Effect of levodopa-carbidopa intestinal gel infusion on objective measures of daytime sleepiness and nocturnal sleep in Parkinson's disease - 04/09/26

Doi : 10.1016/j.neurol.2026.07.002

M. Bucy ^a,^b,^c,⁎ , N. Carpentier ^a,^c, G. Clement ^a,^b, S. Richard ^a,^d, S. Frismand-Kryloff ^a,^b,^{^{1
Are shared last co-authors.}}, E. Ruppert ^e,^f,^{^{1
Are shared last co-authors.}}

^a Department of Neurology, Nancy University Hospital, Nancy, France

^b Parkinson Expert Center, Nancy University Hospital, Nancy, France

^c Center for Medicine and Research in Sleep, Nancy University Hospital, Nancy, France

^d Strokes Unit, Nancy University Hospital, Nancy, France

^e Department of Neurology, Sleep Disorders Center – CIRCSom, University Hospital of Strasbourg, Strasbourg, France

^f CNRS UPR 3212, Institute for Cellular and Integrative Neurosciences, University of Strasbourg, 8, allée du Général-Rouvillois, 67000 Strasbourg, France

^⁎ Corresponding author . Department of Neurology, Nancy University Hospital, 29, avenue du Maréchal-de-Lattre-de-Tassigny, 54000 Nancy, France. Department of Neurology, Nancy University Hospital 29, avenue du Maréchal-de-Lattre-de-Tassigny Nancy 54000 France

Sous presse. Épreuves corrigées par l'auteur. Disponible en ligne depuis le Friday 04 September 2026

Highlights

•	Sleepiness and poor sleep are common in patients with advanced Parkinson's disease (PD).
•	Antiparkinsonian medications can affect sleep and complicate sleep-wake management.
•	Evidence on objective effects of levodopa-carbidopa intestinal gel infusion (LCIGI) is limited.
•	LCIGI had no significant impact on daytime sleepiness measured by the multiple sleep latency test.
•	LCIGI had no significant impact on sleep parameters assessed using polysomnography.

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Abstract

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.