Improving Sleep Quality in Parkinson’s: Is Levodopa-Carbidopa Intestinal Gel Effective?

man in bed not able to sleep
man in bed not able to sleep
Further prospective masked studies with larger number of patients on levodopa-carbidopa intestinal gel (LCIG) infusion therapy are necessary to clarify the positive influence of LCIG on sleep quality in patients with advanced Parkinson disease.

Participants with advanced Parkinson disease (PD) who were treated with levodopa-carbidopa intestinal gel infusion did not experience reduced quality of sleep and results showed trends toward sleep quality improvement, according to a review published in Parkinson’s Disease.

The investigators of this single-center, open-label prospective pilot study (ClinicalTrials.gov identifier: NCT03602924) sought to evaluate the effect of levodopa-carbidopa intestinal gel infusion on sleep quality in patients with advanced PD using quantitative and qualitative measures.

The study sample included 7 consecutive participants who received an implant for continuous levodopa-carbidopa intestinal gel infusion; dosage was titrated individually until greatest motor control was attained. The investigators performed overnight polysomnography before and after 6 months of treatment, reporting on parameters including sleep efficiency, wake after sleep onset, REM sleep and non-REM sleep, snoring sounds, apnea-hypopnea index, arousals, leg movements in sleep, and more. The investigators also administered questionnaires at baseline and follow-up, including the Epworth Sleepiness Scale, fatigue scale, Pittsburgh Sleep Quality Index, Beck Depression Inventory, and the Hamilton Anxiety Rating Scale.

Motor fluctuations and symptoms showed significant improvement after 6 months of continuous levodopa-carbidopa intestinal gel infusion. Polysomnography results showed improvements in generalized sleep efficiency; however, changes observed in sleep parameters from baseline to follow-up were not considered statistically significant.

After 6 months of levodopa-carbidopa intestinal gel infusion, the percentage of REM sleep decreased from 16.2%±9.9% to 10.4%±6.8% (=.08) and sleep arousals decreased from 15.0±7.0 to 12.9±5.6 (=.115); these reductions were attributed primarily to a reduction of spontaneous arousals (7.5±3.1 to 5.2±5.0; =.075) and periodic leg movements during REM sleep (20.7±31.6 to 2.9±3.7; =.285). At follow-up, the mean percentage of non-REM sleep increased from 83.6%±10.2% to 89.6%±6.8% but did not reach statistical significance.

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Compared with baseline scores, the questionnaires also reported an improvement in sleep quality, fatigue, and daytime sleepiness after 6 months of levodopa-carbidopa intestinal gel infusion.

A limitation of the study was the small sample population of 7 patients which was insufficient to attribute clinical significance to any of the results.

The results indicated that treatment with levodopa-carbidopa intestinal gel infusion did not aggravate the quality of sleep in patients with advanced PD as shown by a reduction in spontaneous arousals and periodic leg movements during REM sleep. The researchers conclude that future research with larger study populations is necessary “to clarify the positive influence of [levodopa-carbidopa intestinal gel] on sleep quality in patients with advanced PD.” 

Reference                    

De Fabregues O, Ferré A, Romero O, Quintana M, Alvarez-Sabin J. Sleep quality and levodopa intestinal gel infusion in Parkinson’s disease: a pilot study [published online November 1, 2018]. Parkinsons Dis. doi:10.1155/2018/8691495