Department of Neurology, University Hospital of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany.
Parkinson Foundation International Centre of Excellence, King's College Hospital, London, UK.
J Parkinsons Dis. 2021;11(1):323-335. doi: 10.3233/JPD-202278.
Sleep disturbances and neuropsychiatric symptoms are some of the most common nonmotor symptoms in Parkinson's disease (PD). The effect of subthalamic stimulation (STN-DBS) on these symptoms beyond a short-term follow-up is unclear.
To examine 36-month effects of bilateral STN-DBS on quality of sleep, depression, anxiety, and quality of life (QoL) compared to standard-of-care medical therapy (MED) in PD.
In this prospective, controlled, observational, propensity score matched, international multicenter study, we assessed sleep disturbances using the PDSleep Scale-1 (PDSS), QoL employing the PDQuestionnaire-8 (PDQ-8), motor disorder with the Scales for Outcomes in PD (SCOPA), anxiety and depression with the Hospital Anxiety and Depression Scale (HADS), and dopaminergic medication requirements (LEDD). Within-group longitudinal outcome changes were tested using Wilcoxon signed-rank and between-group longitudinal differences of change scores with Mann-Whitney U tests. Spearman correlations analyzed the relationships of outcome parameter changes at follow-up.
Propensity score matching applied on 159 patients (STN-DBS n = 75, MED n = 84) resulted in 40 patients in each treatment group. At 36-month follow-up, STN-DBS led to significantly better PDSS and PDQ-8 change scores, which were significantly correlated. We observed no significant effects for HADS and no significant correlations between change scores in PDSS, HADS, and LEDD.
We report Class IIb evidence of beneficial effects of STN-DBS on quality of sleep at 36-month follow-up, which were associated with QoL improvement independent of depression and dopaminergic medication. Our study highlights the importance of sleep for assessments of DBS outcomes.
睡眠障碍和神经精神症状是帕金森病（PD）中最常见的非运动症状之一。丘脑底核刺激（STN-DBS）对这些症状的影响在短期随访之外尚不清楚。
与标准医疗疗法（MED）相比，检查双侧 STN-DBS 对 PD 患者睡眠质量、抑郁、焦虑和生活质量（QoL）的 36 个月影响。
在这项前瞻性、对照、观察性、倾向评分匹配、国际多中心研究中，我们使用帕金森病睡眠量表-1（PDSS）评估睡眠障碍，使用帕金森病问卷-8（PDQ-8）评估 QoL，使用帕金森病评定量表（SCOPA）评估运动障碍，使用医院焦虑和抑郁量表（HADS）评估焦虑和抑郁，使用多巴胺能药物需求（LEDD）。使用 Wilcoxon 符号秩检验测试组内纵向结果变化，使用 Mann-Whitney U 检验测试组间纵向变化差异。Spearman 相关分析用于分析随访时结果参数变化的关系。
对 159 名患者（STN-DBS n = 75，MED n = 84）进行倾向评分匹配后，每个治疗组有 40 名患者。在 36 个月的随访中，STN-DBS 导致 PDSS 和 PDQ-8 的变化评分显著改善，这些评分之间存在显著相关性。我们没有观察到 HADS 的显著影响，也没有观察到 PDSS、HADS 和 LEDD 的变化评分之间存在显著相关性。
我们报告了 STN-DBS 在 36 个月随访时对睡眠质量有有益影响的 IIb 级证据，这些影响与 QoL 改善独立于抑郁和多巴胺能药物有关。我们的研究强调了睡眠对 DBS 结果评估的重要性。
