Sleep macro-architecture in patients with Parkinson's disease does not change during the first night of neurostimulation in a pilot study

Study Objectives: A growing body of literature suggests that deep brain stimulation to treat motor symptoms of Parkinson's disease may also ameliorate certain sleep deficits. Many foundational studies have examined the impact of stimulation on sleep following several months of therapy, leaving an open question regarding the time course for improvement. It is unknown whether sleep improvement will immediately follow onset of therapy or accrete over a prolonged period of stimulation. The objective of our study was to address this knowledge gap by assessing the impact of deep brain stimulation on sleep macro-architecture during the first nights of stimulation. Methods: Polysomnograms were recorded for 3 consecutive nights in 14 patients with advanced Parkinson's disease (10 male, 4 female; age: 53-74 years), with intermittent, unilateral subthalamic nucleus deep brain stimulation on the final night or 2. Sleep scoring was determined manually by a consensus of 4 experts. Sleep macro-architecture was objectively quantified using the percentage, latency, and mean bout length of wake after sleep onset and on each stage of sleep (rapid eye movement and non-rapid eye movement stages 1, 2, 3). Results: Sleep was found to be highly disrupted in all nights. Sleep architecture on nights without stimulation was consistent with prior results in treatment naive patients with Parkinson's disease. No statistically significant difference was observed due to stimulation. Conclusions: These objective measures suggest that 1 night of intermittent subthreshold stimulation appears insufficient to impact sleep macro-architecture. Clinical Trial Registration: Registry: ClinicalTrials.gov; Name: Adaptive Neurostimulation to Restore Sleep in Parkinson's Disease; URL: https://clinicaltrials. gov/ct2/show/NCT04620551; Identifier: NCT04620551.