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.