Objective: To examine 36-month effects of bilateral subthalamic nucleus (STN) deep brain stimulation (DBS) on quality of sleep, depression, and quality of life (QoL) compared to standard-of-care medical therapy in patients with Parkinson’s disease (PD).

Background: Sleep disturbances and depression are some of the most common nonmotor symptoms (NMS) in patients with PD. Several studies provided evidence that STN-DBS improves sleep and there is heterogeneous data concerning its influence on depression. Previous studies have provided evidence that dopamine agonists improve quality of sleep, depression and QoL co-dependently, whereas little is known about their relationship in patients undergoing STN-DBS.

Method: In this ongoing, prospective, observational, multicenter study including 66 patients undergoing STN-DBS and 229 patients with standard-of-care medical therapy (=MED), we assessed sleep disturbances using the PD Sleep Scale-1 (PDSS), QoL employing the PD Questionnaire-8 (PDQ-8) and depression with corresponding subscale of the Hospital Anxiety and Depression Scale (HADS-D). Propensity score matching was conducted in order to balance baseline characteristics between both treatment groups. Mixed model statistical analyses were performed to determine possible interaction effects between type of treatment (STN-DBS vs. MED) and time (baseline vs. 36-month follow-up). The relationship between changes of these outcome parameters at 36-month follow-up was tested with Spearman correlations.

Results: Propensity score matching resulted in matched sub-cohorts of 40 patients in each treatment group. The difference in mean change at 36-month follow-up between both treatment groups was statistically significant for PDSS and PDQ-8, but not for HADS-D. PDSS and PDQ-8 improvements were significantly correlated. There were no significant correlations between mean changes in PDSS, HADS-D and dopamine agonist dosage. However, a reduction of rotigotine, in particular, was significantly correlated with a worsening of depression and morning refreshment.

Conclusion: This is the first report of 36-month beneficial effects of STN-DBS on quality of sleep. Sleep was significantly associated with QoL outcome independent from depression and overall medication requirements for dopamine agonists. Our study highlights the importance of sleep for holistic assessments of DBS outcomes.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/beneficial-effect-of-36-month-bilateral-subthalamic-stimulation-on-quality-of-sleep-compared-to-standard-of-care-medication-in-parkinsons-disease/