Predicting Sleep Quality Improvement in Parkinson’s Disease Patients Post-DBS: A Nomogram Approach

Abstract

Introduction:

Sleep disorder is a common concomitant symptom of Parkinson's disease (PD).

Methods:

We retrospectively analyzed the medical records and questionnaire responses of 468 patients with PD who received DBS of the subthalamic nucleus (STN) between 2017 and 2020. These patients were categorized into two groups based on whether their PD Sleep Disorder Scale (PDSS) scores showed improvement three years post-surgery: the improved group and the non-improved group. To identify factors that influence sleep disorder improvement, we conducted both univariate and multivariate regression analyses. Subsequently, we developed a nomogram to predict the likelihood of sleep disturbance improvement. We assessed the nomogram's accuracy and predictive performance through calibration plots, Receiver Operating Characteristic (ROC) curves, and Decision Curve Analysis (DCA).

Results:

Patients who experienced improvement in sleep disorders following surgery showed better preoperative responses to medication, higher Mini-Mental State Examination (MMSE) scores, and lower Hamilton Anxiety Scale (HAMA) scores, despite having poorer PDSS scores compared to those without post-surgical sleep disorder improvement. Further analysis using univariate and multivariate regression identified preoperative medication responsiveness, MMSE, HAMA, and PDSS score as independent predictors of postoperative PDSS score improvement in PD patients. Utilizing these findings, we developed a nomogram model, which demonstrated a strong predictive accuracy with an area under the ROC curve of 0.78 (95% CI: 0.69–0.88). Calibration plots and decision curve analysis confirmed the nomogram's excellent alignment between predicted outcomes and actual observations.

Conclusions:

A nomogram was developed to forecast the likelihood of sleep disorder improvement in PD patients three years following DBS of the STN. This tool may hold significant value in prognosticating sleep quality in PD patients after DBS.