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.

中文翻译：

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下丘脑刺激可改善帕金森病患者的睡眠质量：一项为期 36 个月的对照研究

背景：睡眠障碍和神经精神症状是帕金森病 (PD) 中一些最常见的非运动症状。丘脑底刺激 (STN-DBS) 在短期随访后对这些症状的影响尚不清楚。目的：与标准护理药物治疗 (MED) 相比，检查双侧 STN-DBS 对睡眠质量、抑郁、焦虑和生活质量 (QoL) 的 36 个月影响。方法：在这项前瞻性、对照、观察性、倾向评分匹配的国际多中心研究中，我们使用 PDSleep Scale-1 (PDSS)、使用 PDQuestionnaire-8 (PDQ-8) 的 QoL、使用结果量表的运动障碍评估睡眠障碍在 PD (SCOPA)、医院焦虑和抑郁量表 (HADS) 的焦虑和抑郁以及多巴胺能药物需求 (LEDD)。使用 Wilcoxon 符号秩和组间变化评分的纵向差异以及 Mann-Whitney U 检验来测试组内纵向结果的变化。Spearman 相关性分析了随访结果参数变化的关系。结果：倾向评分匹配应用于 159 名患者（STN-DBS n = 75，MED n = 84）导致每个治疗组中有 40 名患者。在 36 个月的随访中，STN-DBS 显着改善了 PDSS 和 PDQ-8 变化评分，这两者显着相关。我们观察到对 HADS 没有显着影响，并且在 PDSS、HADS 和 LEDD 的变化分数之间没有显着相关性。结论：我们报告了 STN-DBS 对 36 个月随访时睡眠质量有益影响的 IIb 类证据，这与独立于抑郁症和多巴胺能药物的 QoL 改善相关。