Deep Brain Stimulation and Sleep-Wake Disturbances in Parkinson Disease: A Review

Abstract

Sleep-wake disturbances are common non-motor manifestations in Parkinson Disease (PD). Complex pathophysiological changes secondary to neurodegeneration in combination with motor symptoms and dopaminergic medications contribute to development of sleep-wake disturbances. The management of sleep complaints in PD is important as this symptom can affect daily activities and impair quality of life. Deep brain stimulation (DBS) is an effective adjunctive therapy for management of motor symptoms in PD. However, its effect on non-motor symptoms including sleep-wake disturbances is not widely understood. In this article, we reviewed studies assessing the effect of DBS at various therapeutic targets on sleep-wake disturbances. Of the studies examining the role of DBS in sleep-wake disturbances, the effect of subthalamic nucleus stimulation is most widely studied and has shown improvement in sleep quality, sleep efficiency, and sleep duration. Although, studies investigating changes in sleep with stimulation of thalamus, globus pallidus interna, and pedunculopontine nucleus are limited, they support the potential for modulation of sleep-wake centers with DBS at these sites. The mechanism by which DBS at different anatomical targets affects sleep-wake disturbances in PD is unclear and may involves multiple factors, including improved motor symptoms, medication adjustment, and direct modulation of sleep-wake centers.

Inferring sleep stage from local field potentials recorded in the subthalamic nucleus of Parkinson's patients

“…This would serve a crucial unmet need in this patient population (Chaudhuri et al., ), as there are currently no effective treatments with a low side‐effect burden (Arnulf et al., ). Although DBS is an established therapy for the treatment of motor symptoms of Parkinson's disease, the effect of DBS on the sleep disturbances of Parkinson's disease has not yet been fully characterized, and the mechanism(s) underlying the improvements reported in sleep quality, efficiency and duration remains to be elucidated (Sharma, Sengupta, Chitnis, & Amara, ).…”

“…In our prior work, we used a support vector machine (SVM) model that performed well when tested on novel epochs derived from the familiar patient used to train the model but failed to generalize to novel subjects (Thompson et al, 2018 (Arnulf et al, 2000). Although DBS is an established therapy for the treatment of motor symptoms of Parkinson's disease, the effect of DBS on the sleep disturbances of Parkinson's disease has not yet been fully characterized, and the mechanism(s) underlying the improvements reported in sleep quality, efficiency and duration remains to be elucidated (Sharma, Sengupta, Chitnis, & Amara, 2018).…”

Effect of acupuncture and its influence on cerebral activity in patients with persistent asthma: study protocol for a randomized controlled clinical trial

“…The limitations of this study lie primarily in the seasonality of asthma attacks (48) and the diversity of routine medical treatment for patients with asthma (49). Thus, the inconsistent regular treatments of asthma may be a confounding of our results.…”

Practical Evaluation and Management of Insomnia in Parkinson's Disease: A Review

“…77,78 Specifically, significant improvements occurred in most PSQI subscores (ie, sleep quality, sleep latency, sleep efficiency, sleep duration) and PDSS sleep quality, sleep onset, and maintenance insomnia items. 77,78 In addition, improvements in objective PSG parameters have also been noted (wake after sleep onset time, sleep efficiency). Although insomnia is not a primary indication for DBS, improvements in sleep may be an added benefit.…”

“…Most studies have examined subthalamic nucleus DBS and have shown improvements in PSQI or PDSS scores from pre‐ to postimplantation at variable periods (1 week–26 months) . Specifically, significant improvements occurred in most PSQI subscores (ie, sleep quality, sleep latency, sleep efficiency, sleep duration) and PDSS sleep quality, sleep onset, and maintenance insomnia items . In addition, improvements in objective PSG parameters have also been noted (wake after sleep onset time, sleep efficiency).…”