Transdermal, infusion, and surgical therapies and effect on sleep dysfunction in Parkinson's disease

Abstract

Sleep dysfunction is dominant in patients on oral dopamine replacement therapies as nighttime therapy is suboptimal and often not attempted. Non oral infusion-based Parkinson’s disease (PD) therapies, transdermal therapies, as well as deep brain stimulation (DBS) of the subthalamic nucleus (STN) bridge this gap and provide nighttime cover in most cases in PD. DBS of the STN also show significant improvement in PD sleep scale scores and improvement in sleep quality. Apart from the Euroinf 2 study, comparative data on nonmotor and sleep symptoms comparing DBS with infusion therapies are scarce and are much needed for future. KEY POINTS • Continuous drug delivery strategies using dopamine agonists or levodopa appear to have a consistent benefit on sleep. • Level 1 evidence to support the use of rotigotinepatch or overnight apomorphine infusion for management of sleep dysfunction. • Subcutaneous foslevodopa/foscarbidopa infusion is a 24 hours treatment helping aspects of nighttime sleep. • Deep brain stimulation of the subthalamic nucleus has a significant impact on sleep in PD, with improvements in subjective sleep quality, nocturnal mobility, and sleep architecture. However, its effect on specific sleep disorders such as REM sleep behavior disorder, restless legs syndrome, and excessive daytime sleepiness is inconsistent.