Baumgartner Alexander J, Kushida Clete A, Summers Michael O, Kern Drew S, Abosch Aviva, Thompson John A
Department of Neurology, University of Colorado School of Medicine, Aurora, CO, United States.
Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, United States.
Front Neurol. 2021 Oct 28;12:765203. doi: 10.3389/fneur.2021.765203. eCollection 2021.
Sleep disturbances, specifically decreases in total sleep time and sleep efficiency as well as increased sleep onset latency and wakefulness after sleep onset, are highly prevalent in patients with Parkinson's disease (PD). Impairment of sleep significantly and adversely impacts several comorbidities in this patient population, including cognition, mood, and quality of life. Sleep disturbances and other non-motor symptoms of PD have come to the fore as the effectiveness of advanced therapies such as deep brain stimulation (DBS) optimally manage the motor symptoms. Although some studies have suggested that DBS provides benefit for sleep disturbances in PD, the mechanisms by which this might occur, as well as the optimal stimulation parameters for treating sleep dysfunction, remain unknown. In patients treated with DBS, electrophysiologic recording from the stimulating electrode, in the form of local field potentials (LFPs), has led to the identification of several findings associated with both motor and non-motor symptoms including sleep. For example, beta frequency (13-30 Hz) oscillations are associated with worsened bradykinesia while awake and decrease during non-rapid eye movement sleep. LFP investigation of sleep has largely focused on the subthalamic nucleus (STN), though corresponding oscillatory activity has been found in the globus pallidus internus (GPi) and thalamus as well. LFPs are increasingly being recognized as a potential biomarker for sleep states in PD, which may allow for closed-loop optimization of DBS parameters to treat sleep disturbances in this population. In this review, we discuss the relationship between LFP oscillations in STN and the sleep architecture of PD patients, current trends in utilizing DBS to treat sleep disturbance, and future directions for research. In particular, we highlight the capability of novel technologies to capture and record LFP data , while patients continue therapeutic stimulation for motor symptoms. These technological advances may soon allow for real-time adaptive stimulation to treat sleep disturbances.
睡眠障碍，特别是总睡眠时间和睡眠效率的降低，以及入睡潜伏期延长和睡眠开始后觉醒增加，在帕金森病（PD）患者中非常普遍。睡眠障碍对该患者群体的几种合并症有显著的不利影响，包括认知、情绪和生活质量。随着深部脑刺激（DBS）等先进疗法有效控制运动症状，PD的睡眠障碍和其他非运动症状日益受到关注。尽管一些研究表明DBS对PD的睡眠障碍有益，但这种情况可能发生的机制以及治疗睡眠功能障碍的最佳刺激参数仍不清楚。在用DBS治疗的患者中，以局部场电位（LFP）形式从刺激电极进行的电生理记录，已经发现了一些与运动和非运动症状（包括睡眠）相关的结果。例如，β频率（13 - 30 Hz）振荡与清醒时运动迟缓加重相关，在非快速眼动睡眠期间减少。对睡眠的LFP研究主要集中在丘脑底核（STN），不过在苍白球内侧部（GPi）和丘脑也发现了相应的振荡活动。LFP越来越被认为是PD睡眠状态的潜在生物标志物，这可能允许对DBS参数进行闭环优化，以治疗该人群的睡眠障碍。在这篇综述中，我们讨论了STN中LFP振荡与PD患者睡眠结构之间的关系、利用DBS治疗睡眠障碍的当前趋势以及未来的研究方向。特别是，我们强调了新技术在患者继续接受运动症状治疗刺激时捕获和记录LFP数据的能力。这些技术进步可能很快允许进行实时自适应刺激来治疗睡眠障碍。
