Objective: To describe the effects of levodopa/carbidopa intestinal gel (LCIG) infusion on sleep quality in patients with advanced Parkinson’s disease (PD). 

Background: Worsening of sleep quality and sleep disorders are common in advanced PD. LCIG infusion is a new therapeutic option for advanced PD that has demonstrated to improve motor fluctuations. However, even it can also improve some non-motor symptoms of PD disease, its effect specifically on sleep are unknown and poorly studied.

Methods: Prospective open-label study of sleep quality in patients with advanced PD with disabling motor fluctuations treated with LCIG evaluated with Epworth scale, fatigue scale, Pittsburg Sleep Quality questionnaire, Beck Depression Inventory (BDI), Hamilton Anxiety scale and overnight polysomnography (PSG) study at baseline and at 6 months after treatment.

Results: Seven patients were included (1M/6F) with advanced PD to treatment with LCIG. The mean age was 69.6 years (range 60-78) and the mean duration of the disease was of 12.7 years (range 8-18).

At baseline their sleep quality was bad either in objective and subjective parameters, with absence of drowsiness, presence of fatigue, depression and anxiety and 5 patients presented a rapid eye movement (REM) phase without atony.

The subjective questionnaire on drowsiness showed that patients with drowsiness improved after LCIG but not significantly. The Pittsburgh Sleep Quality Questionnaire does not change significantly after treatment. However there is an improvement in severity: 4 patients had a severe Pittsburgh score at baseline of these, 3 became to moderate; 1 moderate at baseline became normal and of the 2 normal ones at baseline, 1 became slight. Questionnaires of fatigue, depression and anxiety do not change after treatment. 

PSG showed a low sleep efficiency. After treatment there is a tendency to decrease the percentage of  REM sleep time. However, there is also a tendency to improve the number of arousals, especially due to the reduction of spontaneous arousals. In addition, periodic leg movement in REM phase also has a tendency to improve.

Conclusions: Our results corroborate that patients with advanced PD have a poor sleep quality and that treatment with LCIG does not aggravate but does not significantly modify the sleep quality of these patients.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/sleep-quality-in-patients-with-advanced-parkinsons-disease-treated-with-levodopacarbidopa-intestinal-gel-infusion/