The Effects of Deep Brain Stimulation on Sleep: A Systematic Review and Meta-Analysis

Abstract

Abstract Background Deep brain stimulation (DBS) is a standard treatment for movement disorders, epilepsy, and others, yet its influence on post-procedural sleep quality remains an under-researched topic. Objective We performed a systematic review and meta-analysis of all DBS effects on sleep. Methods The use of preferred reporting items for systematic reviews and meta-analyses guidelines (PRISMA) was utilized. We extracted demographic data, disease type/duration, DBS target, stimulation laterality (unilateral vs bilateral), follow-up lengths, and sleep pre/post-op measurements with polysomnography or across four standard sleep scales. The Cochrane methodology for evaluating RCTs was employed using risk of bias assessments, data synthesis, and statistical methods, including forest plots (risk ratio; M-H random effects; 95% CI). Results Sixty-three studies were included in the overall analysis, representing 3,022 patients. In a subgroup meta-analysis of subthalamic nucleus (STN) DBS for Parkinson’s disease (PD), patients showed significant sleep improvement at three but not twelve months post-operatively with PDSS, at twelve but not three months with ESS, and at six months with NMSS. PSQI showed no significant improvement in sleep at any time. Bilateral DBS showed significantly more improvement than unilateral DBS in the PSQI at six but not three months. Polysomnography showed significant sleep improvement at one week but not three or six months. Most studies showed no significant sleep improvement for globus pallidus internus, centromedian thalamus, and ventral intermediate nucleus DBS. Conclusions STN-DBS for PD likely improves sleep, however significant standardization in sleep scale outcome reporting and follow-up time is needed to effectively determine the target-dependent effects of DBS surgery on sleep.