Effects of Subthalamic Nucleus Deep Brain Stimulation on Objective Sleep Outcomes in Parkinson's Disease
Effects of Subthalamic Nucleus Deep Brain Stimulation on Objective Sleep Outcomes in Parkinson's Disease
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DOI：
10.1002/mdc3.12375
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发表时间：
2017-03-01
影响因子：
4
通讯作者：
Standaert, David G.
中科院分区：
文献类型：
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作者：
Amara, Amy W.;Walker, Harrison C.;Standaert, David G.
研究背景睡眠障碍是帕金森病（Parkinson's disease，PD）常见的致残性非运动症状。脑深部电刺激可改善PD患者的运动症状和主观睡眠，但尚未探索优化睡眠的替代刺激参数。我们假设，低频DBS将改善客观的睡眠比传统settings.MethodsTwenty PD受试者与DBS DBS（18单边，2双边）进行了3个非连续的多导睡眠图（PSG）的夜晚：DBS关闭; DBS高频（130 Hz）;和DBS低频（60 Hz）。运动症状耐受性在PSG后的早晨恢复基线设置后30分钟进行评估。主要结果是重复测量方差分析测量的高频率和低频率之间的睡眠效率的变化。（82.1% [72.6-90.1]）（中位数[四分位距]）、低频率（81.2% [56.2-88.8]）或DBS关闭（82.8% [75.7-87.4]; P = 0.241）。此外，在睡眠阶段百分比、觉醒、肢体运动、主观睡眠质量或客观警惕性测量方面没有差异。在调整年龄、性别、病程或手术侧后，这些结局没有改变。没有残留的不良运动影响noted.ConclusionsAlthough耐受性良好，低频率的DBS并没有改善PD的客观睡眠。值得注意的是，客观的睡眠指标并没有因为DBS关闭而变差。这些观察结果指出了自适应刺激方法的潜力，通过该方法，可以在睡眠期间优化DBS设置以满足个人需求。此外，这些变化可以在不影响患者结局的情况下保持电池寿命。
BackgroundSleep dysfunction is a common and disabling nonmotor symptom in Parkinson's disease (PD). DBS of the STN improves motor symptoms and subjective sleep in PD, but alternative stimulation parameters to optimize sleep have not been explored. We hypothesized that low-frequency STN DBS would improve objective sleep more than conventional settings.MethodsTwenty PD subjects with STN DBS (18 unilateral, 2 bilateral) underwent 3 nonconsecutive nights of polysomnography (PSG): DBS off; DBS high frequency (130 Hz); and DBS low frequency (60 Hz). Motor symptom tolerability was assessed 30 minutes after resumption of baseline settings the morning following PSG. The primary outcome was change in sleep efficiency between high- and low-frequency nights measured with repeated-measures analysis of variance.ResultsThere was no difference in sleep efficiency between nights at high frequency (82.1% [72.6-90.1]) (median [interquartile range]), low frequency (81.2% [56.2-88.8]), or DBS off (82.8% [75.7-87.4]; P = 0.241). Additionally, there was no difference in sleep stage percent, arousals, limb movements, subjective sleep quality, or objective vigilance measures. These outcomes did not change after adjusting for age, sex, disease duration, or side of surgery. No residual adverse motor effects were noted.ConclusionsAlthough well tolerated, low-frequency STN DBS did not improve objective sleep in PD. Remarkably, objective measures of sleep were not worse with DBS off. These observations point to the potential for adaptive stimulation approaches, through which DBS settings could be optimized during sleep to meet individual needs. Additionally, these changes could preserve battery life without compromising patient outcomes.