NPJ Parkinsons Dis—Wang Xikim's team found that high PSQI is an independent risk factor for dyskinesia in Parkinson's disease

Editor—Summer Leaf

Parkinson's disease (PD) is the second most common central nervous system degenerative disease, and levodopa can significantly improve the clinical symptoms of Parkinson's disease, but with the use of drugs and the progression of the disease, some patients will develop motor complications, including dyskinesia ）
。 Manson et al.
[1] reviewed previous studies and found that the incidence of dyskinesia within 5 years of taking antiparkinson's disease drugs was 40-50%, 10 The incidence of dyskinesia is 50-75%
after the year.
Dyskinesia is a disabling motor complication that places a heavy burden
on patients, families and society.

At present, it is widely believed that the occurrence of dyskinesia is related to abnormal neural circuits [2], and good sleep quality is essential to maintain the homeostasis of neural circuits [3].

A large number of studies have shown that patients with PD have sleep disorders, including difficulty falling asleep, sleep maintenance disorders, and daytime sleepiness [4].

Recent studies suggest that cortical slow-wave activity slows down in animal models of PD dyskinesia, and normal cortical slow-wave activity plays an important role in maintaining sleep homeostasis during non-rapid eye movement sleep, and sleep deprivation can cause dyskinesia to occur earlier and aggravate the symptoms [5].

However, there is a lack of prospective studies in humans to explore the correlation
between sleep quality and the occurrence of dyskinesia.
Based on the above, this study conducted follow-up observation of PD patients, aiming to explore the relationship between sleep quality and dyskinesia, and expected to provide new valuable targets for the mechanism research and prevention strategy of PD dyskinesia
.

On September 29, 2022, the team of Professor Wang Xijin, Department of Neurology, Tongji Hospital affiliated to Tongji University, published the latest research results online in the journal NPJ Parkinson's Disease" High PSQI score is associated with the development of dyskinesia in Parkinson's disease", suggests Pittsburgh Sleep Quality Index, PSQI≥6) is an independent risk factor for dyskinesia in PD patients, and a predictive model
for dyskinesia is constructed.
Through the study of the correlation between sleep disorders and dyskinesia, it is expected to provide new valuable targets for the mechanism research and prevention strategies of PD dyskinesia
.

Studies have suggested that the occurrence of dyskinesia is associated with abnormalities in the neural circuits, and that good sleep quality is essential for maintaining homeostasis in neural circuits, and studies have shown that patients with PD have sleep disorders, however, there is a lack of prospective studies in humans to explore the correlation between sleep quality and the occurrence of dyskinesia in PD
。 Therefore, this study followed up patients
with PD for 36 months.

A total of 61 patients with PD who did not have dyskinesia at baseline completed this follow-up study
.
The KM curve was first used to show the risk of dyskinesia in PD patients over the next 3 years (Figure 1).
The results showed that follow-up began at 24 months, 28 months, 32 months and more At 35 months, the risk of dyskinesia was 8.
2%, 11.
5%, 21.
3% and 32.
8%, respectively
。 At the end of follow-up, the proportion of dyskinesia was significantly higher in the patient group with poor sleep quality than in the group with good sleep quality (48.
1% vs.
20.
6%, p=0.
023).

Fig.
1 KM curve of cumulative risk of dyskinesia

(Source: Tang X, et al.
, npj Parkinsons Dis, 2022).

Subsequently, non-motor symptoms (NMSS), anxiety (HAMA), daily levodopa equivalent dose (LEDD), daily levodopa equivalent dose / Effects of body weight (LEDD/weight), PD duration, and sleep quality (PSQI) on the cumulative risk of dyskinesia (Figure).
2), the results showed that compared with patients with good sleep quality, PD patients with poor sleep quality had an increased risk of dyskinesia (p=0.
017).

。

Fig.
2 KM curve of different clinical variables affecting the risk of dyskinesia

(Source: Tang X, et al.
, npj Parkinsons Dis, 2022).

In order to further explore the risk factors of dyskinesia, univariate Cox regression analysis and multivariate Cox regression analysis were performed (Table 1).

。 In the multivariate Cox regression model, PD duration, sleep quality, cognition, depression, and daily levodopa equivalent doses were included in the dyskinesia risk model, and the results showed high PSQI ( PSQI≥6) was an independent risk factor for dyskinesia in patients with PD (HR = 2.
96, 95% CI 1.
05 to 8.
35, p= 0.
041).

In addition, long PD duration (HR = 2.
09, 95% CI 1.
05 to 4.
17, p= 0.
037) and low cognitive scores (HR = 4.
12, 95% CI 1.
40-14, p= 0.
011) were also significantly associated with the occurrence of dyskinesia
。

Table 1 Cox regression analysis results

(Source: Tang X, et al.
, npj Parkinsons Dis, 2022).

Finally, this study used the time-dependent area under the curve (AUC) of the receiver operating characteristic (ROC).
To assess the accuracy of the above model, the results showed AUCs of 0.
78 from the start of follow-up to 24 months, 28 months, and 32 months , 0.
80 and 0.
78, at month 35, the model reached its highest accuracy, AUC is 0.
83 (Figure 3).

Fig.
3 Time-dependent subject operating characteristic curve of predicted change

(Source: Tang X, et al.
, npj Parkinsons Dis, 2022).