Abstract
Sleep-wake disturbances are common non-motor manifestations in Parkinson Disease (PD). Complex pathophysiological changes secondary to neurodegeneration in combination with motor symptoms and dopaminergic medications contribute to development of sleep-wake disturbances. The management of sleep complaints in PD is important as this symptom can affect daily activities and impair quality of life. Deep brain stimulation (DBS) is an effective adjunctive therapy for management of motor symptoms in PD. However, its effect on non-motor symptoms including sleep-wake disturbances is not widely understood. In this article, we reviewed studies assessing the effect of DBS at various therapeutic targets on sleep-wake disturbances. Of the studies examining the role of DBS in sleep-wake disturbances, the effect of subthalamic nucleus stimulation is most widely studied and has shown improvement in sleep quality, sleep efficiency, and sleep duration. Although, studies investigating changes in sleep with stimulation of thalamus, globus pallidus interna, and pedunculopontine nucleus are limited, they support the potential for modulation of sleep-wake centers with DBS at these sites. The mechanism by which DBS at different anatomical targets affects sleep-wake disturbances in PD is unclear and may involves multiple factors, including improved motor symptoms, medication adjustment, and direct modulation of sleep-wake centers.
Highlights
Parkinson disease (PD) is a complex neurodegenerative disorder that leads to both motor and non-motor symptoms
Deep brain stimulation (DBS) therapy revolutionized the management of motor symptoms in PD and has become a widely accepted treatment option
The current evidence suggest that DBS therapy improves different aspects of sleep-wake disturbances in PD
Summary
Parkinson disease (PD) is a complex neurodegenerative disorder that leads to both motor and non-motor symptoms. Sleep-wake disturbances are a common non-motor symptom associated with PD and were first described by James Parkinson in his original article “Essay on shaking palsy” [4]. The effects of DBS therapy on non-motor symptoms, including sleep-wake disturbances, have received less attention. The following keywords were used in different combination for searching articles: “Deep brain stimulation,” “Parkinson disease,” “sleep disturbances,” “sleep quality,” “REM sleep behavior disorder,” “restless legs syndrome,” “excessive daytime sleepiness,” subthalamic nucleus, “globus pallidus interna,” “ventral intermediate nucleus,” “pedunculopontine nucleus,” “sleep pathophysiology.”. Both prospective and retrospective studies published in English language between 2000 and 2017 were reviewed. This article will briefly discuss pathophysiology of sleep-wake disturbances in PD; review existing literature exploring the effects of DBS at different therapeutic targets on sleep-wake disturbances, highlight the gaps in our understanding, and offer insight into potential future directions of investigating DBS as therapy for managing PD-related sleep disorders
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