Yin Zixiao, Bai Yutong, Guan Boyuan, Jiang Yin, Wang Zhan, Meng Fangang, Yang Anchao, Zhang Jianguo
Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China; Beijing Key Laboratory of Neurostimulation, Beijing, China.
Department of Neuropsychiatry, Behavioral Neurology and Sleep Center, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
Sleep Med. 2021 Mar;79:195-204. doi: 10.1016/j.sleep.2020.10.021. Epub 2020 Nov 4.
To explore how subjective and objective sleep parameters respond to bilateral subthalamic nucleus-deep brain stimulation (STN-DBS) in patients with Parkinson's disease (PD).
Thirty DBS sleep studies were included by searching PubMed, Embase, and the Cochrane Library, and only 21 prospectively designed studies, including 541 patients, were eligible for the main analysis. We evaluated sleep disturbance using 1 objective measurement, polysomnography (PSG), and 4 subjective scales, including PD Sleep Scale (PDSS), Pittsburgh Sleep Quality Index (PSQI), Epworth Sleepiness Scale (ESS), and restless legs syndrome (RLS). We pooled data using the standard mean difference (SMD). The primary outcome was a change in sleep parameters 6 months postoperatively. Outcomes from <12 months to ≥12 months follow-up were compared in the subgroup analysis. Meta-regression was further conducted.
STN-DBS significantly improved all 4 subjective sleep scales in the 6-month follow-up: ESS (SMD = 0.234), PDSS (SMD = 0.724), PSQI (SMD = 1.374) and RLS (SMD = 1.086), while most PSG parameters remained unchanged, except for shortened rapid eye movement sleep latency (RSL) (SMD = 0.520). In the over-12-month follow-up, improvement persisted in PDSS but not in ESS. Dopamine drug reduction (p = 0.009) and motor improvement (p = 0.036) were correlated with ESS improvement and PDSS improvement, respectively.
Bilateral STN-DBS continuously improved subjective nocturnal sleep, while its effect on ESS lasted for only 1 year. Medication reduction and motor improvement may contribute to improved daytime sleepiness and better subjective nocturnal sleep, respectively. Except for a shortened RSL, STN-DBS did not change PSG parameters, including sleep efficiency and sleep architecture.
Open Science Framework: DOI 10.17605/OSF.IO/3EGRC.
探讨帕金森病（PD）患者的主观和客观睡眠参数对双侧丘脑底核深部脑刺激（STN-DBS）的反应。
通过检索PubMed、Embase和Cochrane图书馆纳入30项DBS睡眠研究，只有21项前瞻性设计研究（包括541例患者）符合主要分析的条件。我们使用1种客观测量方法多导睡眠图（PSG）和4种主观量表评估睡眠障碍，这4种主观量表包括帕金森病睡眠量表（PDSS）、匹兹堡睡眠质量指数（PSQI）、爱泼华嗜睡量表（ESS）和不安腿综合征（RLS）。我们使用标准平均差（SMD）汇总数据。主要结局是术后6个月睡眠参数的变化。在亚组分析中比较了随访<12个月至≥12个月的结局。进一步进行了Meta回归分析。
在6个月的随访中，STN-DBS显著改善了所有4种主观睡眠量表：ESS（SMD = 0.234）、PDSS（SMD = 0.724）、PSQI（SMD = 1.374）和RLS（SMD = 1.086），而大多数PSG参数保持不变，除了快速眼动睡眠潜伏期（RSL）缩短（SMD = 0.520）。在超过12个月的随访中，PDSS持续改善，但ESS没有改善。多巴胺药物减量（p = 0.009）和运动改善（p = 0.036）分别与ESS改善和PDSS改善相关。
双侧STN-DBS持续改善夜间主观睡眠，而其对ESS的影响仅持续1年。药物减量和运动改善可能分别有助于改善白天嗜睡和夜间主观睡眠质量。除了RSL缩短外，STN-DBS未改变包括睡眠效率和睡眠结构在内的PSG参数。
开放科学框架：DOI 10.17605/OSF.IO/3EGRC。
