Efficacy of low-frequency repetitive transcranial magnetic stimulation in the treatment of sleep disorders in the early stage of Parkinson disease: A single-center double-blind controlled study

Abstract

This study evaluates the efficacy and safety of low-frequency repetitive transcranial magnetic stimulation (rTMS) targeting the dorsolateral prefrontal cortex (DLPFC) for improving sleep disturbances in patients with early-stage Parkinson disease (PD). Eighty patients with PD (Hoehn-Yahr grades 1-3) with sleep disorders were randomized into a treatment group (n = 40) that received 1 Hz rTMS over the right DLPFC (90% motor threshold, 20 minutes/day for 10 days) and a control group (n = 40) that received sham stimulation. Outcomes including Parkinson's Disease Sleep Scale, Pittsburgh Sleep Quality Index, polysomnography parameters, Hamilton Depression, and Hamilton Anxiety scores were assessed at baseline and 1 month after treatment. Compared to baseline, the treatment group exhibited significant improvements in the Hamilton Depression, Hamilton Anxiety, Pittsburgh Sleep Quality Index, and Parkinson's Disease Sleep Scale scores (all P < .001). Polysomnography data revealed prolonged total sleep time (TST, P < .001), reduced sleep latency (SL) (P < .001), fewer nighttime awakenings (P < .001), enhanced sleep efficiency (P < .001), and shortened rapid eye movement SL. In contrast, the control group showed no significant changes, except for a worsened TST (P < .001). Between-group comparisons demonstrated superior outcomes in the treatment group for all sleep and mood metrics (P < .001). All participants completed the study, and no severe adverse effects were observed. Low-frequency rTMS stimulation of the unilateral DLPFC region can improve sleep disorders in early PD patients in the short term, and the improvement of sleep quality may be manifested in the extension of TST, improvement of sleep efficiency, shortening of SL, and reduction of the number of nighttime awakenings. The improvement of sleep disorders may be related to the improvement of anxiety and depression symptoms in patients, which persist for at least 1 month, supporting rTMS as a safe adjunct therapy for PD-related sleep disorders.

Keywords: Parkinson disease; low-frequency repetitive transcranial magnetic stimulation; polysomnography; sleep disorder; unilateral dorsolateral prefrontal area.