Sleep is crucial to wellness, but it is disrupted in almost all patients with Parkinson’s disease. Many factors can cause disturbed sleep in people with Parkinson’s disease, such as motor dysfunction at night, altered sleep architecture, and medication effects, and problems with sleep might also result in daytime somnolence. Patients rate sleep dysfunction as one of their top ten “most bothersome” symptoms, and bedside assessment of sleep—with validated tools such as the Parkinson’s disease sleep scale (PDSS)—has shone a light on the high prevalence and broad effects of poor sleep on quality of life for patients and their carers. In case series and open-label studies, improvements in PDSS scores have been noted after subthalamic deep brain stimulation and continuous drug delivery of dopaminergic therapies such as levodopa-carbidopa intestinal gel infusion, rotigotine patch, and ropinirole prolonged release. Although the effects of dopamine agonists on sleep in Parkinson’s disease are complex (eg, low doses can cause daytime somnolence, whereas high doses can cause insomnia), the potential beneficial effects of these treatments on sleep dysfunction in Parkinson’s disease have not been investigated. Apomorphine infusion is a device-aided therapy for Parkinson’s disease that, in the 1990s, showed substantial effects on sleep disruption in a small pilot study, but nocturnal apomorphine infusion has not been studied since then in larger trials.
Apomorphine infusion for improving sleep in Parkinson’s disease – The Lancet Neurology
