Modulation and subcortical sleep signatures in Parkinson’s disease under chronic STN-DBS using synchronized sensing and videopolysomnography

Deep brain stimulation (DBS) of the subthalamic nucleus (STN) influences the sleep-wake cycle, yet in vivo evidence remains limited. We conducted a longitudinal, multimodal study in 38 patients with Parkinson's disease undergoing STN-DBS, integrating full-night video-polysomnography with synchronized subthalamic local field potentials (LFPs) 6 months post-surgery. Twenty patients completed pre/post video-polysomnography (19 with LFPs data). Slow-wave sleep increased after DBS, with no change of efficiency and fragmentation indices. Mean heart rate decreased in wake and sleep. REM-related motor events within REM sleep Behavior Disorder (RBD) declined, no change was seen in REM sleep without atonia (RSWA). LFPs showed delta/theta-band increase from wake to NREM and marked beta suppression in N2-N3. Arousals exhibited alpha/beta-band elevation. During REM, RSWA featured higher alpha/beta/gamma with lower delta versus atonic REM; RBD episodes further increased theta/beta/gamma and total power. These measures identify promising subcortical signatures of sleep and REM motor phenomena, informing sleep-aware adaptive DBS.