Effect of levodopa-carbidopa intestinal gel infusion on objective measures of daytime sleepiness and nocturnal sleep in Parkinson's disease.

BACKGROUND

Excessive daytime sleepiness and sleep disturbances are common in Parkinson's disease (PD), considerably affecting the quality of life of patients and caregivers. Antiparkinsonian medications further complicate sleep-wake management. Advanced PD with motor fluctuations often requires continuous dopaminergic stimulation via apomorphine subcutaneous infusion or levodopa/carbidopa intestinal gel infusion (LCIGI). Evidence on LCIGI's effects on sleep and sleepiness remains limited, relying mainly on subjective bias-prone measures.

OBJECTIVE

This pilot study used overnight in-laboratory polysomnography (PSG) and the multiple sleep latency test (MSLT), the gold standards for objective measurements, to evaluate effects of LCIGI initiation on sleep and sleepiness.

METHODS

In this prospective, monocentric observational study, 34 patients with motor fluctuations underwent PSG and MSLT before (M0) and three months after (M3) LCIGI initiation. Clinical characteristics included body mass index (BMI), L-Dopa equivalent daily dose (LEDD), and Epworth Sleepiness Scale (ESS) scores to examine correlations between subjective questionnaire-based and objective MSLT-based measures.

RESULTS

Twenty-three patients completed both assessments. MSLT values remained stable (M0: 12.5 [10.9; 15.8] min; M3: 15.3 [12.2; 16.6] min; P=0.401) as did PSG parameters. As expected, BMI decreased, LEDD increased, dopamine agonist use declined, and clozapine/quetiapine use increased. ESS scores did not correlate with MSLT results at baseline or follow-up.

CONCLUSIONS

LCIGI had no significant impact on objectively measured daytime sleepiness (MSLT) or PSG sleep parameters.