Objective: The objective of this study was to assess long-term effects of deep brain stimulation (DBS) of the subthalamic nucleus (STN) on sleep in patients with Parkinson’s disease (PD).

Background: Although STN DBS has been reported to have a positive effect on sleep-wake disturbances in PD, improvement in sleep is inconsistent especially for excessive daytime sleepiness, and little known about long-term effects of STN DBS.

Method: Sixty-one patients with PD who had received a bilateral STN DBS and were followed for 3 years. The following were included: the Parkinson’s disease sleep scale (PDSS) and Epworth sleepiness scale (ESS), Unified PD Rating Scale part I-III and Hoehn & Yahr stage in the on and off anti-parkinsonian medication condition, total daily levodopa equivalent dose, quality of life measures, and depression scale measured preoperatively and at 6 months after surgery and annually thereafter.

Results: Patients who had undergone bilateral STN DBS and a follow-up evaluation at baseline (61 patients) and at 6, 12, 24 and 36 months (46 patients) were included in this study. Total PDSS score significantly improved after STN DBS from baseline up to year 3, and the largest improvement was observed at 6 months (79.0±30, 100.0±23.3, 98.8±23.0, 97.1±29.6, and 93.3±28.0 at baseline, 6, 12, 24, and 36 months, respectively, p < 0.0001 for the change over time). Among the eight PDSS items, items for sleep onset and maintenance insomnia, nocturnal restlessness, nocturnal psychosis, nocturnal motor symptoms, and daytime dozing showed significant improvement after STN DBS. Total ESS score and total sleep hours per day did not show significant changes after STN DBS (p = 0.4264 for the change over time). Changes in total PDSS were associated with changes in the depression and motivation items in the Unified PD Rating Scale part I, depression scale, and quality of life measures, but those variables at baseline were not predictive of changes in total PDSS after STN DBS.

Conclusion: In our longitudinal follow-up study of 3 years, bilateral STN DBS in PD significantly improved sleep parameters especially for sleep onset and maintenance, nocturnal motor symptoms, and nocturnal psychosis. However, STN DBS did not significantly reduce excessive daytime sleepiness despite significant reductions in antiparkinsonian medications.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/long-term-effects-of-bilateral-subthalamic-nucleus-stimulation-on-sleep-in-patients-with-parkinsons-disease/