Subthalamic Stimulation Improves Quality of Sleep in Parkinson Disease: A 36-Month Controlled Study

Article type: Research Article

Authors: Jost, Stefanie T.^{a; *} | Ray Chaudhuri, K.^{b; c} | Ashkan, Keyoumars^b | Loehrer, Philipp A.^d | Silverdale, Monty^e | Rizos, Alexandra^b | Evans, Julian^e | Petry-Schmelzer, Jan Niklas^a | Barbe, Michael T.^a | Sauerbier, Anna^{a; c} | Fink, Gereon R.^{a; f} | Visser-Vandewalle, Veerle^g | Antonini, Angelo^h | Martinez-Martin, Pabloⁱ | Timmermann, Lars^d | Dafsari, Haidar S.^{a; *} | On behalf of EUROPAR and the International Parkinson and Movement Disorders Society Non-Motor Parkinson’s Disease Study Group

Affiliations: [a] Department of Neurology, University Hospital of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany | [b] Parkinson Foundation International Centre of Excellence, King’s College Hospital, London, UK | [c] Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK | [d] Department of Neurology, University Hospital Giessen and Marburg, Campus Marburg, Marburg, Germany | [e] Department of Neurology and Neurosurgery, Salford Royal NHS Foundation Trust, Manchester Academic Health Science Centre, University of Manchester, Greater Manchester, UK | [f] Cognitive Neuroscience, Institute of Neuroscience and Medicine (INM-3), Research Centre Jülich, Jülich, Germany | [g] Department of Stereotaxy and Functional Neurosurgery, University Hospital of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany | [h] Department of Neurosciences (DNS), Padova University, Padova, Italy | [i] Center for Networked Biomedical Research in Neurodegenerative Diseases (CIBERNED), Carlos III Institute of Health, Madrid, Spain

Correspondence: [*] Correspondence to: Stefanie T. Jost and Haidar S. Dafsari, Department of Neurology, University Hospital Cologne, Kerpener Str. 62, 50937 Cologne, Germany. Tel.: (S.T.J.) +49 221 478 86180; (H.S.D.) +49 221 478 37445; (S.T.J.) E-mails: [email protected]; (H.S.D.) [email protected].

Abstract: Background:Sleep disturbances and neuropsychiatric symptoms are some of the most common nonmotor symptoms in Parkinson’s disease (PD). The effect of subthalamic stimulation (STN-DBS) on these symptoms beyond a short-term follow-up is unclear. Objective:To examine 36-month effects of bilateral STN-DBS on quality of sleep, depression, anxiety, and quality of life (QoL) compared to standard-of-care medical therapy (MED) in PD. Methods:In this prospective, controlled, observational, propensity score matched, international multicenter study, we assessed sleep disturbances using the PDSleep Scale-1 (PDSS), QoL employing the PDQuestionnaire-8 (PDQ-8), motor disorder with the Scales for Outcomes in PD (SCOPA), anxiety and depression with the Hospital Anxiety and Depression Scale (HADS), and dopaminergic medication requirements (LEDD). Within-group longitudinal outcome changes were tested using Wilcoxon signed-rank and between-group longitudinal differences of change scores with Mann-Whitney U tests. Spearman correlations analyzed the relationships of outcome parameter changes at follow-up. Results:Propensity score matching applied on 159 patients (STN-DBS n = 75, MED n = 84) resulted in 40 patients in each treatment group. At 36-month follow-up, STN-DBS led to significantly better PDSS and PDQ-8 change scores, which were significantly correlated. We observed no significant effects for HADS and no significant correlations between change scores in PDSS, HADS, and LEDD. Conclusions:We report Class IIb evidence of beneficial effects of STN-DBS on quality of sleep at 36-month follow-up, which were associated with QoL improvement independent of depression and dopaminergic medication. Our study highlights the importance of sleep for assessments of DBS outcomes.

Keywords: Deep brain stimulation, sleep dysfunction, subthalamic nucleus, quality of life, nonmotor symptoms

DOI: 10.3233/JPD-202278

Journal: Journal of Parkinson's Disease, vol. 11, no. 1, pp. 323-335, 2021