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Pharmacological and non-pharmacological management of sleep disturbances in Parkinson's disease: if when and how.

Expert opinion on pharmacotherapy
November 1, 2024
Cristian Falup-Pecurariu et al. (7 authors)
Journal ArticleReviewHuman Study
Study Details

Study Goal

The researchers aimed to evaluate the safety and efficacy of pharmacological strategies, including Melatonin, for managing sleep disturbances in Parkinson's disease.

Results Summary

Melatonin was identified as a commonly used therapy for REM sleep behavior disorder (RBD) and insomnia in PD patients, though further confirmatory evidence is needed for general recommendation.

Population

Patients with Parkinson's disease experiencing sleep disturbances.

Effective Dosage

Not specified

Duration

Not specified

Interactions

None mentioned

Extracted Claims (10)
InterventionDirectionEndpointPopulationDosageImpactClaim #
Melatonin
no change
REM sleep behavior disorder (RBD)
Parkinson's disease patients
-
most commonly used therapy
#1
Clonazepam
no change
REM sleep behavior disorder (RBD)
Parkinson's disease patients
-
most commonly used therapy
#2
Modafinil
no change
excessive daytime sleepiness (EDS)
Parkinson's disease patients
-
most used pharmacological wake-promoting agent
#3
Caffeine
no change
excessive daytime sleepiness (EDS)
Parkinson's disease patients
-
most used pharmacological wake-promoting agent
#4
Proper sleep hygiene
increase
nocturnal sleep quality
Parkinson's disease patients
-
recommended
#5
Optimization of dopaminergic treatment during nighttime
decrease
insomnia
Parkinson's disease patients
-
highly recommended
#6
Eszopiclone
decrease
insomnia
Parkinson's disease patients
-
further intervention
#7
Melatonin
decrease
insomnia
Parkinson's disease patients
-
further intervention
#8
Calcium channel alpha-2-delta ligands
decrease
restless legs syndrome (RLS)
Parkinson's disease patients
-
therapeutic option
#9
Low-dose dopamine agonists (DA)
decrease
restless legs syndrome (RLS)
Parkinson's disease patients
-
therapeutic option
#10
Abstract

INTRODUCTION: Sleep dysfunction occurs in various forms and is a bothersome and intrusive non-motor symptom of Parkinson's disease (PD). Frequently undiagnosed, their poor management can have a great impact on the quality of life of PD patients and their caregivers. AREAS COVERED: This article covers the safety and efficacy of pharmacological strategies for the management of the most frequent sleep disturbances in Parkinson's disease. Non-pharmacological aspects are also discussed, but these are not the main focus. Literature searches using electronic databases (Medline, Cochrane Library) and systematic checking of references from review articles/other reports were performed. EXPERT OPINION: Melatonin and clonazepam are the most commonly used therapies for the management of REM sleep behavior disorder (RBD). The most used pharmacological wake-promoting agents in the treatment of excessive daytime sleepiness (EDS) are modafinil and caffeine. Poor nocturnal sleep quality is usually linked to EDS, thus proper sleep hygiene is recommended. As nocturnal motor symptoms are commonly associated with sleep fragmentation and early morning off, optimization of dopaminergic treatment during nighttime is highly recommended for the proper management of insomnia. Further interventions include eszopiclone and melatonin for the management of insomnia. Therapeutic options for restless legs syndrome (RLS) include calcium channel alpha-2-delta ligands and low-dose dopamine agonists (DA). Further confirmatory evidence is needed before the general recommendation of these treatments.

Medical Subject Headings (MeSH)
HumansParkinson DiseaseSleep Wake DisordersQuality of LifeWakefulness-Promoting AgentsMelatoninREM Sleep Behavior Disorder
Study Links
Quality Scores
SafetyNot Assessed
Efficacy75/10
Quality80/10
Research Impact Scores
APT Score0.05
Weight Score2.43
Normalized Score0.66
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