The Impact of Subthalamic Deep Brain Stimulation on Sleep–Wake Behavior: A Prospective Electrophysiological Study in 50 Parkinson Patients

Baumann‐Vogel, Heide; Imbach, Lukas L.; Sürücü, Oǧuzkan; Stieglitz, Lennart; Waldvogel, Daniel; Baumann, Christian; Werth, Esther

doi:10.1093/sleep/zsx033

Cited by 47 publications

(91 citation statements)

References 41 publications

(40 reference statements)

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“…In addition, recordings analysed in our experiment were acquired 3 weeks after DBS electrode implantation (vs 2–4 days after surgery by Urrestarazu et al ) with the former paradigm resulting in minimising the confounding effect of postsurgical oedema on neuronal recordings 37. In addition, our STN-LFP findings complement other groups’ work examining the effect of DBS on PD subject sleep quality 20. In recently published work from Baumann-Vogel et al , STN stimulation was found to improve subjective sleep quality as well as quantitative measures of sleep.…”

Section: Discussionsupporting

confidence: 59%

“…In recently published work from Baumann-Vogel et al , STN stimulation was found to improve subjective sleep quality as well as quantitative measures of sleep. However, pattern of sleep-state transitions and REM sleep characteristics remained atypical 20. Interestingly, the authors report that the more dorsal the STN-DBS contact, the greater the increase in sleep efficiency.…”

Section: Discussionmentioning

confidence: 99%

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Sleep patterns in Parkinson’s disease: direct recordings from the subthalamic nucleus

Thompson

Tekriwal

Felsen

et al. 2017

J Neurol Neurosurg Psychiatry

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Sleep is a fundamental homeostatic process, and disorders of sleep can greatly affect quality of life. Parkinson's disease (PD) is highly comorbid for a spectrum of sleep disorders and deep brain stimulation (DBS) of the subthalamic nucleus (STN) has been reported to improve sleep architecture in PD. We studied local field potential (LFP) recordings in PD subjects undergoing STN-DBS over the course of a full-night's sleep. We examined the changes in oscillatory activity recorded from STN between ultradian sleep states to determine whether sleep-stage dependent spectral patterns might reflect underlying dysfunction. For this study, PD (n=10) subjects were assessed with concurrent polysomnography and LFP recordings from the DBS electrodes, for an average of 7.5 hours in 'off' dopaminergic medication state. Across subjects, we found conserved spectral patterns among the canonical frequency bands (delta 0-3 Hz, theta 3-7 Hz, alpha 7-13 Hz, beta 13-30 Hz, gamma 30-90 Hz and high frequency 90-350 Hz) that were associated with specific sleep cycles: delta (0-3 Hz) activity during non-rapid eye movement (NREM) associated stages was greater than during Awake, whereas beta (13-30 Hz) activity during NREM states was lower than Awake and rapid eye movement (REM). In addition, all frequency bands were significantly different between NREM states and REM. However, each individual subject exhibited a unique mosaic of spectral interrelationships between frequency bands. Our work suggests that LFP recordings from human STN differentiate between sleep cycle states, and sleep-state specific spectral mosaics may provide insight into mechanisms underlying sleep pathophysiology.

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Section: Discussionsupporting

confidence: 59%

Section: Discussionmentioning

confidence: 99%

Sleep patterns in Parkinson’s disease: direct recordings from the subthalamic nucleus

Thompson

Tekriwal

Felsen

et al. 2017

J Neurol Neurosurg Psychiatry

View full text Add to dashboard Cite

show abstract

“…PLMS indices doubled with stimulation, which was associated with reduction in dose of dopamine agonists. No significant change was seen in sleep fragmentation, occurrence of RBD and prevalence of RLS (39). …”

Section: Resultsmentioning

confidence: 90%

Section: Discussionmentioning

confidence: 99%

“…Studies analyzing effects of STN DBS on both subjective and objective sleep parameters have shown a significant improvement in sleep quality, sleep efficiency and sleep duration (39, 46, 52, 54). The duration of WASO and REM latency is reduced after STN DBS, however, available data suggests that DBS therapy may not change sleep fragmentation or RBD (39, 50, 51, 54, 55). Conflicting outcomes were seen in studies investigating the influence of DBS on RLS, (42, 47, 53) with some studies showing significant improvement in RLS scores while other studies reported no change and re-emergence of RLS post-DBS.…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2018

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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.

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Sodium Oxybate for Excessive Daytime Sleepiness and Sleep Disturbance in Parkinson Disease

et al. 2018

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IMPORTANCE Sleep-wake disorders are a common and debilitating nonmotor manifestation of Parkinson disease (PD), but treatment options are scarce.OBJECTIVE To determine whether nocturnal administration of sodium oxybate, a first-line treatment in narcolepsy, is effective and safe for excessive daytime sleepiness (EDS) and disturbed nighttime sleep in patients with PD. DESIGN, SETTING, AND PARTICIPANTS Randomized, double-blind, placebo-controlled, crossover phase 2a study carried out between January 9, 2015, and February 24, 2017. In a single-center study in the sleep laboratory at the University Hospital Zurich, Zurich, Switzerland, 18 patients with PD and EDS (Epworth Sleepiness Scale [ESS] score >10) were screened in the sleep laboratory. Five patients were excluded owing to the polysomnographic diagnosis of sleep apnea and 1 patient withdrew consent. Thus, 12 patients were randomized to a treatment sequence (sodium oxybate followed by placebo or placebo followed by sodium oxybate, ratio 1:1) and, after dropout of 1 patient owing to an unrelated adverse event during the washout period, 11 patients completed the study. Two patients developed obstructive sleep apnea during sodium oxybate treatment (1 was the dropout) and were excluded from the per-protocol analysis (n = 10) but included in the intention-to-treat analysis (n = 12).INTERVENTIONS Nocturnal sodium oxybate and placebo taken at bedtime and 2.5 to 4.0 hours later with an individually titrated dose between 3.0 and 9.0 g per night for 6 weeks with a 2-to 4-week washout period interposed. MAIN OUTCOMES AND MEASURESPrimary outcome measure was change of objective EDS as electrophysiologically measured by mean sleep latency in the Multiple Sleep Latency Test. Secondary outcome measures included change of subjective EDS (ESS), sleep quality (Parkinson Disease Sleep Scale-2), and objective variables of nighttime sleep (polysomnography).RESULTS Among 12 patients in the intention-to-treat population (10 men, 2 women; mean [SD] age, 62 [11.1] years; disease duration, 8.4 [4.6] years), sodium oxybate substantially improved EDS as measured objectively (mean sleep latency, +2.9 minutes; 95% CI, 2.1 to 3.8 minutes; P = .002) and subjectively (ESS score, −4.2 points ; 95% CI, −5.3 to −3.0 points; P = .001). Thereby, 8 (67%) patients exhibited an electrophysiologically defined positive treatment response. Moreover, sodium oxybate significantly enhanced subjective sleep quality and objectively measured slow-wave sleep duration (+72.7 minutes; 95% CI, 55.7 to 89.7 minutes; P < .001). Differences were more pronounced in the per-protocol analysis. Sodium oxybate was generally well tolerated under dose adjustments (no treatment-related dropouts), but it induced de novo obstructive sleep apnea in 2 patients and parasomnia in 1 patient, as detected by polysomnography, all of whom did not benefit from sodium oxybate treatment. CONCLUSIONS AND RELEVANCEThis study provides class I evidence for the efficacy of sodium oxybate in treating EDS and nocturnal sleep disturbance in patie...

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The Impact of Subthalamic Deep Brain Stimulation on Sleep–Wake Behavior: A Prospective Electrophysiological Study in 50 Parkinson Patients

Cited by 47 publications

References 41 publications

Sleep patterns in Parkinson’s disease: direct recordings from the subthalamic nucleus

Sleep patterns in Parkinson’s disease: direct recordings from the subthalamic nucleus

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

Sodium Oxybate for Excessive Daytime Sleepiness and Sleep Disturbance in Parkinson Disease

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