Sleep outcomes and related factors in Parkinson's disease after subthalamic deep brain electrode implantation: a retrospective cohort study

Ruoyu Ma; Zixiao Yin; Yingchuan Chen; Tianshuo Yuan; Qi An; Yifei Gan; Yichen Xu; Yin Jiang; Tingting Du; Anchao Yang; Fangang Meng; Guanyu Zhu; Jianguo Zhang

doi:10.1177/17562864231161163

Sleep outcomes and related factors in Parkinson's disease after subthalamic deep brain electrode implantation: a retrospective cohort study

Ther Adv Neurol Disord. 2023 May 10:16:17562864231161163. doi: 10.1177/17562864231161163. eCollection 2023.

Authors

Ruoyu Ma¹, Zixiao Yin¹, Yingchuan Chen¹, Tianshuo Yuan¹, Qi An¹, Yifei Gan¹, Yichen Xu¹, Yin Jiang², Tingting Du², Anchao Yang¹, Fangang Meng^{2

3}, Guanyu Zhu⁴, Jianguo Zhang^{4

2

3}

Affiliations

¹ Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
² Department of Functional Neurosurgery, Beijing Neurosurgical Institute, Capital Medical University, Beijing, China.
³ Beijing Key Laboratory of Neurostimulation, Beijing, China.
⁴ Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, No. 119 South 4th Ring West Road, Fengtai District, Beijing 100070, China.

Abstract

Background: Subthalamic nucleus deep brain stimulation (STN-DBS) improves sleep qualities in Parkinson's disease (PD) patients; however, it remains elusive whether STN-DBS improves sleep by directly influencing the sleep circuit or alleviates other cardinal symptoms such as motor functions, other confounding factors including stimulation intensity may also involve. Studying the effect of microlesion effect (MLE) on sleep after STN-DBS electrode implantation may address this issue.

Objective: To examine the influence of MLE on sleep quality and related factors in PD, as well as the effects of regional and lateral specific correlations with sleep outcomes after STN-DBS electrode implantation.

Study design: Case-control study; Level of evidence, 3.

Data sources and methods: In 78 PD patients who underwent bilateral STN-DBS surgery in our center, we compared the sleep qualities, motor performances, anti-Parkinsonian drug dosage, and emotional conditions at preoperative baseline and postoperative 1-month follow-up. We determined the related factors of sleep outcomes and visualized the electrodes position, simulated the MLE-engendered volume of tissue lesioned (VTL), and investigated sleep-related sweet/sour spots and laterality in STN.

Results: MLE improves sleep quality with Pittsburgh Sleep Quality Index (PSQI) by 13.36% and Parkinson's Disease Sleep Scale-2 (PDSS-2) by 17.95%. Motor (P = 0.014) and emotional (P = 0.001) improvements were both positively correlated with sleep improvements. However, MLE in STN associative subregions, as an independent factor, may cause sleep deterioration (r = 0.348, P = 0.002), and only the left STN showed significance (r = 0.327, P = 0.004). Sweet spot analysis also indicated part of the left STN associative subregion is the sour spot indicative of sleep deterioration.

Conclusion: The MLE of STN-DBS can overall improve sleep quality in PD patients, with a positive correlation between motor and emotional improvements. However, independent of all other factors, the MLE in the STN associative subregion, particularly the left side, may cause sleep deterioration.

Keywords: Parkinson’s disease; electrode position; microlesion effect; non-motor symptoms; sleep outcomes; subthalamic deep brain stimulation.