METHOD: During the acute trial, response to zonisamide was assessed weekly for the first 4 weeks and every 2 weeks for the second 4 weeks with the Clinical Global Impressions scale modified for bipolar illness (CGI-BP), the Young Mania Rating Scale (YMRS), and the Inventory for Depressive Symptomatology (IDS). During the continuation trial, patients were assessed with these scales every 4 weeks. Patients' weights and side effects were also evaluated. Outcome measures were analyzed with repeated-measures analyses of variance. RESULTS: Patients with manic symptoms at study entry (N = 34) displayed significant reductions in CGI-BP-Mania Severity and YMRS scores in the acute and continuation (N = 19) trials (p values < .0001 and < .001, respectively). Patients with depressive symptoms at study entry (N = 22) showed significant decreases in CGI-BP-Depression Severity and IDS scores in the acute trial (p values < .001 and < .05, respectively), but only 9 patients entered the continuation trial. Among these 9 patients, maintenance of anti-depressant response was mostly maintained. Initially euthymic patients (N = 6) showed no change in any rating scale scores acutely, but 2 of 4 patients who entered the continuation trial developed depressive symptoms. The 62 patients as a group showed significant weight loss in both trials (p values < .001). However, 20 patients (32%) discontinued zonisamide for worsening mood symptoms. CONCLUSION: Adjunctive zonisamide was associated with beneficial effects on mood and body weight in some patients with bipolar disorders, but was also associated with a high discontinuation rate due to worsening mood symptoms. Double-blind, placebo-controlled studies are necessary to determine zonisamide's thymoleptic properties, if any, in bipolar disorders.     

Effect of continuous positive airway pressure treatment on seizure control in patients with obstructive sleep apnea and epilepsy

In patients with epilepsy, improvement in seizure control with treatment of coexisting obstructive sleep apnea (OSA) has been reported, but there is lack of data on the effect of continuous positive airway pressure (CPAP) compliance on seizure control in these patients. We examined the variability in seizure frequency in patients who were CPAP compliant and those who were not CPAP compliant. We undertook a retrospective review of clinical and polysomnographic data of adult patients with OSA and epilepsy seen at the Boston University Medical Center Epilepsy and Sleep Clinics between 2000 and 2010. Data were reviewed for CPAP compliance and seizure frequency after at least 6 months of CPAP use. Only patients with no changes in antiepileptic drug regimens during CPAP trial were included. Of the 660 patients identified, 41 fulfilled inclusion criteria, of whom 28 were CPAP compliant and 13 were not CPAP compliant. In the compliant group, CPAP use led to decreased seizure frequency from 1.8 per month to 1 per month (p = 0.01). In the noncompliant group, no significant difference in seizure frequency was noted between baseline (2.1 per month) and at follow-up (1.8 per month, p = 0.36). Sixteen of 28 CPAP-compliant subjects were seizure free, whereas only 3 of 13 non-CPAP compliant subjects were seizure free [relative risk (RR) 1.54, p = 0.05]. Patients with epilepsy and OSA not compliant with CPAP treatment are at higher risk of seizures than are CPAP-compliant patients. To validate this observation, further prospective studies are warranted.     

Excessive Daytime Sleepiness and Subjective Sleep Quality in Patients with Nocturnal Frontal Lobe Epilepsy: A Case-Control Study

Summary:   Purpose: Nocturnal frontal lobe epilepsy (NFLE) may be associated with sleep fragmentation and reduced sleep efficiency. Daytime sleepiness and disturbed sleep quality have been reported in some patients. We investigated the occurrence of daytime sleepiness-related symptoms and subjective sleep quality in patients with NFLE in comparison with matched controls.
Methods: Patients with NFLE at a single epilepsy center and matched controls randomly selected from the general population self-administered questionnaires on daytime sleepiness-related symptoms and subjective sleep quality [Epworth sleepiness scale (ESS), Bologna questionnaire on sleepiness-related symptoms (BQS), Berlin questionnaire].
Results: Thirty-three patients with NFLE and 27 controls were enrolled. "Tiredness after awakening" and "spontaneous mid-sleep awakenings" were more frequent in NFLE patients than in controls (36.4% versus 11.1%, p = 0.04, and 50.0% versus 22.2%, p = 0.03). The frequency of excessive daytime sleepiness (EDS) did not differ between groups. Posthoc analysis showed that patients with a complaint of "midsleep awakenings" had higher ESS and BQS scores than those without (7.3 versus 4.3, p = 0.004, and 5.0 versus 2.2, p = 0.001, respectively) and more frequent "tiredness after awakening" (56.3% versus 18.8%, p = 0.03).
Conclusions: Patients with NFLE have no pathological level of EDS with respect to controls. However, daytime sleepiness-related symptoms could be more frequent in a subgroup of patients with subjective disturbed sleep quality, irrespective of the perceived frequency of seizures.     

Psychiatric opinion and antipsychotic selection in the management of schizophrenia

OBJECTIVES: This study examined psychiatrists' opinions regarding the use of second-generation antipsychotics for treatment-resistant schizophrenia. It then sought to identify factors associated with these opinions. METHODS: A national survey was conducted (September 2003-January 2004) of psychiatrists engaged in the management of patients with schizophrenia. RESULTS: Among survey respondents (N=431), most psychiatrists (88%) believed that one or more of the five currently available second-generation antipsychotics could improve treatment-resistant positive symptoms after a failed trial of optimal oral haloperidol treatment. Psychiatrists who reported familiarity with schizophrenia practice guidelines were more likely to have high levels of optimism that these medications improve positive symptoms (odds ratio [OR]=3.6, 95% confidence interval [CI]=1.4-9.3, p=.009). Psychiatrists who met with a pharmaceutical representative at least once a week were also more likely to have high levels of optimism toward second-generation antipsychotics (OR=2.3, CI=1.4-3.9, p=.001). CONCLUSIONS: Reported familiarity with treatment guidelines and frequent contact with pharmaceutical representatives appear to be associated with optimism toward second-generation antipsychotics.     

Prevalence of central sleep apnea during continous positive airway pressure (CPAP) titration in subjects with obstructive sleep apnea syndrome at an altitude of 2640 m

BackgroundThe occurrence of central apneas when applying positive pressure (CPAP) to patients with obstructive sleep apnea syndrome (OSAS) is called complex sleep apnea (CompSA). This causes poor adherence to CPAP and persistence of symptoms. In Bogota, a city located at an altitude of 2640 m above sea level, chronic hypoxemia can generate certain instability of the respiratory system during sleep which could increase the presence of central apnea. The aim was to establish the prevalence of central apnea (central apnea index >5/h) in adults with moderate or severe OSAS during CPAP titration, and the factors associated with this.MethodPatients over 18 years old with OSAS were referred to the Fundacion Neumologica Colombiana Sleep Center, from January 2008 to June 2010. Polysomnogram (PSG) for CPAP titration was performed according to the American Academy of Sleep Medicine criteria. The prevalence was calculated and the clinical and baseline PSG factors associated with the CompSA were analyzed.ResultsWe included 988 patients, 58% men. CompSA prevalence was 11.6%. Factors associated with CompSA were: central apneas in the baseline PSG (OR: 5.34 [3.49–8.16]), history of heart failure (OR: 2.53 [1.58–4.07]), and male sex (OR: 1.68 [1.06–2.69]).ConclusionThe prevalence of complex sleep apnea in Bogota (11.6%) was intermediate compared to the reported in lower altitudes. The factors associated with the development of CompSA were male sex, heart failure, and the presence of central apnea in the baseline PSG.     

Delusions increase functional impairment in Alzheimer's disease

Background/Aims: Delusions in Alzheimer's disease (AD) may be associated with functional impairment. No studies to date have used functional instruments sensitive to changes in frontal executive function, possibly underestimating the impact. Methods: Patients with AD with and without delusions were administered cognitive tests and questionnaires to assess depression and quality of life. Caregivers were administered questionnaires to assess functional impairment, caregiver burden and behavioural symptoms. Results: AD patients with delusions (n = 19) when compared to AD patients without delusions (n = 19) matched for age, education and global cognitive function were significantly more functionally impaired based on performance on the Disability Assessment for Dementia Scale (p < 0.005). Conclusion: AD patients with delusions have significantly worse functional performance.     

No evidence for allelic association of serotonin 2A receptor and transporter gene polymorphisms with depression in Alzheimer disease

Patients with Alzheimer disease (AD) often exhibit psychiatric symptoms associated with cognitive impairment. The serotoninergic system may be involved in the development of depressive symptoms in AD patients, as suggested by the evidence that antidepressant drugs having the serotonin transporter as their target are effectively used to treat depressive AD patients. The aim of this study was to investigate the role of serotonin in depression, searching for association of two serotoninergic polymorphisms (T102C of serotonin receptor 5-HT2A and serotonin transporter linked polymorphic region -5-HTTLPR- of SLC6A4 gene) with depressive symptoms and considering their possible interactions with Apolipoprotein E (ApoE) and between themselves, in a sample of 208 sporadic AD patients and 116 normal controls from Italy. 5-HTTLPR and T102C are not associated with AD when separately analysed. However, we found out an interaction between the two polymorphisms in L/L and C/C genotype carriers increasing the risk for the disease (p=0.015, OR=8.048; 95% CI: 1.497-43.262). No association of the polymorphisms was detected with depression linked to AD. No interaction between 5-HTTLPR and T102C was detected in depressive AD subjects, even after stratification according to the presence of ApoE4 allele. These results suggest that the serotoninergic system may be not involved in the pathogenesis of depressive symptoms in AD patients, and it may be involved in other aspects of disease pathophysiology like cognitive symptoms and psychosis.     

Effects of vagus nerve stimulation on sleep-related breathing in epilepsy patients

PURPOSE: To describe the effects of vagus nerve stimulation (VNS) on sleep-related breathing in a sample of 16 epilepsy patients. METHODS: Sixteen adults with medically refractory epilepsy (nine men, seven women, ages 21-58 years) underwent baseline polysomnograms (PSGs). Three months after VNS therapy was initiated, PSGs were repeated. In addition, patient 7 had a study with esophageal pressure monitoring, and patient 1 had a continuous positive airway pressure (CPAP) trial. RESULTS: Baseline PSGs: One of 16 patients had an apnea-hypopnea index (AHI) >5 (6.8). Treatment PSGs: Five of 16 patients had treatment AHIs >5. Respiratory events were more frequent during periods with VNS activation (on-time) than without VNS activation (off-time; p = 0.016). Follow-up studies: Esophageal pressure monitoring in patient 7 showed crescendos in esophageal pressure during VNS activation, supporting an obstructive pattern. The CPAP trial of patient 1 showed that all respiratory events were associated with VNS stimulation at low CPAP levels. They were resolved at higher CPAP levels. CONCLUSIONS: Treatment with VNS affects respiration during sleep and should be used with care, particularly in patients with preexisting obstructive sleep apnea. The AHI after VNS treatment remained <5 in the majority of patients and was only mildly elevated (<12) in five patients. In one patient, CPAP resolved VNS-related respiratory events.     

Impact of sleep-related complaints on depressive symptoms in patients with restless legs syndrome

OBJECTIVE: Restless legs syndrome (RLS) is a distressing sensorimotor disorder with a 5% to 10% prevalence in the United States and Western Europe. The nocturnal occurrence of symptoms often leads to severe sleep disturbances. RLS has been reported to be associated with depression and anxiety. The aim of the present study was to investigate the relationship between RLS symptom severity, sleep disturbances, and depressive symptoms. METHOD: Questionnaire data from 100 consecutive patients with idiopathic RLS who had been investigated in our Sleep Disorders Unit from April 1999 to December 2004 were evaluated. Patients were untreated regarding RLS, depression, or sleep disturbances. Severity of RLS was assessed with the International RLS Study Group rating scale (IRLS). Depressive symptoms and subjective sleep quality were determined using the Beck Depression Inventory (BDI) and the Pittsburgh Sleep Quality Index (PSQI), respectively. RESULTS: IRLS scores indicated moderate-to-severe RLS symptoms in the population studied (mean +/- SD IRLS score = 23.6 +/- 6.7). The mean +/- SD BDI score was 9.3 +/- 5.6, with highest values on the "reduced sleep," "loss of energy," and "work difficulties" items, indicating predominating somatic symptoms of depression. Fourteen patients had a BDI score of 15 to 20 ("mild depression"), and 3 patients had a BDI score of 20 to 30 ("mild to moderate depression"). Overall, patients estimated their sleep quality as moderately impaired (mean +/- SD PSQI score = 10.9 +/- 3.7). Severity of RLS correlated with the impairment of subjective sleep quality (r = 0.281, p = .007) but not with self-rated depressive symptoms (r = 0.119, p = .237). CONCLUSION: RLS patients scored high on the somatic items of the BDI, particularly on those related to sleep disturbance, but not on the other items that mostly address cognitive symptoms. Our results indicate that RLS might be associated with some features of depression but not with the full spectrum of a depressive disorder. The relationship between the 2 disorders should be investigated in further studies.     

A pilot study evaluating acute use of eszopiclone in patients with mild to moderate obstructive sleep apnea syndrome

OBJECTIVE: To evaluate the effects of eszopiclone on measures of respiration and sleep using polysomnography in patients with mild to moderate obstructive sleep apnea syndrome (OSAS). METHODS: This double-blind, randomized crossover study included patients (35-64 years) with mild-to-moderate OSAS [apnea and hypopnea index (AHI) range 10 and 40]. Patients received either eszopiclone 3mg or placebo for two consecutive nights, with a 5-7 day washout between treatments. Continuous positive airway pressure (CPAP) was not allowed on nights in the sleep laboratory. RESULTS: The primary endpoint, mean total AHI, was not significantly different from placebo (16.5 with placebo and 16.7 with eszopiclone; 90% confidence interval (CI) -1.7, 1.9). No significant differences in total arousals, respiratory arousals, duration of apnea and hypopnea episodes, or oxygen saturation were noted. Significant differences in spontaneous arousals (13.6 versus 11.4 for placebo and eszopiclone, respectively; 90% CI -3.7, -0.7), sleep efficiency (85.1% and 88.4%; p=0.0075), wake time after sleep onset (61.8 and 48.1 min; p=0.0125), and wake time during sleep (55.9 and 43.2 min; p=0.013) were noted after eszopiclone treatment. Eszopiclone was well tolerated. CONCLUSIONS: In this pilot study, eszopiclone did not worsen AHI, and it improved sleep maintenance and efficiency. Further study is warranted to determine whether eszopiclone could improve CPAP compliance or next-day function in patients with OSAS.     

Predictors of CPAP adherence following stroke and transient ischemic attack

ObjectiveContinuous positive airway pressure (CPAP) has been shown to improve functional, motor and cognitive outcomes in post-stroke obstructive sleep apnea (OSA). However, rates of CPAP adherence are often low and factors impacting CPAP adherence remain under-explored. Our objective was to determine predictors of CPAP adherence in patients who had a stroke or transient ischemic attack (TIA).MethodsWe screened 313 stroke/TIA patients for OSA using in-hospital polysomnography or the ApneaLink home sleep apnea test. Potential predictors were recorded at baseline and adherence to CPAP was recorded during a six-month follow-up visit. Selected variables from our univariate analyses were included in multivariate regression models to determine predictors of CPAP adherence. For our logistic regression analyses, CPAP adherence (CPAP use of ≥4 h per night) was the dependent outcome variable. In our linear regression analyses, total CPAP use per week (recorded in hours) was the dependent outcome variable.ResultsEighty-eight patients (mean age 67.81 ± 13.09 years, 69.32% male, mean body mass index 27.93 ± 5.23 kg/m²) were diagnosed with OSA, prescribed CPAP, and assessed for adherence at a six-month follow-up visit. In these 88 patients, 46 (52.27%) were adherent with CPAP therapy. From our regression models, two significant predictors of CPAP adherence were identified: greater functional status (p = 0.04) and not endorsing daytime tiredness (p = 0.047) post-stroke/TIA.ConclusionPatients with greater functional capacity and those with less daytime fatigue demonstrated stronger adherence to CPAP therapy. Our findings may facilitate future treatment strategies for enhancing CPAP adherence in the vulnerable stroke/TIA population.     

The effect of treatment of obstructive sleep apnea on quality of life in children with cerebral palsy

Benefits of treatment for obstructive sleep apnea (OSA) in children with cerebral palsy could differ from those in otherwise healthy children. We examined the effects of OSA treatment by comparing a group of children with cerebral palsy treated with adenotonsillectomy or continuous positive airway pressure (CPAP) by nasal mask with controls who had not received treatment. Parents completed a structured questionnaire assessing change in their child's quality of life (QOL) and OSA symptoms after treatment, or between 6 months ago and the present time for controls. Fifty-one children were eligible, of whom 19 (37%) completed questionnaires: treatment group, n=10 (adenotonsillectomy 7, CPAP 3); and controls, n=9. The treatment group showed an improvement in OSA symptoms compared to controls, especially sleep disturbance (p=0.005), daytime functioning (p=0.03) and caregiver concern (p=0.03). Parental QOL score improved by a mean of 18% in the treatment group (p=0.06 for a difference from controls). Treatment of OSA in children with cerebral palsy leads to significant benefit in some aspects of health and QOL.     

Imipramine is effective in preventing relapse in electroconvulsive therapy-responsive depressed inpatients with prior pharmacotherapy treatment failure: a randomized, placebo-controlled trial

OBJECTIVE: To compare the efficacy of imipramine versus placebo in preventing relapse after successful electroconvulsive therapy (ECT) in depressive inpatients with pharmacotherapy treatment failure prior to ECT. METHOD: During a 6-month period, the incidence of relapse was assessed. Two centers, both inpatient units for treatment of depressed patients, participated in this trial. Patients with DSM-IV-diagnosed major depressive disorder resistant to an anti-depressant and subsequent lithium addition and/or a monoamine oxidase inhibitor were included. Patients were randomly assigned to double-blind treatment with imipramine with adequate plasma levels (N=12) or placebo (N=15) after successful ECT. The mean imipramine dosage was 209 mg/day (standard deviation: 91.7, range: 75-325 mg/day). The main outcome measure was relapse defined as at least "moderately worse" compared with baseline score on the Clinical Global Impressions-Improvement scale. Treatments were compared with survival analysis using the Cox proportional hazards model, including psychotic features and the score on the Hamilton Rating Scale for Depression (HAM-D) at baseline as prespecified covariables. Patients were enrolled in the study from April 1997 to July 2001. RESULTS: In the placebo group, 80% (12/15) of the patients relapsed compared with 18% (2/11) in the imipramine group. The Cox regression analysis showed a significant reduction in the risk of relapse of 85.6% with imipramine compared to placebo (p=.007; 95% confidence interval [CI]=24.6% to 97.2%) adjusted for the covariables. There was an 18% increase in the relapse rate (p=.032; 95% CI=2% to 36%) per unit increase in HAM-D score before the start of the trial; psychotic features had no significant effect (p=.794). CONCLUSIONS: Depressed patients with pharmacotherapy treatment failure may benefit from the prophylactic effect of the same class of drug during maintenance therapy after response to ECT.     

Mandibular advancement device in Parkinson's disease: a pilot study on efficacy and usability

Background/objectivesContinuous positive airway pressure (CPAP) is efficacious in the treatment of obstructive sleep apnea syndrome (OSAS) in patients with Parkinson's disease (PD). However, this treatment is often not well tolerated in this disabled population. We explored, in a pilot study, the efficacy, observance, and usability of mandibular advancement device (MAD) for the treatment of OSAS in this peculiar population.Patients/methodsTwenty patients with PD and moderate or severe OSAS were included in the study. Ten patients had refused or not tolerated the validated treatment with CPAP so that they were treated with MAD. The patients treated with MAD were matched for sex, age and body mass index (BMI) to 10 patients with PD treated with CPAP.We explored the efficacy of MAD on sleep disorders complaints (PDSS-2) and on sleep recordings. We compared adherence, tolerance and usability with MAD and with CPAP.ResultsMAD improved sleep complaints increasing PDSS-2 scores (85 [55–106] vs 106 [88–126], p < 0.005), and sleep respiratory measures reducing apnea/hypopnea index (AHI) (50.8 [30.0–76.4] vs 9.4 [5.0–45.2], <0.001) and oxygen desaturation index (22.9 [2.1–92.0] vs 3.8 [0.2–34.2], p < 0.05). Observance was higher with MAD than with CPAP. Usability and caregiver satisfaction were higher with MAD than with CPAP whereas side effects were similarly reported.ConclusionMandibular advancement device may be an noteworthy alternative treatment of OSAS in patients with PD.