Deep Brain Stimulation Alters Sleep Physiology and Architecture in Parkinson’s Disease: A Prospective, Multi-Night, Naturalistic Polysomnography Study

Deep Brain Stimulation Alters Sleep Physiology and Architecture in Parkinson’s Disease: A Prospective, Multi-Night, Naturalistic Polysomnography Study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Article Deep Brain Stimulation Alters Sleep Physiology and Architecture in Parkinson’s Disease: A Prospective, Multi-Night, Naturalistic Polysomnography Study Alexander J. Baumgartner, Lisa Hirt, Evan Doll, Drew S. Kern, and 2 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8642012/v1 This work is licensed under a CC BY 4.0 License Status: Under Revision Version 1 posted 11 You are reading this latest preprint version Abstract Sleep disturbances are among the most common non-motor Parkinson’s disease (PD) symptoms. Deep brain stimulation (DBS) may improve sleep, though methodological inconsistencies in prior studies have produced inconsistent results. We sought to investigate the effect of DBS on sleep, including both sleep architecture and physiological features such as sleep spindles and slow waves. We prospectively enrolled PD patients undergoing DBS surgery and performed in-home sleep monitoring over multiple nights both pre-operatively and post-operatively. After DBS implantation, improvements were seen in several parameters, including both subjective measures (Parkinson Disease Sleep Scale, version 2) and objective measures (total sleep time, N2 duration, N3 duration, and sleep efficiency). Slow wave density and duration, as well as sleep spindle frequency and amplitude, were affected by DBS. This study provides the most comprehensive evaluation of the effect of DBS on sleep in PD, and the first to prospectively study the effect of DBS on sleep physiological features, including slow waves and sleep spindles. Health sciences/Neurology Biological sciences/Neuroscience Figures Figure 1 Figure 2 Figure 3 Figure 4 Introduction Parkinson’s Disease (PD) is a neurodegenerative disorder primarily characterized by motor symptoms including tremor, bradykinesia, and rigidity. However, non-motor symptoms can emerge as early as the prodromal phase, ten or more years before motor symptoms occur. Sleep disorders, including insomnia, REM behavior disorder (RBD), and daytime sleepiness, are among the most common non-motor symptoms of PD, affecting up to 90% of people with PD and significantly impairing quality of life 1 – 4 . Moreover, sleep dysfunction has the potential to exacerbate and compound other PD symptoms including cognition, mood, and mobility, and may be correlated with faster disease progression 5 – 9 . Targeted and highly efficacious therapies for sleep disorders in PD are lacking and therefore remain a crucial unmet need for the care of people with PD 4,10 . Deep brain stimulation (DBS), targeting either the subthalamic nucleus (STN) or globus pallidus pars interna (GPi), is a widely established treatment for advanced PD, and improves symptoms including motor fluctuations and levodopa-induced dyskinesias 11 – 13 . Prior studies have indicated that STN DBS can impact sleep, though results are mixed. STN DBS has been shown to increase total sleep time, decrease wakefulness after sleep onset, and increase time spent in non-rapid eye movement (NREM) stage 2 (N2) sleep 14 , 15 . Others have shown a trend towards a decrease in N2 sleep, though not reaching statistical significance 16 , or no change in N2 sleep but an increase in NREM stage 3 (N3) 15 . These conflicting results are potentially related to methodological differences. In particular, prior studies have largely been limited to a single night of sleep recording in a sleep lab, rather than the home environment, and did not assess sleep both on and off dopaminergic medication. Consequently, the lack of definite conclusions about the impact of DBS on objective sleep outcomes precludes clear guidance. Furthermore, quantification of sleep macro-architectural features may not fully capture the impact of DBS on sleep. In recent years, technical advancements have allowed for a more detailed quantification of neural oscillations during sleep and advanced the field of sleep research 17 . Of particular interest are physiological features including sleep spindles (SPs), which are hallmark oscillations of N2 sleep with a frequency of 9–15Hz that wax and wane in amplitude, lasting 0.5–3 seconds 17 . They originate from interactions between thalamic reticular, thalamocortical, and cortical pyramidal networks 17 . Sleep spindles have been increasingly recognized as critical for sleep maintenance and continuity 18 , 19 . Slow waves (SWs) are paramount indicators of N3 sleep, and occur with lower density in people with PD compared to controls 20 . Finally, spectral power analysis has been shown to provide insight into other aspects of PD, including cognitive performance: recent studies indicate higher delta spectral power in N3 sleep is associated with better executive and global cognitive function 21 . In a prior post hoc analysis of a within-subject, crossover study of the effects of DBS on sleep, we found that spindle density was increased during a night of high frequency DBS compared to nights with DBS off or at low frequency 22 . Slow wave amplitude was also higher with low frequency DBS than with high frequency or off DBS during combined N2-N3 sleep. These data suggest that DBS may promote the return of physiological sleep structure, including spindle formation, and thus allow for improved sleep maintenance. We therefore sought to prospectively investigate the effect of DBS on sleep architecture and physiology over multiple nights, as well as self-reported sleep quality, in patients undergoing DBS implantation. Patients with PD were enrolled prospectively with a goal of characterizing sleep both before and after DBS implantation as well as on and off dopaminergic medication. We recorded EEG data during sleep from a wearable device, used in the home environment, across multiple nights and obtained subjective questionnaires to evaluate sleep quality in four states: pre-operative off-stimulation/on-medication, pre-operative off-stimulation/off-medication, post-operative on-stimulation/on-medication, and post-operative on-stimulation/off-medication. We hypothesized that sleep parameters including total sleep time, wakefulness after sleep onset, and sleep efficiency would be significantly improved by DBS, and that sleep spindle and slow wave density would also be increased by DBS. Methods Participants Fifteen participants with idiopathic PD were recruited from the University of Colorado Advanced Therapies in Movement Disorders program between October 2022 and March 2025. The study was approved by the Colorado Multiple Institutional Review Board (#22-0393) and registered on ClinicalTrials.gov (NCT05348837, registration date 21-April-2022). The study was conducted in accordance with the Declaration of Helsinki; all participants provided written, informed consent before any study procedures. Patients with an established clinical diagnosis of idiopathic PD according to the International Parkinson and Movement Disorder Society (MDS) criteria 23 undergoing a standardized evaluation for DBS candidacy were eligible to participate in the study. Participants underwent bilateral DBS implantation in either the STN or GPi and then completed the second, post-operative phase of the study. Exclusion criteria included: (1) any condition that would preclude DBS surgery, (2) diagnosis of dementia, (3) current or recent (within 30 days) use of a sedative-hypnotic agent for sleep (e.g., zolpidem, zaleplon, eszopiclone, doxepin, doxylamine, orexin antagonists; use of melatonin was permitted), (4) presence of obstructive sleep apnea requiring positive airway pressure treatment, and (5) fulfillment of criteria for a circadian rhythm sleep-wake disorder as defined by the American Academy of Sleep Medicine 24 . Surgical procedure and DBS programming Details of the surgical procedure have previously been published 25 . Briefly, directional, octopolar DBS leads (Boston Scientific 2202-45, Medtronic B33005, or Abbott 6172) were implanted bilaterally in either the STN or GPi using frame-guided surgeries supported by intraoperative microelectrode recording and test stimulation. Subsequently, leads were connected to an implanted pulse generator. DBS targets were determined by the clinical team and not by the study. Thus, participants with either STN or GPi DBS were included in the study, though we did not prospectively power the study to detect differences in sleep outcomes between DBS targets. Post-operatively, participants underwent DBS programming and medication adjustments to optimize daytime motor symptom relief and minimize adverse effects of stimulation and medications. DBS settings were considered optimized when at least 90 days had passed from initial DBS implantation surgery, no stimulation changes had been made in the preceding 30 days by the clinician, and no further stimulation changes were anticipated in the opinion of the participant’s treating neurologist. Clinical and physiological assessments Sleep studies were performed twice: 1) prior to DBS implantation, and 2) post-operatively, once DBS programming was considered optimized. During both phases, participants were off dopaminergic medication for at least one night. Before DBS, participants wore the PSG headband for three nights on their normal medications and stopped medication for a single night prior to the first DBS lead implantation surgery when patients routinely stop medication as part of standard of care. The decision to perform the pre-operative, off-medication study on a single night before surgery was made to minimize discomfort associated with withdrawal of medications over multiple nights. Post-operatively, participants wore the PSG headband for six nights: three while on their usual medication regimen and optimized DBS settings and for up to three nights while they withheld dopaminergic medications after 4pm (but could resume medications during the day). Therapeutic stimulation remained on throughout the day and night in the post-operative phase. Subjective sleep measures included the Epworth Sleepiness Scale (ESS) 26,27 , Pittsburgh Sleep Quality Index (PSQI) 28 , Fatigue Severity Scale (FSS) 29 , and Parkinson’s Disease Sleep Scale, version 2 (PDSS-2) 30 . For these scales, interpretation is as follows: an ESS score >10 is indicative of excessive daytime sleepiness, a PSQI score >5 is indicative of poor sleep, an FSS score ³4 is indicative of significant fatigue, and a PDSS-2 score ³18 is indicative of clinically relevant sleep disturbance. If participants had a bed partner, the partner was asked to complete the Mayo Sleep Questionnaire (MSQ) 31 . Question 1 of the MSQ specifically screens for the presence of dream enactment behavior suggestive of REM-sleep behavior disorder (RBD). These subjective sleep measures reflect sleep quality in the preceding seven days to one month and were collected at baseline and post-operatively. Levodopa equivalent daily dose (LEDD) was calculated as previously described 32 . Polysomnography (PSG) data was collected with a portable PSG headband device (Dreem 3, Beacon Biosignals, Boston, MA). This device includes five dry EEG electrodes, an accelerometer, and a pulse oximeter and is validated against laboratory-based PSG 33 . Data provided by the device include raw electroencephalogram (EEG) data (F8-O1, F7-O2, Fp1-F7, F8-F7, F7-O1, F8-O2, Fp1-F8; 250 Hz), automated sleep staging according to American Academy of Sleep Medicine methods, as well as total sleep time (TST), sleep onset latency (SOL), wakefulness after sleep onset (WASO), wakefulness duration, latency to N2, N3, and REM sleep, number of awakenings, and sleep efficiency (SE, defined as the total sleep time divided by the duration of the recording). Recordings were obtained in the home for approximately 5 nights both pre- and post-operatively on nights that were predominantly consecutive. We included any participant who had at least one night of data collected both before and after DBS implantation in the final analysis. Data preprocessing PSG-derived EEG data were visually inspected to ensure that the recording start and end times matched participant-reported times on the PSQI. On rare occasions, participants inadvertently continued EEG data collection for several hours after waking. These nights that far exceeded normal sleep durations were excluded from analysis after it was confirmed, by visual inspection of raw EEG data and self-reported wake times from the PSQI, that sleep automated sleep classifications for these recordings could be spurious. Analysis of other outcomes including spindle and slow wave detection and spectral analyses was still performed on the portion of recording that matched self-reported sleep time on the PSQI. Slow wave and sleep spindle detection EEG data were processed using a custom MATLAB script that utilized validated algorithms previously employed 20,22,34 . Slow-wave events were detected from 30 second epochs of EEG data using a zero-crossing based half-wave detection approach. Signals were sampled at 250 Hz and analyzed on a per-epoch basis for the F7-O8 channel. To minimize edge artifacts during filtering, each epoch was mirror-padded by 2 s on both ends prior to filtering. Data were band-pass filtered between 0.1 and 1 Hz using a fourth-order zero-phase IIR filter (applied with the f iltfilt function in Matlab), after which padding was removed. Zero crossings in the filtered signal were identified, and consecutive zero-crossing pairs were used to define candidate half-waves. For each half-wave, duration was computed as the time between zero crossings, and peak-to-peak amplitude was calculated as the difference between the local maximum and minimum occurring within each half-wave segment. Events were retained if they met predefined criteria for duration (0.5–1.2 s) and amplitude (≥75 µV). The following characteristics were computed for stage N2 and N3 sleep: (1) density (events/min), (2) duration (s), (3) amplitude (peak-to-peak, mV), and (4) slope (V/msec). Sleep spindles were quantified from the F8–O2 EEG channel. For each recording night, EEG was segmented into scored epochs. Spindle detection was performed independently within each N2/N3 epoch using a continuous wavelet transform (CWT) approach, and epoch-level summary measures were computed including density (events/min), mean oscillation frequency (Hz), and mean amplitude (mV). Within each epoch, the data was mirror-padded by 2 sec at the beginning and end to reduce boundary artifacts. A CWT was then computed using a Morlet wavelet over an expanded frequency range surrounding the spindle band. Spindle-band power was obtained by averaging power across frequencies within 11–16 Hz at each time point. Padding samples were removed after band-averaging to restore the original epoch length. To reduce sensitivity to outliers, the spindle-band power trace was standardized using a z-score based on the median and median absolute deviation (MAD). Putative spindle intervals were first defined using thresholds based on the z-scored spindle-band power. Samples exceeding the lower threshold (>1.5) were grouped into contiguous putative events. Candidate events were constrained to durations between 0.5 and 2.0 sec. For each candidate event, at least 25% of samples within the event were required to exceed the upper z-score threshold (>3.0). Events separated by short gaps were merged to avoid artificial splitting: if the time between the end of one event and the start of the next was <0.10 s, the events were combined into a single event 35–38 . Spectral analysis The spectral power analysis utilized a Hamming window with a duration of 512 msec and a 50% overlap between consecutive windows, resulting in a frequency resolution of 1 Hz. To determine the absolute spectral power within specific frequency ranges, separate averages were computed for wakefulness and sleep stages N1, N2, N3, and REM. The frequency ranges of interest included delta (1–4 Hz), theta (5–8 Hz), alpha (9–12 Hz), beta (13–30 Hz), and gamma (31–125 Hz). In addition, a slow to fast frequencies ratio ([delta + theta]) / [alpha + beta]) during REM was calculated. This was motivated by prior studies demonstrating that increases in this ratio are associated with a higher likelihood of neurodegeneration across various disease states 39,40 and a higher risk of dementia in patients with PD 41 . Statistical methods Summary statistics were calculated for patient demographics and sleep characteristics for both normally and non-normally distributed variables, as determined by the Shapiro-Wilk test. We report mean and standard deviation (SD) for normally distributed variables and median and interquartile range (IQR) for non-normally distributed variables. Changes in UPDRS, LEDD, and sleep survey results after DBS implantation were compared with paired t -tests. Linear mixed effects models (LME) were utilized to investigate the interactions between DBS condition (pre vs. post) and medication state (on vs. off); these were considered fixed effects, with subject intercept as a random effect. Similarly, LMEs with DBS condition (pre vs. post) and DBS target (STN or GPi) as fixed effects and subject intercept as random effects, were used to evaluate whether sleep architecture changes after DBS were differently affected by DBS target choice. Correlations between changes before and after DBS implantation in MDS-UPDRS, LEDD, sleep survey results, and sleep architecture were analyzed with Spearman rank correlation coefficient, which was corrected for multiple comparisons with the Benjamini-Hochberg procedure with a false discovery rate set at 0.20. Mean band power was calculated per night for each frequency band of interest (alpha, beta, delta, theta, gamma) during wakefulness, N1, N2, N3, and REM sleep. To compare the effect of DBS across frequency bands and sleep stages, a model was constructed with DBS condition, frequency, and sleep stage considered fixed effects, and subject intercept as a random effect. An LME model with DBS condition and medication state as fixed effects and subject intercept as a random effect was used to evaluate the interaction of DBS condition and medication state on the REM slow to fast frequencies ratio. For sleep microarchitectural outcomes, LMEs were constructed with DBS condition and medication state as fixed effects and subject intercept as a random effect; dependent variables in individual models included SP density, oscillation frequency and amplitude in N2 and N3, SW density, duration, amplitude, and slope in N2 and N3. Results Participants Of the 15 participants enrolled, 11 had data available both pre- and post-DBS implantation and were included in the analysis. Reasons for incomplete data collection included missing data post-operatively (1), loss to follow-up post-operatively (1), and withdrawal of consent (2). Of the included participants, five either did not wear the headband device while off-medications prior to DBS surgery or did not stop medications prior to surgery, resulting in only on-medication data being obtained from these participants at baseline. Two of these same five also declined to go off medications post-operatively, resulting in only on-medication data being obtained in either phase of the study. Another one of these five participants completely stopped dopaminergic medication after DBS implantation and programming, resulting in only off-medication data being obtained post-operatively. The participants included eight men and three women, with a mean (SD) age of 65.4 (8.5) years, mean disease duration of 10.6 (4.6) years, and mean pre-operative LEDD of 1225 (392) mg. Demographic and clinical information is presented in Table 1 . At baseline, participants reported poor sleep, with moderate daytime sleepiness. Mean scores (SD) for the PSQI, ESS, FSS, and PDSS-2 were 9.78 (4.7), 8.60 (3.8), 3.58 (1.6), and 27.3 (10.5), respectively. Six of the 11 participants had a bed partner who reported dream enactment behavior consistent with RBD. Nine patients underwent DBS implantation in the bilateral STN, and two underwent implantation in the bilateral GPi. Motor outcomes after DBS surgery and stimulation parameters are provided in Table 2 . After DBS, motor function as measured by the MDS-UPDRS part III in the on-medication state remained similar to the pre-operative, on-medication baseline (mean UPDRS-III at baseline: 28.5, post-DBS: 21.9, paired t -test, p = 0.249). Post-operative, off-medication UPDRS-III scores were not obtained for all participants and so were not analyzed. LEDD was reduced by 60% (mean LEDD at baseline: 1225mg, post-DBS: 500mg, paired t- test, p < 0.001, Table 2 ). This was primarily driven by medication reduction in the STN DBS group, as LEDD in the two GPi DBS participants increased slightly after DBS surgery (mean LEDD for GPi participants at baseline: 700mg, post-DBS: 772mg). In total, 93 nights of sleep recording were available for analysis: 38 in the pre-DBS, on-medication state, 6 in the pre-DBS, off-medication state, 26 in the post-DBS, on-medication state, and 23 in the post-DBS, off-medication state. Post-operative data collection occurred at a median of 147 (IQR 89) days after the first DBS lead implantation surgery. Subjective sleep quality Subjective sleep quality outcomes are provided in Table 3 . After DBS implantation, scores on the PDSS-2 decreased from a mean of 27.3 (10.5) pre-operatively to 14.3 (7.5) post-operatively (paired t -test, p = 0.034). Scores on the FSS decreased from a mean of 3.58 (1.6) pre-operatively to 2.25 (0.9) post-operatively (paired t -test, p = 0.007). Although the mean PSQI score decreased from 9.78 (4.7) before DBS to 8.50 (3.1) after DBS and the mean ESS score decreased from 8.56 (3.8) to 6.20 (5.8), these changes were not statistically significant (paired t -tests, p PSQI = 0.54, p ESS = 0.23). The proportion of participants reporting dream enactment behavior consistent with RBD remained unchanged (6/11). Sleep continuity and architecture Sleep continuity Linear mixed-effects models demonstrated significant effects of DBS condition, medication state, and their interaction on multiple measures of sleep continuity ( Table 4 ). After DBS implantation, participants experienced significantly increased total sleep time (TST), shorter sleep onset latency (SOL), reduced wakefulness duration, and higher sleep efficiency ( Figure 1 and Figure 2 ). Medication state independently affected these outcomes, with the off-medication condition associated with shorter TST, longer SOL, greater wakefulness, and lower sleep efficiency. Significant DBS × medication interactions were observed for TST, SOL, wakefulness duration, and sleep efficiency ( Table 4 ). Simple main effects analyses demonstrated that DBS significantly increased TST and reduced SOL in the off-medication state but not in the on-medication state. In contrast, DBS significantly reduced wakefulness duration and improved sleep efficiency in both medication states, although the magnitude of effect was greater in the off-medication state. Sleep architecture After DBS implantation, participants also experienced significantly increased NREM sleep, including greater N2 duration, N3 duration, and total NREM duration ( Table 4) . Significant DBS × medication interactions were observed for N2 and total NREM duration, with simple main effects analyses demonstrating significant DBS-related increases in these measures in the off-medication state but not in the on-medication state ( Figure 1 and Figure 2 ). In contrast, the increase in N3 duration after DBS occurred independently of medication state, as no significant interaction was observed. Medication state had an independent effect on N3 and total NREM duration, with the off-medication condition associated with shorter N3 duration and reduced total NREM sleep. No significant fixed effects of DBS condition, medication state, or their interaction were observed for wake after sleep onset (WASO), N1 duration, REM duration, proportions of NREM or REM sleep, number of awakenings, or latencies to N2, N3, or REM sleep. See Supplementary Table S1 for results of all sleep continuity and architecture outcomes. DBS target Linear mixed effect (LME) models, with DBS condition and DBS target as fixed effects and participants as random effects, did not reveal any significant interactions between DBS condition (pre vs. post) and DBS target (STN or GPi) for any of the sleep continuity or architecture outcomes. Furthermore, the fixed effects omnibus tests were not significant for DBS target in any of these outcomes, suggesting that changes in sleep after DBS surgery were similar for participants with STN and GPi DBS, and that sleep continuity and architecture were similar for the STN and GPi DBS groups when collapsed across within-subjects levels (pre vs. post DBS). Correlation analyses The changes in UPDRS, LEDD, subjective sleep quality, and sleep architecture with DBS implantation (post - pre DBS) were compared with Spearman’s rank correlation coefficient. The change in LEDD was negatively correlated with change in N2 duration ( r = -0.655). However, this correlation was not significant after correction for multiple comparisons. Other correlations were not statistically significant. Spectral power and sleep physiology Spectral power The LME model evaluating differences in band power across sleep stages and DBS condition demonstrated significant fixed effects omnibus tests for the interaction between DBS condition, frequency band, and sleep stage ( F (12) = 2.62, p = 0.002). Simple effects analysis of frequency bands across sleep stages demonstrated significant effects of DBS on multiple frequency bands during wakefulness only ( Table 5 ). Beta and gamma power during wakefulness were lower after DBS, while delta and theta power during wakefulness were higher after DBS. Differences in band power in N2, N3, and REM before and after DBS implantation were not significant for any frequency band. REM slow to fast frequencies ratio The LME model evaluating the interaction of DBS condition and medication state on the REM slow to fast frequencies ratio demonstrated a significant effect of DBS condition ( F (1) = 7.96, p = 0.013) but not medication state ( p = 0.69) nor the interaction between them ( p = 0.88). The slow to fast frequencies ratio was higher after DBS ( Table 5 ). Due to the lack of significant interactions in the fixed effects omnibus tests, further simple effects analyses were not conducted. Slow waves The LME model evaluating the effects of DBS and medication on SW density demonstrated significant fixed effects omnibus tests for the effect of DBS and medication on N2 SW density but not N3 SW density ( Table 6 ). The interaction between DBS condition and medication state was not significant for either N2 or N3. N2 SW density was higher after DBS and on medication ( Figure 3 and Figure 4 ). For SW duration, the LME model demonstrated a significant fixed effect omnibus test for DBS condition in N2 sleep, with SW duration being shorter after DBS. The effect of DBS was not significant on SW duration in N3. There was no significant effect of medication state, nor DBS × medication interaction in N2 or N3. For SW amplitude, the LME model demonstrated no significant fixed effects of DBS or medication in either N2 or N3 sleep. However, there were significant DBS × medication interactions; simple main effects analyses demonstrated that DBS increased SW amplitude in the on-medication state only, during both N2 and N3 sleep. There was a significant fixed effect of DBS on SW slope in N2, but not N3, sleep. The effects of medication were not significant in either N2 or N3 sleep. However, there were significant DBS × medication interactions; simple main effects analyses demonstrated that DBS increased SW slope in the on-medication state only, during both N2 and N3 sleep. Sleep spindles The LME model evaluating the effects of DBS and medication on SP density demonstrated no significant effects of DBS or medication on SP density in N2 or N3 sleep ( Table 6 , Figure 3 and Figure 4 ). For SP peak frequency, there was a significant effect of DBS condition and medication state during N2 sleep, but no DBS × medication interaction. These effects were observed in opposite directions: SP frequency was lower after DBS, but higher on medication. For SP amplitude, the LME model demonstrated significant fixed effects for DBS and medication as well as DBS × medication interactions in both N2 and N3 sleep. Again, these effects were observed in opposite directions: SP amplitude was lower after DBS, but higher on medication. Simple effects analysis demonstrated that SP amplitude was higher after DBS both on and off medication, though the change was larger in the off-medication state. See Supplementary Table S2 for results of all SW and SP outcomes. Discussion In this study, we prospectively evaluated the effect of STN or GPi DBS on sleep in PD, using an in-home, multiple-night design to better capture naturalistic sleep patterns. This design also allowed us to obtain data in both the on-medication and off-medication state, thus helping account for the effect of dopaminergic medication. We found that, compared to pre-surgical baseline, DBS implantation improved both subjective sleep quality and fatigue (as measured by the PDSS-2 and FSS, respectively) as well as several measures of sleep architecture, including total sleep time, N2 and N3 sleep duration, sleep onset latency, wakefulness, and sleep efficiency. In many cases, the fixed effect coefficient for DBS condition was large, indicating a large increase in these outcomes after DBS. For example, the magnitude change in total sleep time after DBS was an increase of 141 minutes, on N2 duration was an increase of 82 minutes, and for N3 duration was an increase of 29 minutes. When we considered the interaction between DBS and medication state, many of the improvements in sleep architecture were significant in the off-medication state only, including total sleep time, sleep onset latency, N2 duration and total NREM duration. In that sense, it may be that therapeutic stimulation ‘rescues’ the disruptions in sleep architecture caused by the withdrawal of dopaminergic medication. For others, the effects of DBS were significant in both the on and off-medication states, including wakefulness duration and sleep efficiency, indicating that DBS may provide an additive benefit over dopaminergic medication in these parameters. We did not find that any sleep architecture outcomes were affected differently by STN vs. GPi DBS, though the limited sample size of two GPi DBS patients precludes definite conclusions about the differences between these targets. Spectral analyses revealed that changes in frequency band power were affected by DBS only during wakefulness. For example, beta power was lower after DBS, which is not surprising: pathologic beta activity in PD is elevated not only in the basal ganglia but also in the cortex, and may be diminished in the cortex as well as in subcortical structures by DBS 42–44 . We did not detect changes induced by DBS during N2, N3, or REM sleep. Overall, we believe these spectral analyses should be interpreted with caution, as the results do not necessarily conform to canonical changes in frequency bands across sleep stages. For example, gamma power during wakefulness was lower after DBS, which may be unexpected since gamma power is generally considered a ‘pro-kinetic’ marker and typically is higher in wakefulness during therapeutic stimulation 45,46 . On the other hand, it should be noted that wakefulness captured here is only nighttime wakefulness and likely reflects relatively little active movement. The lack of any other changes in spectral power may reflect a limitation of the use of the wearable PSG headband, which comprises only frontal and occipital electrodes and thus may lack the spatial resolution to fully capture the emergence and fronto-central transition of delta power across the night 47 . We also found that the REM slow to fast frequencies ratio was higher after DBS but was not impacted by medication. Given this ratio’s known correlation with dementia risk 39–41 , our findings could partially explain the observed cognitive decline after DBS surgery 48 . Although our study did not include longitudinal neuropsychological assessments to verify this, future studies should investigate the change in REM slow to fast frequencies after DBS as a correlate of post-operative cognitive impairment. We also evaluated changes in sleep microarchitectural features, including spindles and slow waves. These results add to a small but growing body of literature on the changes in spindle and slow wave morphology in PD and may be contextualized by studies of SP and SW alterations in normal aging and other neurodegenerative diseases. Prior studies have demonstrated altered SP characteristics in people with PD compared to controls, including decreased SP density, longer duration, slower oscillation frequency, and higher maximum amplitude 49 . We did not find any effect of DBS or medication on SP density in either N2 or N3 sleep. This contrasts our prior finding of higher SP density during nights with DBS on at high frequency (≥ 130 Hz) compared to off or at low frequency (60 Hz) 22 . However, it should be noted that the prior study was methodologically different, in that it compared different DBS settings only in the post-operative state. We found that SP oscillation frequency in N2 was decreased after DBS, but higher in the on-medication state compared to off-medication. We also found that SP amplitude in N2 was higher after DBS, but lower on medication. These contrasting effects of DBS and dopaminergic medication on spindle morphology warrant further investigation into the mechanistic effects of each therapy on sleep physiology, but could partially explain why the effects of DBS on sleep architecture were more pronounced in the off-medication state. If levodopa promotes more ‘physiological’ spindle morphology (i.e., higher frequency and lower amplitude), it seems that DBS exerts its effect through different mechanisms and thus may not produce as profound effects on sleep architecture in the on-medication state. SW alterations in PD patients compared to controls include reduced SW density, without differences in SW amplitude or slope 20 . SWs represent large-scale synchronization of neuronal populations 50 ; their diminution in density and amplitude is associated with cognitive decline 51 and may play a particularly pivotal role in the pathogenesis of Alzheimer’s disease 52 . Little is known on how changes in slow wave duration may affect sleep or cognitive function, but at least one prior study demonstrated that SW morphologic features, including duration, can reliably serve as a biomarker of aging 53 . We found that SW density in N2 was higher after DBS but was not significantly different across DBS conditions in N3 sleep. DBS had a significant effect on SW duration in N2 only, with duration being longer in the pre-DBS condition compared to post-DBS. We also found that SW amplitude in N3 was increased by DBS in the on-medication state only. In our prior study, we found that SW amplitude during combined N2-N3 sleep was higher during a night with DBS on at low frequency compared to DBS off or at high frequency 22 . Of note, as DBS parameters were not altered in the current study, participants remained in their typical therapeutic DBS settings, which did not include any low frequency stimulation. Our findings of differential effects of DBS on SW features in N2 compared to N3 sleep may reflect the proposed different subtypes of SWs. ‘Global’ SWs are hypothesized to be generated frontally, predominantly occur in N2, and favor synaptic potentiation, while ‘local’ SWs are hypothesized to occur predominantly in N3 and drive synaptic downscaling 51,54,55 , although our present methods lack the spatial resolution to differentiate between these subtypes. Overall, we believe that our findings – particularly of increased SW density and amplitude – warrant further investigation into DBS as a modulatory therapy for SWs, especially given the broader interest in slow wave enhancement as a mechanism to improve cognitive function 56 . Strengths of this study include the prospective design and recording of sleep data across multiple nights in varying stimulation and medication conditions. The use of a wearable sleep monitor facilitated in-home assessments which more closely capture naturalistic sleep patterns and help mitigate alterations in sleep caused by unfamiliar or uncomfortable sleep laboratory environments. This study does have important limitations, including the small number of participants, though this sample size is similar to other studies of the effect of DBS on objective sleep outcomes 14–16,57 . Unlike those studies which have enrolled only STN DBS patients, we also included GPi DBS patients, though the small number of GPi participants in our study prevents definite conclusions regarding the difference between STN and GPi DBS on sleep. Although the wearable PSG headband is easy for participants to use across multiple nights, its limited electrode montage may mean that certain physiological features are not captured as accurately as with formal PSG. This would be particularly true for SPs, which typically demonstrate a central/parietal predominance 18 . Furthermore, we relied on automated sleep staging provided by the PSG headband and automated quantitative EEG analysis of SPs and SWs. Although the PSG headband is validated in healthy controls 33 , it has not yet been validated in people with PD and thus may be prone to sleep stage misclassification, particularly as features which are used for staging (e.g., SPs and K-complexes) are known to be morphologically altered in PD 49,58 . This variability could possibly affect the threshold for spindle detection as well as automated sleep stage determination. Finally, although data presented here contrast, in some regards, our prior post hoc analysis of SP and SW features during separate nights with DBS on at high frequency, on at low frequency, and off, important methodological differences should be considered. Sleep data in the prior study upon which the post hoc analysis was based were obtained across a one-month time frame with in-lab PSG, rather than over a longer period with a wearable device, and so may not be directly comparable. Furthermore, the majority (14/15) of participants in the prior study had unilateral STN DBS, whereas all participants in the present study had bilateral DBS. In conclusion, we present the first (to our knowledge) prospective, multiple night study of the effect of DBS and medication state on sleep disturbance in PD, including not only assessment of sleep architecture, but also sleep physiology such as SPs and SWs. We demonstrate that DBS implantation improves subjective sleep as well as several objective sleep measures with large magnitudes of change, including total sleep time, sleep efficiency, and N2 and N3 duration. We also show that certain properties of SPs and SWs, such as spindle amplitude and oscillation frequency, N2 slow wave density, and N3 SW amplitude are affected by DBS. These findings motivate future studies to further examine the potential for the optimization of DBS to enhance sleep, as well as the therapeutic implications of altering sleep microarchitecture. Tailoring DBS therapy for sleep enhancement would represent a substantial advancement in the search for improved treatments for sleep dysfunction in PD. Declarations Competing Interests AJB has received research funding from Medtronic and the University of Colorado, travel stipends from Medtronic, Boston Scientific, and BlueRock Therapeutics/Bayer, has served as a site investigator for studies sponsored by BlueRock Therapeutics/Bayer and PhotoPharmics, Inc., and has received consulting fees from General Dynamics Information Technology. ED and LH confirm they have no competing interests. DSK has received honoraria for advisement/consulting from Abbott, AbbVie Pharmaceutics, Alpha Omega Engineering, Boston Scientific, Insightec, Medtronic, has served as a site investigator for studies sponsored by Abbvie and Ceregate, and has received grants from the Boston Scientific and Medtronic. JAT has received research funding from Medtronic. AWA has received research funding from the University of Colorado and NIH NICHD, has served as a site investigator for studies sponsored by Michael J Fox Foundation for Parkinson’s Research, Parkinson Study Group, Aligning Science Across Parkinson’s (ASAP) Initiative, Koneksa Health, Biohaven Pharmaceuticals, Inc., Bial, and the NIH NINDS, has received honoraria for consultancy to Aevum through Parkinson Study Group, and is a consultant for PhotoPharmics, Inc. Author Contribution AJB designed and supervised the study, analyzed and interpreted the data, and led the writing of the manuscript. LH performed data collection and analysis. ED performed data collection. DSK contributed to the design of the study and contributed to the writing of the manuscript. JAT contributed to the design of the study, contributed to data analysis and interpretation, and contributed to the writing of the manuscript. 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Post-operative clinical characteristics and DBS settings. Participant DBS Target DBS Duration* (d) LEDD (mg) UPDRS-III H&Y Sleep Aid DBS Lead Model Stimulation parameters Contacts Amp. (mA) PW ( m sec) Freq. (Hz) 1 STN 164 343 39 2 - BSCN 2202 L: 3C-, c+ R: 2ABC-, c+ L: 2.4 R: 2.4 60 130 2 STN 102 855 9 1 Melatonin 15mg ABT 6172 L: 3B-, c+ 1-, c+ R: 11B-, c+ 9-, c+ L: 3.0 0.5 R: 2.0 0.5 60 125 3 STN 328 226 39 2 - ABT 6172 L: 2ABC-, 1+ R: 10C-, 9+ L: 3.2 R: 2.9 60 90 4 STN 96 523 26 2 Melatonin 10mg MDT B33005 L: 1B-, 1C-, c+ R: 9ABC-, c+ L: 1.4 R: 2.0 60 125 5 STN 103 600 12 2 - MDT B33005 L: 1A-, 1B-, 1C-, c+ R: 9A-, 9B-, 10A-, 10B-, c+ L: 3.0 R: 1.8 60 125 6 GPi 112 760 29 2 Melatonin 10mg ABT 6172 L: 3ABC-, c+ R: 10ABC-, c+ L: 1.5 R: 1.85 60 130 7 GPi 162 784 20 2 - BSCN 2202 L: 3B-, 3C-, 4-, c+ R: 3A-, 3B-, 3C-, c+ L: 3.5 R: 3.0 60 170 8 STN 278 585 30 2 - MDT B33005 L: 2ABC-, c+ R: 10BC-, c+ L: 2.7 R: 2.2 60 125 9 STN 223 170 4 1 Mirtazapine 7.5mg BSCN 2202 L: 2A-, 2B-, 2C-, 3A-, 3B-, 3C-, c+ R: 2ABC-, c+ L: 4.0 R: 3.9 60 185 10 STN 147 750 29 2 Melatonin 12mg BSCN 2202 L: 2ABC-, c+ R: 2ABC-, c+ L: 1.5 R: 2.0 60 130 11 STN 106 100 21 2 - ABT 6172 L: 3B-, c+ R: 10ABC-, c+ L: 2.25 R: 2.95 60 130 *Duration from DBS lead implantation surgery to start of post-operative sleep study DBS = Deep brain stimulation; LEDD = levodopa equivalent daily dose; UPDRS-III = Movement Disorders Society-Unified Parkinson Disease Rating Scale, part III (on-medication); H&Y = Hoehn and Yahr stage (on-medication); Amp. = Amplitude; PW = Pulse width; Freq. = Frequency; STN = subthalamic nucleus; GPi = globus pallidum interna: BSCN = Boston Scientific; ABT = Abbott; MDT = Medtronic. Table 3. Subjective sleep outcomes before and after DBS implantation. Paired samples t -tests were used to determine significance. Outcome Pre DBS (Mean [SD]) Post DBS (Mean [SD]) p- value PSQI 9.78 [4.68] 8.50 [3.10] 0.542 ESS 8.56 [3.84] 6.20 [5.75] 0.229 FSS 3.58 [1.56] 2.25 [0.90] 0.007 PDSS-2 27.3 [10.5] 14.3 [7.54] 0.034 PSQI = Pittsburgh Sleep Quality Index; ESS = Epworth Sleepiness Scale; FSS = Fatigue Severity Scale; PDSS-2 = Parkinson Disease Sleep Scale, version 2 Table 4. Linear mixed effects model results for the effect of DBS condition and medication state on sleep continuity and architecture outcomes. Outcome Fixed Effect F β [95% CI] p -value Direction / Interpretation Total Sleep Time (TST) DBS (post – pre) 20.62 +141.9 [79.7, 204.0] <0.001 ↑ TST with DBS Medication (on – off) 5.03 +71.0 [8.0, 133.9] 0.028 ↑ TST ON meds DBS × Medication 7.87 +175.5 [51.0, 299.9] 0.006 DBS effect larger OFF meds DBS effect OFF meds 17.90 +229.6 [121.5, 338.0] <0.001 Significant ↑ TST DBS effect ON meds 3.04 — 0.085 NS Sleep Onset Latency (SOL) DBS (post – pre) 31.7 −45.8 [−62.0, −29.6] <0.001 Faster sleep onset with DBS Medication (on – off) 56.0 −61.7 [−78.1, −45.3] <0.001 Faster sleep onset ON meds DBS × Medication 43.6 −107.6 [−140.0, −75.2] <0.001 DBS effect larger OFF meds DBS effect OFF meds 49.65 −99.6 [−127.8, −71.5] <0.001 Markedly shorter SOL DBS effect ON meds 0.97 — 0.33 NS Wakefulness Duration DBS (post – pre) 22.81 −85.1 [−120.6, −49.7] <0.001 ↓ Wake time with DBS Medication (on – off) 25.26 −91.2 [−127.3, −55.1] <0.001 ↓ Wake time ON meds DBS × Medication 6.66 −92.2 [−163.3, −21.1] 0.012 Greater DBS effect OFF meds DBS effect OFF meds 17.98 −131.2 [−192.9, −69.6] <0.001 Large reduction DBS effect ON meds 4.84 −39.1 [−74.4, −3.7] 0.031 Modest reduction Sleep Efficiency DBS (post – pre) 27.32 +24.2 [15.0, 33.4] <0.001 ↑ efficiency with DBS Medication (on – off) 11.87 +16.1 [6.8, 25.5] <0.001 ↑ efficiency ON meds DBS × Medication 6.28 +23.2 [4.8, 41.7] 0.014 Greater DBS effect OFF meds DBS effect OFF meds 19.84 +35.8 [19.8, 51.8] <0.001 Large improvement DBS effect ON meds 7.47 +12.6 [3.4, 21.7] 0.008 Moderate improvement N2 Duration DBS (post – pre) 17.19 +81.9 [42.6, 121.2] <0.001 ↑ N2 with DBS Medication (on – off) 2.60 — 0.11 NS DBS × Medication 8.00 +111.8 [33.2, 190.5] 0.006 Greater DBS effect OFF meds DBS effect OFF meds 16.1 +137.8 [69.4, 206.2] <0.001 Significant ↑ N2 DBS effect ON meds 1.76 — 0.19 NS N3 Duration DBS (post – pre) 13.74 +28.9 [13.4, 44.5] <0.001 ↑ N3 with DBS Medication (on – off) 6.50 +20.2 [4.4, 36.0] 0.013 ↑ N3 ON meds DBS × Medication 1.42 — 0.24 NS Total NREM Duration DBS (post – pre) 21.52 +116.2 [66.4, 166.0] <0.001 ↑ NREM with DBS Medication (on – off) 4.97 +56.2 [6.1, 106.3] 0.029 ↑ NREM ON meds DBS × Medication 8.28 +144.3 [44.5, 244.1] 0.005 Greater DBS effect OFF meds DBS effect OFF meds 18.69 +188.3 [101.6, 275.1] <0.001 Significant ↑ NREM DBS effect ON meds 3.16 — 0.08 NS NS = not significant. Table 5. Linear mixed effects model results for the effect of DBS on spectral power across wakefulness, N2, N3, and REM sleep. Sleep Stage Frequency Band DBS Effect (post–pre) β [95% CI] p -value Direction / Interpretation Wakefulness Delta +0.045 [0.016, 0.074] 0.003 ↑ Delta power post DBS Theta +0.038 [0.009, 0.068] 0.011 ↑ Theta power post DBS Beta −0.071 [−0.100, −0.041] <0.001 ↓ Beta power post DBS Gamma −0.067 [−0.090, −0.031] 0.05 NS N3 All bands — >0.05 NS REM All bands — >0.05 NS REM Slow/fast frequencies ratio +0.018 [0.005, 0.031] 0.013 ↑ Slow relative to fast activity post DBS NS = not significant Table 6. Linear mixed effects model results for the effect of DBS condition and medication state on sleep spindles and slow waves. Outcome Sleep Stage Fixed Effect F β [95% CI] p -value Direction / Interpretation Slow Wave (SW) Density N2 DBS (post – pre) 8.41 +3.50 [1.10, 5.89] 0.005 ↑ SW density after DBS Medication (on – off) 4.16 +2.52 [0.06, 4.98] 0.045 ↑ SW density ON medication DBS × Medication 0.41 — 0.52 NS N3 DBS (post – pre) 0.56 — 0.46 NS Medication (on – off) 0.75 — 0.39 NS DBS × Medication <0.001 — 0.99 NS SW Duration N2 DBS (post – pre) 26.38 -0.019 [-0.027, -0.012] <0.001 ↓ SW duration after DBS Medication (on – off) 3.15 — 0.076 NS DBS × Medication 0.15 — 0.70 NS N3 DBS (post – pre) 1.86 — 0.17 NS Medication (on – off) 0.97 — 0.33 NS DBS × Medication 0.49 0.49 NS SW Amplitude N2 DBS (post – pre) 0.39 — 0.53 NS Medication (on – off) 0.64 — 0.42 NS DBS × Medication 11.78 +25.41 [10.9, 39.91] <0.001 DBS effect significant only ON medication DBS Effect OFF Meds 2.27 — 0.13 NS DBS Effect ON Meds 32.3 +15.0 [9.83, 20.18] <0.001 ↑ SW amplitude N3 DBS (post – pre) 0.16 — 0.69 NS Medication (on – off) <0.001 — 0.98 NS DBS × Medication 6.79 +62.62 [15.5. 109.7] 0.009 DBS effect significant only ON medication DBS Effect OFF Meds 2.33 — 0.13 NS DBS Effect ON Meds 33.10 +26.6 [17.5, 35.6] <0.001 ↑ SW amplitude SW Slope N2 DBS (post – pre) 4.07 +17.14 [0.48, 33.8] 0.044 ↑ SW slope after DBS Medication (on – off) 0.26 — 0.61 NS DBS × Medication 10.79 +56.07 [22.61, 89.5] 0.001 DBS effect significant only ON medication DBS Effect OFF Meds 0.47 — 0.49 NS DBS Effect ON Meds 55.01 +45.2 [33.2, 57.1] <0.001 ↑ SW slope N3 DBS (post – pre) 0.06 — 0.80 NS Medication (on – off) 0.46 — 0.50 NS DBS × Medication 4.51 +121.11 [9.30, 232.9] 0.034 DBS effect significant only ON medication DBS Effect OFF Meds 0.91 — 0.34 NS DBS Effect ON Meds 38.19 +67.8 [46.3, 89.3] <0.001 ↑ SW slope Spindle (SP) Density N2 DBS (post – pre) 1.54 — 0.22 NS Medication (on – off) 0.08 — 0.78 NS DBS × Medication 0.15 — 0.70 NS N3 DBS (post – pre) 2.51 — 0.12 NS Medication (on – off) 1.22 — 0.27 NS DBS × Medication 0.59 — 0.45 NS SP Oscillation Frequency N2 DBS (post – pre) 9.59 -0.048 [-0.080, -0.018 0.002 ↓ SP frequency after DBS Medication (on – off) 8.75 +0.048 [0.016, 0.080] 0.003 ↑ SP frequency ON medication DBS × Medication 0.24 — 0.63 NS N3 DBS (post – pre) 0.62 — 0.43 NS Medication (on – off) 4.65 -0.047 [-0.091, -0.004] 0.03 ↓ SP frequency ON medication DBS × Medication 10.26 -0.134 [-0.216, -0.052] 0.001 DBS effect larger off medication DBS Effect OFF Meds 4.63 -0.084 [-0.161, -0.008] 0.031 ↓ SP frequency after DBS DBS Effect ON Meds 8.92 +0.050 [0.018, 0.083] 0.003 ↑ SP amplitude after DBS SP Amplitude N2 DBS (post – pre) 143.8 +20.99 [17.56, 24.43] <0.001 ↑ SP amplitude after DBS Medication (on – off) 17.36 -7.58 [-11.14, -4.01] < 0.001 ↓ SP amplitude ON medication DBS × Medication 4.73 +7.60 [0.75, 14.46] 0.03 DBS effect larger off medication DBS Effect OFF Meds 62.0 +24.8 [18.6, 31.0] <0.001 Larger ↑ SP amplitude DBS Effect ON Meds 126.8 +14.6 [14.2, 20.2] <0.001 Moderate ↑ SP amplitude N3 DBS (post – pre) 24.91 +13.1 [7.96, 18.27] <0.001 ↑ SP amplitude after DBS Medication (on – off) 13.83 -10.1 [-15.37, -4.76] <0.001 ↓ SP amplitude ON medication DBS × Medication 4.38 +10.7 [0.68, 20.73] 0.04 DBS effect larger off medication DBS Effect OFF Meds 15.2 +18.47 [9.17, 27.8] <0.001 Larger ↑ SP amplitude DBS Effect ON Meds 13.7 +7.76 [3.65, 11.9] <0.001 Moderate ↑ SP amplitude NS = not significant Additional Declarations Competing interest reported. AJB has received research funding from Medtronic and the University of Colorado, travel stipends from Medtronic, Boston Scientific, and BlueRock Therapeutics/Bayer, has served as a site investigator for studies sponsored by BlueRock Therapeutics/Bayer and PhotoPharmics, Inc., and has received consulting fees from General Dynamics Information Technology. ED and LH confirm they have no competing interests. DSK has received honoraria for advisement/consulting from Abbott, AbbVie Pharmaceutics, Alpha Omega Engineering, Boston Scientific, Insightec, Medtronic, has served as a site investigator for studies sponsored by Abbvie and Ceregate, and has received grants from the Boston Scientific and Medtronic. JAT has received research funding from Medtronic. AWA has received research funding from the University of Colorado and NIH NICHD, has served as a site investigator for studies sponsored by Michael J Fox Foundation for Parkinson’s Research, Parkinson Study Group, Aligning Science Across Parkinson’s (ASAP) Initiative, Koneksa Health, Biohaven Pharmaceuticals, Inc., Bial, and the NIH NINDS, has received honoraria for consultancy to Aevum through Parkinson Study Group, and is a consultant for PhotoPharmics, Inc. Supplementary Files Supplement.pdf Cite Share Download PDF Status: Under Revision Version 1 posted Editorial decision: Revision requested 14 Apr, 2026 Reviewers agreed at journal 13 Apr, 2026 Reviews received at journal 10 Apr, 2026 Reviewers agreed at journal 10 Apr, 2026 Reviews received at journal 21 Feb, 2026 Reviewers agreed at journal 18 Feb, 2026 Reviewers agreed at journal 05 Feb, 2026 Reviewers invited by journal 04 Feb, 2026 Editor assigned by journal 24 Jan, 2026 Submission checks completed at journal 24 Jan, 2026 First submitted to journal 19 Jan, 2026 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-8642012","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Article","associatedPublications":[],"authors":[{"id":586639908,"identity":"5f2cd467-fd69-445d-80cb-85ecf2946abd","order_by":0,"name":"Alexander J. Baumgartner","email":"data:image/png;base64,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","orcid":"","institution":"University of Colorado Anschutz Medical Campus","correspondingAuthor":true,"prefix":"","firstName":"Alexander","middleName":"J.","lastName":"Baumgartner","suffix":""},{"id":586639911,"identity":"1da5786b-29aa-46bc-b5d1-453f759ab319","order_by":1,"name":"Lisa Hirt","email":"","orcid":"","institution":"University of Colorado Anschutz Medical Campus","correspondingAuthor":false,"prefix":"","firstName":"Lisa","middleName":"","lastName":"Hirt","suffix":""},{"id":586639912,"identity":"722003c0-32f7-4b1d-a53e-76375942192e","order_by":2,"name":"Evan Doll","email":"","orcid":"","institution":"University of Colorado Anschutz Medical Campus","correspondingAuthor":false,"prefix":"","firstName":"Evan","middleName":"","lastName":"Doll","suffix":""},{"id":586639913,"identity":"91fde796-f27b-459d-b67a-309aa94a034b","order_by":3,"name":"Drew S. Kern","email":"","orcid":"","institution":"University of Colorado Anschutz Medical Campus","correspondingAuthor":false,"prefix":"","firstName":"Drew","middleName":"S.","lastName":"Kern","suffix":""},{"id":586639916,"identity":"53ab6865-b1b8-4ce7-9c18-28b02b8cd0f1","order_by":4,"name":"John A. Thompson","email":"","orcid":"","institution":"University of Colorado Anschutz Medical Campus","correspondingAuthor":false,"prefix":"","firstName":"John","middleName":"A.","lastName":"Thompson","suffix":""},{"id":586639920,"identity":"f29452ed-da3c-4f84-a149-314d7d2d0d09","order_by":5,"name":"Amy W. Amara","email":"","orcid":"","institution":"University of Colorado Anschutz Medical Campus","correspondingAuthor":false,"prefix":"","firstName":"Amy","middleName":"W.","lastName":"Amara","suffix":""}],"badges":[],"createdAt":"2026-01-19 17:51:42","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-8642012/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-8642012/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":102238464,"identity":"cbde9932-d962-409b-b602-0374209a1f9c","added_by":"auto","created_at":"2026-02-09 16:40:41","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":245912,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eSleep continuity and architecture are improved by both DBS and dopaminergic medication, and the effects of DBS are more pronounced in the off-medication state. (A) Scatter plot of total sleep time (minutes), separated by DBS condition and medication state. The linear mixed effects model demonstrated a significant fixed effect of DBS (black brackets); the fixed effect of medication is not shown but was significant (*), as was the DBS × medication interaction. The simple main effect of DBS was significant in the off-medication state only (grey lines). (B) Scatter plot of sleep efficiency (%), separated by DBS condition and medication state. There was a significant fixed effect of DBS (black brackets); the fixed effect of medication is not shown but was significant (***), as was the DBS × medication interaction. The simple main effect of DBS was significant both on-medication and off-medication (grey lines). (C) Scatter plot of N2 duration (minutes), separated by DBS condition and medication state. There was a significant fixed effect of DBS (black brackets) as well as a significant DBS × medication interaction. The fixed effect of medication was not significant. The simple main effect of DBS was significant in the off-medication state only (grey lines). (D) Scatter plot of N3 duration (minutes), separated by DBS condition and medication state. There was a significant fixed effect of DBS (upper brackets) and medication (lower brackets). There was not a significant DBS × medication interaction, so simple effects analyses were not conducted. For all panels, circles represent individual nights and horizontal bars represent medians. *** p \u0026lt; 0.001; ** p \u0026lt; 0.01; * p \u0026lt; 0.05; NS: not significant\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"floatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-8642012/v1/e7d60d2d0fd5c666ea5b6c6d.png"},{"id":102238426,"identity":"5dce19bf-2498-4dcc-a473-71010b241663","added_by":"auto","created_at":"2026-02-09 16:40:33","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":127841,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eFixed effect coefficients (\u003c/strong\u003eβ)\u003cstrong\u003e demonstrate changes in sleep continuity and architecture across DBS condition and medication state. Bar chart showing \u003c/strong\u003eβ\u003cstrong\u003e values from linear mixed effects models for several sleep continuity and architecture outcomes. Error bars represent 95% confidence intervals. All comparisons are post – pre DBS or on – off medication, such that positive \u003c/strong\u003eβ\u003cstrong\u003e values represent increased outcome values after DBS or on medication, while negative \u003c/strong\u003eβ\u003cstrong\u003e values represent decreased outcome values after DBS or on medication. Only those outcomes with at least one statistically significant \u003c/strong\u003eβ\u003cstrong\u003e value are shown. \u003c/strong\u003eβ\u003cstrong\u003e for other outcomes, including wakefulness after sleep onset, N1 duration, REM duration, proportion of N1, N2, N3 and REM sleep, and latency to N2, N3, and REM sleep were not significant for either DBS or medication.\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"floatimage2.png","url":"https://assets-eu.researchsquare.com/files/rs-8642012/v1/bff976e28f778b1f79b0792a.png"},{"id":102238448,"identity":"c37b2c0f-c382-4f88-a3f7-ed9326362f87","added_by":"auto","created_at":"2026-02-09 16:40:35","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":267572,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eSleep microarchitectural features are affected by both DBS and dopaminergic medication. (A) Scatter plot of slow wave density (events/minute) in N2 sleep, separated by DBS and medication condition. There was a significant fixed effect of DBS (upper bracket, black) as well as medication (lower bracket). There was not a significant DBS × medication interaction, so simple effects analyses were not conducted. (B) Scatter plot of slow wave duration (seconds) in N2 sleep, separated by DBS and medication condition. Only the fixed effect of DBS was significant (black bracket). There was not a significant fixed effects of medication nor a significant DBS × medication interaction, so simple effects analyses were not conducted. (C) Scatter plot of slow wave amplitude (\u003c/strong\u003eμ\u003cstrong\u003eV) in N3 sleep, separated by DBS and medication condition. Although the fixed effects of DBS and medication were not significant, there was a significant DBS × medication interaction. The effect of DBS significant only in the on-medication state (grey lines). (D) Scatter plot of spindle oscillation frequency (Hz) in N2 sleep, separated by DBS and medication condition. There was a significant fixed effect of DBS (upper bracket, black) as well as medication (lower bracket). There was not a significant DBS × medication interaction, so simple effects analyses were not conducted. (E) Scatter plot of spindle amplitude (\u003c/strong\u003eμ\u003cstrong\u003eV) in N2 sleep, separated by DBS and medication condition. There was a significant fixed effect of DBS (bracket, black) and a significant DBS × medication interaction. The fixed effect of medication is not shown but was also significant (***). The effect of DBS was significant both on-medication and off medication (grey lines). (E) Scatter plot of spindle\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eamplitude (\u003c/strong\u003eμ\u003cstrong\u003eV) in N3 sleep, separated by DBS and medication condition. There was a significant fixed effect of DBS (bracket, black) and a significant DBS × medication interaction. The fixed effect of medication is not shown but was also significant (***). The effect of DBS was significant both on-medication and off medication (grey lines). For all panels, to improve readability, data are presented as averages for individual nights of recording, though data analysis was conducted on slow waves and spindles on a per-epoch basis. Horizontal bars represent medians. *** p \u0026lt; 0.001; ** p \u0026lt; 0.01; * p \u0026lt; 0.05; NS: not significant\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"floatimage3.png","url":"https://assets-eu.researchsquare.com/files/rs-8642012/v1/0b92123d74a2211d41047f12.png"},{"id":102297667,"identity":"6cc2dc32-a6af-4946-8903-1496af9f2289","added_by":"auto","created_at":"2026-02-10 10:28:43","extension":"png","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":122921,"visible":true,"origin":"","legend":"\u003cp\u003eFixed effect coefficients (β) demonstrate changes in sleep microarchitectural features across DBS condition and medication state. Bar charts showing β values from linear mixed effects models for the same slow wave and sleep spindle features that are shown in Figure 3 (A: N2 slow wave density; B: N2 slow wave duration; C: N3 slow wave amplitude; D: N2 sleep spindle oscillation frequency; E: N2 sleep spindle amplitude; F: N3 sleep spindle amplitude). Error bars represent 95% confidence intervals. All comparisons are post – pre DBS or on – off medication, such that positive β values represent increased outcome values after DBS or on medication, while negative β values represent decreased outcome values after DBS or on medication.\u003c/p\u003e","description":"","filename":"floatimage4.png","url":"https://assets-eu.researchsquare.com/files/rs-8642012/v1/b2affe07c57b0d1bcd59b4c6.png"},{"id":102397156,"identity":"719dcb93-eaf7-428c-b949-bbec062aac95","added_by":"auto","created_at":"2026-02-11 10:05:05","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":4325196,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8642012/v1/d68e8d6b-f18f-451e-a846-b73bdbe5991a.pdf"},{"id":102238472,"identity":"708514a4-1d88-4d21-886d-d450f051b7c8","added_by":"auto","created_at":"2026-02-09 16:40:45","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"supplement","size":127833,"visible":true,"origin":"","legend":"","description":"","filename":"Supplement.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8642012/v1/866c86cba639846f265a4c8b.pdf"}],"financialInterests":"Competing interest reported. AJB has received research funding from Medtronic and the University of Colorado, travel stipends from Medtronic, Boston Scientific, and BlueRock Therapeutics/Bayer, has served as a site investigator for studies sponsored by BlueRock Therapeutics/Bayer and PhotoPharmics, Inc., and has received consulting fees from General Dynamics Information Technology. ED and LH confirm they have no competing interests. DSK has received honoraria for advisement/consulting from Abbott, AbbVie Pharmaceutics, Alpha Omega Engineering, Boston Scientific, Insightec, Medtronic, has served as a site investigator for studies sponsored by Abbvie and Ceregate, and has received grants from the Boston Scientific and Medtronic. JAT has received research funding from Medtronic. AWA has received research funding from the University of Colorado and NIH NICHD, has served as a site investigator for studies sponsored by Michael J Fox Foundation for Parkinson’s Research, Parkinson Study Group, Aligning Science Across Parkinson’s (ASAP) Initiative, Koneksa Health, Biohaven Pharmaceuticals, Inc., Bial, and the NIH NINDS, has received honoraria for consultancy to Aevum through Parkinson Study Group, and is a consultant for PhotoPharmics, Inc.","formattedTitle":"Deep Brain Stimulation Alters Sleep Physiology and Architecture in Parkinson’s Disease: A Prospective, Multi-Night, Naturalistic Polysomnography Study","fulltext":[{"header":"Introduction","content":"\u003cp\u003eParkinson\u0026rsquo;s Disease (PD) is a neurodegenerative disorder primarily characterized by motor symptoms including tremor, bradykinesia, and rigidity. However, non-motor symptoms can emerge as early as the prodromal phase, ten or more years before motor symptoms occur. Sleep disorders, including insomnia, REM behavior disorder (RBD), and daytime sleepiness, are among the most common non-motor symptoms of PD, affecting up to 90% of people with PD and significantly impairing quality of life\u003csup\u003e\u003cspan additionalcitationids=\"CR2 CR3\" citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u003c/sup\u003e. Moreover, sleep dysfunction has the potential to exacerbate and compound other PD symptoms including cognition, mood, and mobility, and may be correlated with faster disease progression\u003csup\u003e\u003cspan additionalcitationids=\"CR6 CR7 CR8\" citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u003c/sup\u003e. Targeted and highly efficacious therapies for sleep disorders in PD are lacking and therefore remain a crucial unmet need for the care of people with PD\u003csup\u003e4,10\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eDeep brain stimulation (DBS), targeting either the subthalamic nucleus (STN) or globus pallidus pars interna (GPi), is a widely established treatment for advanced PD, and improves symptoms including motor fluctuations and levodopa-induced dyskinesias\u003csup\u003e\u003cspan additionalcitationids=\"CR12\" citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e\u003c/sup\u003e. Prior studies have indicated that STN DBS can impact sleep, though results are mixed. STN DBS has been shown to increase total sleep time, decrease wakefulness after sleep onset, and increase time spent in non-rapid eye movement (NREM) stage 2 (N2) sleep\u003csup\u003e\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e,\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e\u003c/sup\u003e. Others have shown a trend towards a decrease in N2 sleep, though not reaching statistical significance\u003csup\u003e\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e\u003c/sup\u003e, or no change in N2 sleep but an increase in NREM stage 3 (N3)\u003csup\u003e\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e\u003c/sup\u003e. These conflicting results are potentially related to methodological differences. In particular, prior studies have largely been limited to a single night of sleep recording in a sleep lab, rather than the home environment, and did not assess sleep both on and off dopaminergic medication. Consequently, the lack of definite conclusions about the impact of DBS on objective sleep outcomes precludes clear guidance.\u003c/p\u003e \u003cp\u003eFurthermore, quantification of sleep macro-architectural features may not fully capture the impact of DBS on sleep. In recent years, technical advancements have allowed for a more detailed quantification of neural oscillations during sleep and advanced the field of sleep research\u003csup\u003e\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e\u003c/sup\u003e. Of particular interest are physiological features including sleep spindles (SPs), which are hallmark oscillations of N2 sleep with a frequency of 9\u0026ndash;15Hz that wax and wane in amplitude, lasting 0.5\u0026ndash;3 seconds\u003csup\u003e\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e\u003c/sup\u003e. They originate from interactions between thalamic reticular, thalamocortical, and cortical pyramidal networks\u003csup\u003e\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e\u003c/sup\u003e. Sleep spindles have been increasingly recognized as critical for sleep maintenance and continuity\u003csup\u003e\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e,\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e\u003c/sup\u003e. Slow waves (SWs) are paramount indicators of N3 sleep, and occur with lower density in people with PD compared to controls\u003csup\u003e\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e\u003c/sup\u003e. Finally, spectral power analysis has been shown to provide insight into other aspects of PD, including cognitive performance: recent studies indicate higher delta spectral power in N3 sleep is associated with better executive and global cognitive function\u003csup\u003e\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eIn a prior \u003cem\u003epost hoc\u003c/em\u003e analysis of a within-subject, crossover study of the effects of DBS on sleep, we found that spindle density was increased during a night of high frequency DBS compared to nights with DBS off or at low frequency\u003csup\u003e\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e\u003c/sup\u003e. Slow wave amplitude was also higher with low frequency DBS than with high frequency or off DBS during combined N2-N3 sleep. These data suggest that DBS may promote the return of physiological sleep structure, including spindle formation, and thus allow for improved sleep maintenance.\u003c/p\u003e \u003cp\u003eWe therefore sought to prospectively investigate the effect of DBS on sleep architecture and physiology over multiple nights, as well as self-reported sleep quality, in patients undergoing DBS implantation. Patients with PD were enrolled prospectively with a goal of characterizing sleep both before and after DBS implantation as well as on and off dopaminergic medication. We recorded EEG data during sleep from a wearable device, used in the home environment, across multiple nights and obtained subjective questionnaires to evaluate sleep quality in four states: pre-operative off-stimulation/on-medication, pre-operative off-stimulation/off-medication, post-operative on-stimulation/on-medication, and post-operative on-stimulation/off-medication. We hypothesized that sleep parameters including total sleep time, wakefulness after sleep onset, and sleep efficiency would be significantly improved by DBS, and that sleep spindle and slow wave density would also be increased by DBS.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003e\u003cstrong\u003eParticipants\u003cbr\u003e\u003c/strong\u003eFifteen participants with idiopathic PD were recruited from the University of Colorado Advanced Therapies in Movement Disorders program between October 2022 and March 2025. The study was approved by the Colorado Multiple Institutional Review Board (#22-0393) and registered on ClinicalTrials.gov (NCT05348837, registration date 21-April-2022). The study was conducted in accordance with the Declaration of Helsinki; all participants provided written, informed consent before any study procedures. Patients with an established clinical diagnosis of idiopathic PD according to the International Parkinson and Movement Disorder Society (MDS) criteria\u003csup\u003e23\u003c/sup\u003e undergoing a standardized evaluation for DBS candidacy were eligible to participate in the study. Participants underwent bilateral DBS implantation in either the STN or GPi and then completed the second, post-operative phase of the study. Exclusion criteria included: (1) any condition that would preclude DBS surgery, (2) diagnosis of dementia, (3) current or recent (within 30 days) use of a sedative-hypnotic agent for sleep (e.g., zolpidem, zaleplon, eszopiclone, doxepin, doxylamine, orexin antagonists; use of melatonin was permitted), (4) presence of obstructive sleep apnea requiring positive airway pressure treatment, and (5) fulfillment of criteria for a circadian rhythm sleep-wake disorder as defined by the American Academy of Sleep Medicine\u003csup\u003e24\u003c/sup\u003e.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSurgical procedure and DBS programming\u003cbr\u003e\u003c/strong\u003eDetails of the surgical procedure have previously been published\u003csup\u003e25\u003c/sup\u003e. Briefly, directional, octopolar DBS leads (Boston Scientific 2202-45, Medtronic B33005, or Abbott 6172) were implanted bilaterally in either the STN or GPi using frame-guided surgeries supported by intraoperative microelectrode recording and test stimulation. Subsequently, leads were connected to an implanted pulse generator. DBS targets were determined by the clinical team and not by the study. Thus, participants with either STN or GPi DBS were included in the study, though we did not prospectively power the study to detect differences in sleep outcomes between DBS targets. Post-operatively, participants underwent DBS programming and medication adjustments to optimize daytime motor symptom relief and minimize adverse effects of stimulation and medications. DBS settings were considered optimized when at least 90 days had passed from initial DBS implantation surgery, no stimulation changes had been made in the preceding 30 days by the clinician, and no further stimulation changes were anticipated in the opinion of the participant\u0026rsquo;s treating neurologist.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eClinical and physiological assessments\u003cbr\u003e\u003c/strong\u003eSleep studies were performed twice: 1) prior to DBS implantation, and 2) post-operatively, once DBS programming was considered optimized. During both phases, participants were off dopaminergic medication for at least one night. Before DBS, participants wore the PSG headband for three nights on their normal medications and stopped medication for a single night prior to the first DBS lead implantation surgery when patients routinely stop medication as part of standard of care. The decision to perform the pre-operative, off-medication study on a single night before surgery was made to minimize discomfort associated with withdrawal of medications over multiple nights. Post-operatively, participants wore the PSG headband for six nights: three while on their usual medication regimen and optimized DBS settings and for up to three nights while they withheld dopaminergic medications after 4pm (but could resume medications during the day). Therapeutic stimulation remained on throughout the day and night in the post-operative phase.\u003c/p\u003e\n\u003cp\u003eSubjective sleep measures included the Epworth Sleepiness Scale (ESS)\u003csup\u003e26,27\u003c/sup\u003e, Pittsburgh Sleep Quality Index (PSQI)\u003csup\u003e28\u003c/sup\u003e, Fatigue Severity Scale (FSS)\u003csup\u003e29\u003c/sup\u003e, and Parkinson\u0026rsquo;s Disease Sleep Scale, version 2 (PDSS-2)\u003csup\u003e30\u003c/sup\u003e. For these scales, interpretation is as follows: an ESS score \u0026gt;10 is indicative of excessive daytime sleepiness, a PSQI score \u0026gt;5 is indicative of poor sleep, an FSS score\u0026nbsp;\u0026sup3;4 is indicative of significant fatigue, and a PDSS-2 score\u0026nbsp;\u0026sup3;18 is indicative of clinically relevant sleep disturbance. If participants had a bed partner, the partner was asked to complete the Mayo Sleep Questionnaire (MSQ)\u003csup\u003e31\u003c/sup\u003e. Question 1 of the MSQ specifically screens for the presence of dream enactment behavior suggestive of REM-sleep behavior disorder (RBD). These subjective sleep measures reflect sleep quality in the preceding seven days to one month and were collected at baseline and post-operatively. Levodopa equivalent daily dose (LEDD) was calculated as previously described\u003csup\u003e32\u003c/sup\u003e.\u003c/p\u003e\n\u003cp\u003ePolysomnography (PSG) data was collected with a portable PSG headband device (Dreem 3, Beacon Biosignals, Boston, MA). This device includes five dry EEG electrodes, an accelerometer, and a pulse oximeter and is validated against laboratory-based PSG\u003csup\u003e33\u003c/sup\u003e. Data provided by the device include raw electroencephalogram (EEG) data (F8-O1, F7-O2, Fp1-F7, F8-F7, F7-O1, F8-O2, Fp1-F8; 250 Hz), automated sleep staging according to American Academy of Sleep Medicine methods, as well as total sleep time (TST), sleep onset latency (SOL), wakefulness after sleep onset (WASO), wakefulness duration, latency to N2, N3, and REM sleep, number of awakenings, and sleep efficiency (SE, defined as the total sleep time divided by the duration of the recording). Recordings were obtained in the home for approximately 5 nights both pre- and post-operatively on nights that were predominantly consecutive. We included any participant who had at least one night of data collected both before and after DBS implantation in the final analysis.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData preprocessing\u003cbr\u003e\u003c/strong\u003ePSG-derived EEG data were visually inspected to ensure that the recording start and end times matched participant-reported times on the PSQI. On rare occasions, participants inadvertently continued EEG data collection for several hours after waking. These nights that far exceeded normal sleep durations were excluded from analysis after it was confirmed, by visual inspection of raw EEG data and self-reported wake times from the PSQI, that sleep automated sleep classifications for these recordings could be spurious. Analysis of other outcomes including spindle and slow wave detection and spectral analyses was still performed on the portion of recording that matched self-reported sleep time on the PSQI.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSlow wave and sleep spindle detection\u003cbr\u003e\u003c/strong\u003eEEG data were processed using a custom MATLAB script that utilized validated algorithms previously employed\u003csup\u003e20,22,34\u003c/sup\u003e. Slow-wave events were detected from 30 second epochs of EEG data using a zero-crossing based half-wave detection approach. Signals were sampled at 250 Hz and analyzed on a per-epoch basis for the F7-O8 channel. To minimize edge artifacts during filtering, each epoch was mirror-padded by 2 s on both ends prior to filtering. Data were band-pass filtered between 0.1 and 1 Hz using a fourth-order zero-phase IIR filter (applied with the \u003cem\u003ef\u003c/em\u003e\u003cem\u003eiltfilt\u003c/em\u003e function in Matlab), after which padding was removed. Zero crossings in the filtered signal were identified, and consecutive zero-crossing pairs were used to define candidate half-waves. For each half-wave, duration was computed as the time between zero crossings, and peak-to-peak amplitude was calculated as the difference between the local maximum and minimum occurring within each half-wave segment. Events were retained if they met predefined criteria for duration (0.5\u0026ndash;1.2 s) and amplitude (\u0026ge;75 \u0026micro;V).\u0026nbsp;The following characteristics were computed for stage N2 and N3 sleep: (1) density (events/min), (2) duration (s), (3) amplitude (peak-to-peak,\u0026nbsp;mV), and (4) slope (V/msec). Sleep spindles were quantified from the F8\u0026ndash;O2 EEG channel. For each recording night, EEG was segmented into scored epochs. Spindle detection was performed independently within each N2/N3 epoch using a continuous wavelet transform (CWT) approach, and epoch-level summary measures were computed including density (events/min), mean oscillation frequency (Hz), and mean amplitude (mV). Within each epoch, the data was mirror-padded by 2 sec at the beginning and end to reduce boundary artifacts. A CWT was then computed using a Morlet wavelet over an expanded frequency range surrounding the spindle band. Spindle-band power was obtained by averaging power across frequencies within 11\u0026ndash;16 Hz at each time point. Padding samples were removed after band-averaging to restore the original epoch length. To reduce sensitivity to outliers, the spindle-band power trace was standardized using a z-score based on the median and median absolute deviation (MAD). Putative spindle intervals were first defined using thresholds based on the z-scored spindle-band power. Samples exceeding the lower threshold (\u0026gt;1.5) were grouped into contiguous putative events. Candidate events were constrained to durations between 0.5 and 2.0 sec. For each candidate event, at least 25% of samples within the event were required to exceed the upper z-score threshold (\u0026gt;3.0). Events separated by short gaps were merged to avoid artificial splitting: if the time between the end of one event and the start of the next was \u0026lt;0.10 s, the events were combined into a single event\u003csup\u003e35\u0026ndash;38\u003c/sup\u003e.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSpectral analysis\u003cbr\u003e\u003c/strong\u003eThe spectral power analysis utilized a Hamming window with a duration of 512 msec and a 50% overlap between consecutive windows, resulting in a frequency resolution of 1 Hz. To determine the absolute spectral power within specific frequency ranges, separate averages were computed for wakefulness and sleep stages N1, N2, N3, and REM. The frequency ranges of interest included delta (1\u0026ndash;4 Hz), theta (5\u0026ndash;8 Hz), alpha (9\u0026ndash;12 Hz), beta (13\u0026ndash;30 Hz), and gamma (31\u0026ndash;125 Hz). In addition, a slow to fast frequencies ratio ([delta + theta]) / [alpha + beta]) during REM was calculated. This was motivated by prior studies demonstrating that increases in this ratio are associated with a higher likelihood of neurodegeneration across various disease states\u003csup\u003e39,40\u003c/sup\u003e and a higher risk of dementia in patients with PD\u003csup\u003e41\u003c/sup\u003e.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStatistical methods\u003cbr\u003e\u003c/strong\u003eSummary statistics were calculated for patient demographics and sleep characteristics for both normally and non-normally distributed variables, as determined by the Shapiro-Wilk test. We report mean and standard deviation (SD) for normally distributed variables and median and interquartile range (IQR) for non-normally distributed variables. Changes in UPDRS, LEDD, and sleep survey results after DBS implantation were compared with paired \u003cem\u003et\u003c/em\u003e-tests. Linear mixed effects models (LME) were utilized to investigate the interactions between DBS condition (pre vs. post) and medication state (on vs. off); these were considered fixed effects, with subject intercept as a random effect. Similarly, LMEs with DBS condition (pre vs. post) and DBS target (STN or GPi) as fixed effects and subject intercept as random effects, were used to evaluate whether sleep architecture changes after DBS were differently affected by DBS target choice. Correlations between changes before and after DBS implantation in MDS-UPDRS, LEDD, sleep survey results, and sleep architecture were analyzed with Spearman rank correlation coefficient, which was corrected for multiple comparisons with the Benjamini-Hochberg procedure with a false discovery rate set at 0.20. Mean band power was calculated per night for each frequency band of interest (alpha, beta, delta, theta, gamma) during wakefulness, N1, N2, N3, and REM sleep. To compare the effect of DBS across frequency bands and sleep stages, a model was constructed with DBS condition, frequency, and sleep stage considered fixed effects, and subject intercept as a random effect. An LME model with DBS condition and medication state as fixed effects and subject intercept as a random effect was used to evaluate the interaction of DBS condition and medication state on the REM slow to fast frequencies ratio. For sleep microarchitectural outcomes, LMEs were constructed with DBS condition and medication state as fixed effects and subject intercept as a random effect; dependent variables in individual models included SP density, oscillation frequency and amplitude in N2 and N3, SW density, duration, amplitude, and slope in N2 and N3.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003e\u003cstrong\u003eParticipants\u003c/strong\u003e\u003cbr\u003e\u0026nbsp;Of the 15 participants enrolled, 11 had data available both pre- and post-DBS implantation and were included in the analysis. Reasons for incomplete data collection included missing data post-operatively (1), loss to follow-up post-operatively (1), and withdrawal of consent (2). Of the included participants, five either did not wear the headband device while off-medications prior to DBS surgery or did not stop medications prior to surgery, resulting in only on-medication data being obtained from these participants at baseline. Two of these same five also declined to go off medications post-operatively, resulting in only on-medication data being obtained in either phase of the study. Another one of these five participants completely stopped dopaminergic medication after DBS implantation and programming, resulting in only off-medication data being obtained post-operatively.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe participants included eight men and three women, with a mean (SD) age of 65.4 (8.5) years, mean disease duration of 10.6 (4.6) years, and mean pre-operative LEDD of 1225 (392) mg. Demographic and clinical information is presented in \u003cstrong\u003eTable 1\u003c/strong\u003e. At baseline, participants reported poor sleep, with moderate daytime sleepiness. Mean scores (SD) for the PSQI, ESS, FSS, and PDSS-2 were 9.78 (4.7), 8.60 (3.8), 3.58 (1.6), and 27.3 (10.5), respectively. Six of the 11 participants had a bed partner who reported dream enactment behavior consistent with RBD.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eNine patients underwent DBS implantation in the bilateral STN, and two underwent implantation in the bilateral GPi. Motor outcomes after DBS surgery and stimulation parameters are provided in \u003cstrong\u003eTable 2\u003c/strong\u003e. After DBS, motor function as measured by the MDS-UPDRS part III in the on-medication state remained similar to the pre-operative, on-medication baseline (mean UPDRS-III at baseline: 28.5, post-DBS: 21.9, paired \u003cem\u003et\u003c/em\u003e-test, \u003cem\u003ep\u003c/em\u003e = 0.249). Post-operative, off-medication UPDRS-III scores were not obtained for all participants and so were not analyzed. LEDD was reduced by 60% (mean LEDD at baseline: 1225mg, post-DBS: 500mg, paired \u003cem\u003et-\u003c/em\u003etest, \u003cem\u003ep\u003c/em\u003e \u0026lt; 0.001, \u003cstrong\u003eTable 2\u003c/strong\u003e). This was primarily driven by medication reduction in the STN DBS group, as LEDD in the two GPi DBS participants increased slightly after DBS surgery (mean LEDD for GPi participants at baseline: 700mg, post-DBS: 772mg).\u003c/p\u003e\n\u003cp\u003eIn total, 93 nights of sleep recording were available for analysis: 38 in the pre-DBS, on-medication state, 6 in the pre-DBS, off-medication state, 26 in the post-DBS, on-medication state, and 23 in the post-DBS, off-medication state. Post-operative data collection occurred at a median of 147 (IQR 89) days after the first DBS lead implantation surgery.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSubjective sleep quality\u003c/strong\u003e\u003cbr\u003eSubjective sleep quality outcomes are provided in \u003cstrong\u003eTable 3\u003c/strong\u003e. After DBS implantation, scores on the PDSS-2 decreased from a mean of 27.3 (10.5) pre-operatively to 14.3 (7.5) post-operatively (paired \u003cem\u003et\u003c/em\u003e-test, \u003cem\u003ep\u003c/em\u003e = 0.034). Scores on the FSS decreased from a mean of 3.58 (1.6) pre-operatively to 2.25 (0.9) post-operatively (paired \u003cem\u003et\u003c/em\u003e-test, \u003cem\u003ep\u003c/em\u003e = 0.007). Although the mean PSQI score decreased from 9.78 (4.7) before DBS to 8.50 (3.1) after DBS and the mean ESS score decreased from 8.56 (3.8) to 6.20 (5.8), these changes were not statistically significant (paired \u003cem\u003et\u003c/em\u003e-tests, \u003cem\u003ep\u003csub\u003ePSQI\u003c/sub\u003e\u003c/em\u003e = 0.54, \u003cem\u003ep\u003csub\u003eESS\u003c/sub\u003e\u003c/em\u003e = 0.23). The proportion of participants reporting dream enactment behavior consistent with RBD remained unchanged (6/11).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSleep continuity and architecture\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eSleep continuity\u003cbr\u003e\u0026nbsp;\u003c/em\u003eLinear mixed-effects models demonstrated significant effects of DBS condition, medication state, and their interaction on multiple measures of sleep continuity (\u003cstrong\u003eTable 4\u003c/strong\u003e). After DBS implantation, participants experienced significantly increased total sleep time (TST), shorter sleep onset latency (SOL), reduced wakefulness duration, and higher sleep efficiency (\u003cstrong\u003eFigure 1\u0026nbsp;\u003c/strong\u003eand \u003cstrong\u003eFigure 2\u003c/strong\u003e). Medication state independently affected these outcomes, with the off-medication condition associated with shorter TST, longer SOL, greater wakefulness, and lower sleep efficiency.\u003c/p\u003e\n\u003cp\u003eSignificant DBS \u0026times; medication interactions were observed for TST, SOL, wakefulness duration, and sleep efficiency (\u003cstrong\u003eTable 4\u003c/strong\u003e). Simple main effects analyses demonstrated that DBS significantly increased TST and reduced SOL in the off-medication state but not in the on-medication state. In contrast, DBS significantly reduced wakefulness duration and improved sleep efficiency in both medication states, although the magnitude of effect was greater in the off-medication state.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eSleep architecture\u003cbr\u003e\u003c/em\u003eAfter DBS implantation, participants also experienced significantly increased NREM sleep, including greater N2 duration, N3 duration, and total NREM duration (\u003cstrong\u003eTable 4)\u003c/strong\u003e. Significant DBS \u0026times; medication interactions were observed for N2 and total NREM duration, with simple main effects analyses demonstrating significant DBS-related increases in these measures in the off-medication state but not in the on-medication state (\u003cstrong\u003eFigure 1 and Figure 2\u003c/strong\u003e). In contrast, the increase in N3 duration after DBS occurred independently of medication state, as no significant interaction was observed. Medication state had an independent effect on N3 and total NREM duration, with the off-medication condition associated with shorter N3 duration and reduced total NREM sleep.\u003c/p\u003e\n\u003cp\u003eNo significant fixed effects of DBS condition, medication state, or their interaction were observed for wake after sleep onset (WASO), N1 duration, REM duration, proportions of NREM or REM sleep, number of awakenings, or latencies to N2, N3, or REM sleep. See \u003cstrong\u003eSupplementary Table S1\u0026nbsp;\u003c/strong\u003efor results of all sleep continuity and architecture outcomes.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eDBS target\u003c/em\u003e\u003cbr\u003e\u0026nbsp;Linear mixed effect (LME) models, with DBS condition and DBS target as fixed effects and participants as random effects, did not reveal any significant interactions between DBS condition (pre vs. post) and DBS target (STN or GPi) for any of the sleep continuity or architecture outcomes. Furthermore, the fixed effects omnibus tests were not significant for DBS target in any of these outcomes, suggesting that changes in sleep after DBS surgery were similar for participants with STN and GPi DBS, and that sleep continuity and architecture were similar for the STN and GPi DBS groups when collapsed across within-subjects levels (pre vs. post DBS).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eCorrelation analyses\u003c/em\u003e\u003cbr\u003e\u0026nbsp;The changes in UPDRS, LEDD, subjective sleep quality, and sleep architecture with DBS implantation (post\u0026nbsp;-\u0026nbsp;pre DBS) were compared with Spearman\u0026rsquo;s rank correlation coefficient. The change in LEDD was negatively correlated with change in N2 duration (\u003cem\u003er\u003c/em\u003e = -0.655). However, this correlation was not significant after correction for multiple comparisons. Other correlations were not statistically significant.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSpectral power and sleep physiology\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eSpectral power\u003cbr\u003e\u003c/em\u003eThe LME model evaluating differences in band power across sleep stages and DBS condition demonstrated significant fixed effects omnibus tests for the interaction between DBS condition, frequency band, and sleep stage (\u003cem\u003eF\u003c/em\u003e(12) = 2.62, \u003cem\u003ep\u003c/em\u003e = 0.002). Simple effects analysis of frequency bands across sleep stages demonstrated significant effects of DBS on multiple frequency bands during wakefulness only (\u003cstrong\u003eTable 5\u003c/strong\u003e). Beta and gamma power during wakefulness were lower after DBS, while delta and theta power during wakefulness were higher after DBS. Differences in band power in N2, N3, and REM before and after DBS implantation were not significant for any frequency band.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eREM slow to fast frequencies ratio\u003cbr\u003e\u003c/em\u003eThe LME model evaluating the interaction of DBS condition and medication state on the REM slow to fast frequencies ratio demonstrated a significant effect of DBS condition (\u003cem\u003eF\u003c/em\u003e(1) = 7.96, \u003cem\u003ep\u003c/em\u003e = 0.013) but not medication state (\u003cem\u003ep\u003c/em\u003e = 0.69) nor the interaction between them (\u003cem\u003ep\u003c/em\u003e = 0.88). The slow to fast frequencies ratio was higher after DBS (\u003cstrong\u003eTable 5\u003c/strong\u003e). Due to the lack of significant interactions in the fixed effects omnibus tests, further simple effects analyses were not conducted.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eSlow waves\u003cbr\u003e\u003c/em\u003eThe LME model evaluating the effects of DBS and medication on SW density demonstrated significant fixed effects omnibus tests for the effect of DBS and medication on N2 SW density but not N3 SW density (\u003cstrong\u003eTable 6\u003c/strong\u003e). The interaction between DBS condition and medication state was not significant for either N2 or N3. N2 SW density was higher after DBS and on medication (\u003cstrong\u003eFigure 3 and Figure 4\u003c/strong\u003e). For SW duration, the LME model demonstrated a significant fixed effect omnibus test for DBS condition in N2 sleep, with SW duration being shorter after DBS. The effect of DBS was not significant on SW duration in N3. There was no significant effect of medication state, nor DBS \u0026times; medication interaction in N2 or N3. For SW amplitude, the LME model demonstrated no significant fixed effects of DBS or medication in either N2 or N3 sleep. However, there were significant DBS \u0026times; medication interactions; simple main effects analyses demonstrated that DBS increased SW amplitude in the on-medication state only, during both N2 and N3 sleep. There was a significant fixed effect of DBS on SW slope in N2, but not N3, sleep. The effects of medication were not significant in either N2 or N3 sleep. However, there were significant DBS \u0026times; medication interactions; simple main effects analyses demonstrated that DBS increased SW slope in the on-medication state only, during both N2 and N3 sleep.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eSleep spindles\u003cbr\u003e\u003c/em\u003eThe LME model evaluating the effects of DBS and medication on SP density demonstrated no significant effects of DBS or medication on SP density in N2 or N3 sleep (\u003cstrong\u003eTable 6\u003c/strong\u003e, \u003cstrong\u003eFigure 3\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eand Figure 4\u003c/strong\u003e). For SP peak frequency, there was a significant effect of DBS condition and medication state during N2 sleep, but no DBS \u0026times; medication interaction. These effects were observed in opposite directions: SP frequency was lower after DBS, but higher on medication. For SP amplitude, the LME model demonstrated significant fixed effects for DBS and medication as well as DBS \u0026times; medication interactions in both N2 and N3 sleep. Again, these effects were observed in opposite directions: SP amplitude was lower after DBS, but higher on medication. Simple effects analysis demonstrated that SP amplitude was higher after DBS both on and off medication, though the change was larger in the off-medication state.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eSee \u003cstrong\u003eSupplementary Table S2\u0026nbsp;\u003c/strong\u003efor results of all SW and SP outcomes.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eIn this study, we prospectively evaluated the effect of STN or GPi DBS on sleep in PD, using an in-home, multiple-night design to better capture naturalistic sleep patterns. This design also allowed us to obtain data in both the on-medication and off-medication state, thus helping account for the effect of dopaminergic medication. We found that, compared to pre-surgical baseline, DBS implantation improved both subjective sleep quality and fatigue (as measured by the PDSS-2 and FSS, respectively) as well as several measures of sleep architecture, including total sleep time, N2 and N3 sleep duration, sleep onset latency, wakefulness, and sleep efficiency. In many cases, the fixed effect coefficient for DBS condition was large, indicating a large increase in these outcomes after DBS. For example, the magnitude change in total sleep time after DBS was an increase of 141 minutes, on N2 duration was an increase of 82 minutes, and for N3 duration was an increase of 29 minutes. When we considered the interaction between DBS and medication state, many of the improvements in sleep architecture were significant in the off-medication state only, including total sleep time, sleep onset latency, N2 duration and total NREM duration. In that sense, it may be that therapeutic stimulation \u0026lsquo;rescues\u0026rsquo; the disruptions in sleep architecture caused by the withdrawal of dopaminergic medication. For others, the effects of DBS were significant in both the on and off-medication states, including wakefulness duration and sleep efficiency, indicating that DBS may provide an additive benefit over dopaminergic medication in these parameters. We did not find that any sleep architecture outcomes were affected differently by STN vs. GPi DBS, though the limited sample size of two GPi DBS patients precludes definite conclusions about the differences between these targets.\u003c/p\u003e\n\u003cp\u003eSpectral analyses revealed that changes in frequency band power were affected by DBS only during wakefulness. For example, beta power was lower after DBS, which is not surprising: pathologic beta activity in PD is elevated not only in the basal ganglia but also in the cortex, and may be diminished in the cortex as well as in subcortical structures by DBS\u003csup\u003e42\u0026ndash;44\u003c/sup\u003e. We did not detect changes induced by DBS during N2, N3, or REM sleep. Overall, we believe these spectral analyses should be interpreted with caution, as the results do not necessarily conform to canonical changes in frequency bands across sleep stages. For example, gamma power during wakefulness was lower after DBS, which may be unexpected since gamma power is generally considered a \u0026lsquo;pro-kinetic\u0026rsquo; marker and typically is higher in wakefulness during therapeutic stimulation\u003csup\u003e45,46\u003c/sup\u003e. On the other hand, it should be noted that wakefulness captured here is only nighttime wakefulness and likely reflects relatively little active movement. The lack of any other changes in spectral power may reflect a limitation of the use of the wearable PSG headband, which comprises only frontal and occipital electrodes and thus may lack the spatial resolution to fully capture the emergence and fronto-central transition of delta power across the night\u003csup\u003e47\u003c/sup\u003e. We also found that the REM slow to fast frequencies ratio was higher after DBS but was not impacted by medication. Given this ratio\u0026rsquo;s known correlation with dementia risk\u003csup\u003e39\u0026ndash;41\u003c/sup\u003e, our findings could partially explain the observed cognitive decline after DBS surgery\u003csup\u003e48\u003c/sup\u003e. Although our study did not include longitudinal neuropsychological assessments to verify this, future studies should investigate the change in REM slow to fast frequencies after DBS as a correlate of post-operative cognitive impairment.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eWe also evaluated changes in sleep microarchitectural features, including spindles and slow waves. These results add to a small but growing body of literature on the changes in spindle and slow wave morphology in PD and may be contextualized by studies of SP and SW alterations in normal aging and other neurodegenerative diseases. Prior studies have demonstrated altered SP characteristics in people with PD compared to controls, including decreased SP density, longer duration, slower oscillation frequency, and higher maximum amplitude\u003csup\u003e49\u003c/sup\u003e. We did not find any effect of DBS or medication on SP density in either N2 or N3 sleep. This contrasts our prior finding of higher SP density during nights with DBS on at high frequency (\u0026ge; 130 Hz) compared to off or at low frequency (60 Hz)\u003csup\u003e22\u003c/sup\u003e. However, it should be noted that the prior study was methodologically different, in that it compared different DBS settings only in the post-operative state. We found that SP oscillation frequency in N2 was decreased after DBS, but higher in the on-medication state compared to off-medication. We also found that SP amplitude in N2 was higher after DBS, but lower on medication. These contrasting effects of DBS and dopaminergic medication on spindle morphology warrant further investigation into the mechanistic effects of each therapy on sleep physiology, but could partially explain why the effects of DBS on sleep architecture were more pronounced in the off-medication state. If levodopa promotes more \u0026lsquo;physiological\u0026rsquo; spindle morphology (i.e., higher frequency and lower amplitude), it seems that DBS exerts its effect through different mechanisms and thus may not produce as profound effects on sleep architecture in the on-medication state.\u003c/p\u003e\n\u003cp\u003eSW alterations in PD patients compared to controls include reduced SW density, without differences in SW amplitude or slope\u003csup\u003e20\u003c/sup\u003e. SWs represent large-scale synchronization of neuronal populations\u003csup\u003e50\u003c/sup\u003e; their diminution in density and amplitude is associated with cognitive decline\u003csup\u003e51\u003c/sup\u003e and may play a particularly pivotal role in the pathogenesis of Alzheimer\u0026rsquo;s disease\u003csup\u003e52\u003c/sup\u003e. Little is known on how changes in slow wave duration may affect sleep or cognitive function, but at least one prior study demonstrated that SW morphologic features, including duration, can reliably serve as a biomarker of aging\u003csup\u003e53\u003c/sup\u003e. We found that SW density in N2 was higher after DBS but was not significantly different across DBS conditions in N3 sleep. DBS had a significant effect on SW duration in N2 only, with duration being longer in the pre-DBS condition compared to post-DBS. We also found that SW amplitude in N3 was increased by DBS in the on-medication state only. In our prior study, we found that SW amplitude during combined N2-N3 sleep was higher during a night with DBS on at low frequency compared to DBS off or at high frequency\u003csup\u003e22\u003c/sup\u003e. Of note, as DBS parameters were not altered in the current study, participants remained in their typical therapeutic DBS settings, which did not include any low frequency stimulation. Our findings of differential effects of DBS on SW features in N2 compared to N3 sleep may reflect the proposed different subtypes of SWs. \u0026lsquo;Global\u0026rsquo; SWs are hypothesized to be generated frontally, predominantly occur in N2, and favor synaptic potentiation, while \u0026lsquo;local\u0026rsquo; SWs are hypothesized to occur predominantly in N3 and drive synaptic downscaling\u003csup\u003e51,54,55\u003c/sup\u003e, although our present methods lack the spatial resolution to differentiate between these subtypes. Overall, we believe that our findings \u0026ndash; particularly of increased SW density and amplitude \u0026ndash; warrant further investigation into DBS as a modulatory therapy for SWs, especially given the broader interest in slow wave enhancement as a mechanism to improve cognitive function\u003csup\u003e56\u003c/sup\u003e. \u0026nbsp;\u003c/p\u003e\n\u003cp\u003eStrengths of this study include the prospective design and recording of sleep data across multiple nights in varying stimulation and medication conditions. The use of a wearable sleep monitor facilitated in-home assessments which more closely capture naturalistic sleep patterns and help mitigate alterations in sleep caused by unfamiliar or uncomfortable sleep laboratory environments. This study does have important limitations, including the small number of participants, though this sample size is similar to other studies of the effect of DBS on objective sleep outcomes\u003csup\u003e14\u0026ndash;16,57\u003c/sup\u003e. Unlike those studies which have enrolled only STN DBS patients, we also included GPi DBS patients, though the small number of GPi participants in our study prevents definite conclusions regarding the difference between STN and GPi DBS on sleep. Although the wearable PSG headband is easy for participants to use across multiple nights, its limited electrode montage may mean that certain physiological features are not captured as accurately as with formal PSG. This would be particularly true for SPs, which typically demonstrate a central/parietal predominance\u003csup\u003e18\u003c/sup\u003e. Furthermore, we relied on automated sleep staging provided by the PSG headband and automated quantitative EEG analysis of SPs and SWs. Although the PSG headband is validated in healthy controls\u003csup\u003e33\u003c/sup\u003e, it has not yet been validated in people with PD and thus may be prone to sleep stage misclassification, particularly as features which are used for staging (e.g., SPs and K-complexes) are known to be morphologically altered in PD\u003csup\u003e49,58\u003c/sup\u003e. This variability could possibly affect the threshold for spindle detection as well as automated sleep stage determination. Finally, although data presented here contrast, in some regards, our prior \u003cem\u003epost hoc\u003c/em\u003e analysis of SP and SW features during separate nights with DBS on at high frequency, on at low frequency, and off, important methodological differences should be considered. Sleep data in the prior study upon which the \u003cem\u003epost hoc\u0026nbsp;\u003c/em\u003eanalysis was based were obtained across a one-month time frame with in-lab PSG, rather than over a longer period with a wearable device, and so may not be directly comparable. Furthermore, the majority (14/15) of participants in the prior study had unilateral STN DBS, whereas all participants in the present study had bilateral DBS.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eIn conclusion, we present the first (to our knowledge) prospective, multiple night study of the effect of DBS and medication state on sleep disturbance in PD, including not only assessment of sleep architecture, but also sleep physiology such as SPs and SWs. We demonstrate that DBS implantation improves subjective sleep as well as several objective sleep measures with large magnitudes of change, including total sleep time, sleep efficiency, and N2 and N3 duration. We also show that certain properties of SPs and SWs, such as spindle amplitude and oscillation frequency, N2 slow wave density, and N3 SW amplitude are affected by DBS. These findings motivate future studies to further examine the potential for the optimization of DBS to enhance sleep, as well as the therapeutic implications of altering sleep microarchitecture. Tailoring DBS therapy for sleep enhancement would represent a substantial advancement in the search for improved treatments for sleep dysfunction in PD.\u003c/p\u003e"},{"header":"Declarations","content":"\u003ch2\u003eCompeting Interests\u003c/h2\u003e\n\u003cp\u003eAJB has received research funding from Medtronic and the University of Colorado, travel stipends from Medtronic, Boston Scientific, and BlueRock Therapeutics/Bayer, has served as a site investigator for studies sponsored by BlueRock Therapeutics/Bayer and PhotoPharmics, Inc., and has received consulting fees from General Dynamics Information Technology. ED and LH confirm they have no competing interests. DSK has received honoraria for advisement/consulting from Abbott, AbbVie Pharmaceutics, Alpha Omega Engineering, Boston Scientific, Insightec, Medtronic, has served as a site investigator for studies sponsored by Abbvie and Ceregate, and has received grants from the Boston Scientific and Medtronic. JAT has received research funding from Medtronic. AWA has received research funding from the University of Colorado and NIH NICHD, has served as a site investigator for studies sponsored by Michael J Fox Foundation for Parkinson\u0026rsquo;s Research, Parkinson Study Group, Aligning Science Across Parkinson\u0026rsquo;s (ASAP) Initiative, Koneksa Health, Biohaven Pharmaceuticals, Inc., Bial, and the NIH NINDS, has received honoraria for consultancy to Aevum through Parkinson Study Group, and is a consultant for PhotoPharmics, Inc.\u003c/p\u003e\n\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\n\u003cp\u003eAJB designed and supervised the study, analyzed and interpreted the data, and led the writing of the manuscript. LH performed data collection and analysis. ED performed data collection. DSK contributed to the design of the study and contributed to the writing of the manuscript. JAT contributed to the design of the study, contributed to data analysis and interpretation, and contributed to the writing of the manuscript. AWA contributed to the design of the study, contributed to data analysis and interpretation, and contributed to the writing of the manuscript. All authors read and approved the final manuscript.\u003c/p\u003e\n\u003ch2\u003eAcknowledgement\u003c/h2\u003e\n\u003cp\u003eThe authors would like to thank all the patients who participated in this study.\u003c/p\u003e\n\u003ch2\u003eData Availability\u003c/h2\u003e\n\u003cp\u003eThe data that support the findings of this study are not openly available due to reasons of sensitivity and are available from the corresponding author upon reasonable request. Data are in controlled access data storage at the University of Colorado Anschutz.\u003c/p\u003e\n\u003ch2\u003eCode availability\u003c/h2\u003e\n\u003cp\u003eCode will be made available upon reasonable request via Github.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eAvidan, A. \u003cem\u003eet al.\u003c/em\u003e Associations of sleep disturbance symptoms with health-related quality of life in Parkinson\u0026rsquo;s disease. \u003cem\u003eJ. Neuropsychiatry Clin. Neurosci.\u003c/em\u003e \u003cstrong\u003e25\u003c/strong\u003e, 319\u0026ndash;326 (2013).\u003c/li\u003e\n\u003cli\u003eBarone, P. \u003cem\u003eet al.\u003c/em\u003e The PRIAMO study: A multicenter assessment of nonmotor symptoms and their impact on quality of life in Parkinson\u0026rsquo;s disease. \u003cem\u003eMov. 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Local and widespread slow waves in stable NREM sleep: Evidence for distinct regulation mechanisms. \u003cem\u003eFront. Hum. Neurosci.\u003c/em\u003e \u003cstrong\u003e12\u003c/strong\u003e, 248 (2018).\u003c/li\u003e\n\u003cli\u003eKim, J., Gulati, T. \u0026amp; Ganguly, K. Competing roles of slow-oscillations and delta-waves in memory consolidation versus forgetting. \u003cem\u003eCell\u003c/em\u003e \u003cstrong\u003e179\u003c/strong\u003e, 514-526.e13 (2019).\u003c/li\u003e\n\u003cli\u003eWilckens, K. A., Ferrarelli, F., Walker, M. P. \u0026amp; Buysse, D. J. Slow-wave activity enhancement to improve cognition. \u003cem\u003eTrends Neurosci.\u003c/em\u003e \u003cstrong\u003e41\u003c/strong\u003e, 470\u0026ndash;482 (2018).\u003c/li\u003e\n\u003cli\u003eCicolin, A. \u003cem\u003eet al.\u003c/em\u003e Effects of deep brain stimulation of the subthalamic nucleus on sleep architecture in parkinsonian patients. \u003cem\u003eSleep Med.\u003c/em\u003e \u003cstrong\u003e5\u003c/strong\u003e, 207\u0026ndash;210 (2004).\u003c/li\u003e\n\u003cli\u003eLatreille, V. \u003cem\u003eet al.\u003c/em\u003e Sleep spindles in Parkinson\u0026rsquo;s disease may predict the development of dementia. \u003cem\u003eNeurobiol. Aging\u003c/em\u003e \u003cstrong\u003e36\u003c/strong\u003e, 1083\u0026ndash;1090 (2015).\u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003e\u003cstrong\u003eTable 1.\u0026nbsp;\u003c/strong\u003eParticipant demographics and baseline clinical characteristics.\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"564\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 11.7021%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eParticipant\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.6383%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAge (y)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9.57447%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eGender\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14.8936%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDisease Duration (y)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.6383%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eLEDD\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(mg) \u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12.766%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eUPDRS-III\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.6383%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eH\u0026amp;Y\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 19.1489%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSleep Aid\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 11.7021%;\"\u003e\n \u003cp\u003e1 \u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.6383%;\"\u003e\n \u003cp\u003e73\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9.57447%;\"\u003e\n \u003cp\u003eM\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14.8936%;\"\u003e\n \u003cp\u003e19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.6383%;\"\u003e\n \u003cp\u003e1352\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12.766%;\"\u003e\n \u003cp\u003e35\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.6383%;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 19.1489%;\"\u003e\n \u003cp\u003eQuetiapine 25mg\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 11.7021%;\"\u003e\n \u003cp\u003e2 \u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.6383%;\"\u003e\n \u003cp\u003e64\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9.57447%;\"\u003e\n \u003cp\u003eM\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14.8936%;\"\u003e\n \u003cp\u003e17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.6383%;\"\u003e\n \u003cp\u003e1700\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12.766%;\"\u003e\n \u003cp\u003e17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.6383%;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 19.1489%;\"\u003e\n \u003cp\u003eMelatonin 15mg\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 11.7021%;\"\u003e\n \u003cp\u003e3 \u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.6383%;\"\u003e\n \u003cp\u003e69\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9.57447%;\"\u003e\n \u003cp\u003eM\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14.8936%;\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.6383%;\"\u003e\n \u003cp\u003e670\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12.766%;\"\u003e\n \u003cp\u003e17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.6383%;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 19.1489%;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 11.7021%;\"\u003e\n \u003cp\u003e4 \u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.6383%;\"\u003e\n \u003cp\u003e62\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9.57447%;\"\u003e\n \u003cp\u003eF\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14.8936%;\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.6383%;\"\u003e\n \u003cp\u003e1150\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12.766%;\"\u003e\n \u003cp\u003e33\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.6383%;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 19.1489%;\"\u003e\n \u003cp\u003eMelatonin 3mg\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 11.7021%;\"\u003e\n \u003cp\u003e5 \u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.6383%;\"\u003e\n \u003cp\u003e69\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9.57447%;\"\u003e\n \u003cp\u003eM\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14.8936%;\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.6383%;\"\u003e\n \u003cp\u003e1430\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12.766%;\"\u003e\n \u003cp\u003e39\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.6383%;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 19.1489%;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 11.7021%;\"\u003e\n \u003cp\u003e6 \u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.6383%;\"\u003e\n \u003cp\u003e58\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9.57447%;\"\u003e\n \u003cp\u003eF\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14.8936%;\"\u003e\n \u003cp\u003e15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.6383%;\"\u003e\n \u003cp\u003e730\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12.766%;\"\u003e\n \u003cp\u003e21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.6383%;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 19.1489%;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 11.7021%;\"\u003e\n \u003cp\u003e7 \u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.6383%;\"\u003e\n \u003cp\u003e45\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9.57447%;\"\u003e\n \u003cp\u003eM\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14.8936%;\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.6383%;\"\u003e\n \u003cp\u003e670\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12.766%;\"\u003e\n \u003cp\u003e21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.6383%;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 19.1489%;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 11.7021%;\"\u003e\n \u003cp\u003e8 \u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.6383%;\"\u003e\n \u003cp\u003e77\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9.57447%;\"\u003e\n \u003cp\u003eM\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14.8936%;\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.6383%;\"\u003e\n \u003cp\u003e1400\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12.766%;\"\u003e\n \u003cp\u003e22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.6383%;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 19.1489%;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 11.7021%;\"\u003e\n \u003cp\u003e9 \u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.6383%;\"\u003e\n \u003cp\u003e67\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9.57447%;\"\u003e\n \u003cp\u003eF\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14.8936%;\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.6383%;\"\u003e\n \u003cp\u003e1226\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12.766%;\"\u003e\n \u003cp\u003e48\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.6383%;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 19.1489%;\"\u003e\n \u003cp\u003eMelatonin 5mg\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 11.7021%;\"\u003e\n \u003cp\u003e10 \u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.6383%;\"\u003e\n \u003cp\u003e70\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9.57447%;\"\u003e\n \u003cp\u003eM\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14.8936%;\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.6383%;\"\u003e\n \u003cp\u003e1813\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12.766%;\"\u003e\n \u003cp\u003e34\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.6383%;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 19.1489%;\"\u003e\n \u003cp\u003eMelatonin 9mg\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 11.7021%;\"\u003e\n \u003cp\u003e11 \u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.6383%;\"\u003e\n \u003cp\u003e65\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9.57447%;\"\u003e\n \u003cp\u003eM\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14.8936%;\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.6383%;\"\u003e\n \u003cp\u003e1330\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12.766%;\"\u003e\n \u003cp\u003e26\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.6383%;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 19.1489%;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eLEDD = levodopa equivalent daily dose; UPDRS-III = Movement Disorders Society-Unified Parkinson Disease Rating Scale, part III (on-medication); H\u0026amp;Y = Hoehn and Yahr stage (on-medication).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 2.\u0026nbsp;\u003c/strong\u003ePost-operative clinical characteristics and DBS settings.\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"708\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 72px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eParticipant\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 48px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDBS Target\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDBS Duration* (d)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 48px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eLEDD (mg)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eUPDRS-III\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 42px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eH\u0026amp;Y\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 72px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSleep Aid \u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDBS Lead Model\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"4\" style=\"width: 228px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eStimulation parameters\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 90px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eContacts\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 48px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAmp. (mA)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 48px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePW (\u003c/strong\u003e\u003cstrong\u003em\u003c/strong\u003e\u003cstrong\u003esec)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 42px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFreq. (Hz)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e1 \u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 48px;\"\u003e\n \u003cp\u003eSTN\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003e164\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 48px;\"\u003e\n \u003cp\u003e343\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003e39\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 42px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003eBSCN 2202\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 90px;\"\u003e\n \u003cp\u003eL: 3C-, c+\u003c/p\u003e\n \u003cp\u003eR: 2ABC-, c+\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 48px;\"\u003e\n \u003cp\u003eL: 2.4\u003c/p\u003e\n \u003cp\u003eR: 2.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 48px;\"\u003e\n \u003cp\u003e60\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 42px;\"\u003e\n \u003cp\u003e130\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e2 \u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 48px;\"\u003e\n \u003cp\u003eSTN\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003e102\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 48px;\"\u003e\n \u003cp\u003e855\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 42px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003eMelatonin 15mg\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003eABT 6172\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 90px;\"\u003e\n \u003cp\u003eL: 3B-, c+\u003c/p\u003e\n \u003cp\u003e1-, c+\u003c/p\u003e\n \u003cp\u003eR: 11B-, c+\u003c/p\u003e\n \u003cp\u003e9-, c+\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 48px;\"\u003e\n \u003cp\u003eL: 3.0\u003c/p\u003e\n \u003cp\u003e0.5\u003c/p\u003e\n \u003cp\u003eR: 2.0\u003c/p\u003e\n \u003cp\u003e0.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 48px;\"\u003e\n \u003cp\u003e60\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 42px;\"\u003e\n \u003cp\u003e125\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e3 \u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 48px;\"\u003e\n \u003cp\u003eSTN\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003e328\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 48px;\"\u003e\n \u003cp\u003e226\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003e39\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 42px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003eABT 6172\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 90px;\"\u003e\n \u003cp\u003eL: 2ABC-, 1+\u003c/p\u003e\n \u003cp\u003eR: 10C-, 9+\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 48px;\"\u003e\n \u003cp\u003eL: 3.2\u003c/p\u003e\n \u003cp\u003eR: 2.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 48px;\"\u003e\n \u003cp\u003e60\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 42px;\"\u003e\n \u003cp\u003e90\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e4 \u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 48px;\"\u003e\n \u003cp\u003eSTN\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003e96\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 48px;\"\u003e\n \u003cp\u003e523\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003e26\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 42px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003eMelatonin 10mg\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003eMDT B33005\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 90px;\"\u003e\n \u003cp\u003eL: 1B-, 1C-, c+\u003c/p\u003e\n \u003cp\u003eR: 9ABC-, c+\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 48px;\"\u003e\n \u003cp\u003eL: 1.4\u003c/p\u003e\n \u003cp\u003eR: 2.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 48px;\"\u003e\n \u003cp\u003e60\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 42px;\"\u003e\n \u003cp\u003e125\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e5 \u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 48px;\"\u003e\n \u003cp\u003eSTN\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003e103\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 48px;\"\u003e\n \u003cp\u003e600\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 42px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003eMDT B33005\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 90px;\"\u003e\n \u003cp\u003eL: 1A-, 1B-, 1C-, c+\u003c/p\u003e\n \u003cp\u003eR: 9A-, 9B-, 10A-, 10B-, c+\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 48px;\"\u003e\n \u003cp\u003eL: 3.0\u003c/p\u003e\n \u003cp\u003eR: 1.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 48px;\"\u003e\n \u003cp\u003e60\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 42px;\"\u003e\n \u003cp\u003e125\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e6 \u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 48px;\"\u003e\n \u003cp\u003eGPi\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003e112\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 48px;\"\u003e\n \u003cp\u003e760\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003e29\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 42px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003eMelatonin 10mg\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003eABT 6172\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 90px;\"\u003e\n \u003cp\u003eL: 3ABC-, c+\u003c/p\u003e\n \u003cp\u003eR: 10ABC-, c+\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 48px;\"\u003e\n \u003cp\u003eL: 1.5\u003c/p\u003e\n \u003cp\u003eR: 1.85\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 48px;\"\u003e\n \u003cp\u003e60\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 42px;\"\u003e\n \u003cp\u003e130\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e7 \u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 48px;\"\u003e\n \u003cp\u003eGPi\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003e162\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 48px;\"\u003e\n \u003cp\u003e784\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003e20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 42px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003eBSCN 2202\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 90px;\"\u003e\n \u003cp\u003eL: 3B-, 3C-, 4-, c+\u003c/p\u003e\n \u003cp\u003eR: 3A-, 3B-, 3C-, c+\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 48px;\"\u003e\n \u003cp\u003eL: 3.5\u003c/p\u003e\n \u003cp\u003eR: 3.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 48px;\"\u003e\n \u003cp\u003e60\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 42px;\"\u003e\n \u003cp\u003e170\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e8 \u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 48px;\"\u003e\n \u003cp\u003eSTN\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003e278\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 48px;\"\u003e\n \u003cp\u003e585\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003e30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 42px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003eMDT B33005\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 90px;\"\u003e\n \u003cp\u003eL: 2ABC-, c+\u003c/p\u003e\n \u003cp\u003eR: 10BC-, c+\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 48px;\"\u003e\n \u003cp\u003eL: 2.7\u003c/p\u003e\n \u003cp\u003eR: 2.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 48px;\"\u003e\n \u003cp\u003e60\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 42px;\"\u003e\n \u003cp\u003e125\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e9 \u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 48px;\"\u003e\n \u003cp\u003eSTN\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003e223\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 48px;\"\u003e\n \u003cp\u003e170\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 42px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003eMirtazapine 7.5mg\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003eBSCN 2202\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 90px;\"\u003e\n \u003cp\u003eL: 2A-, 2B-, 2C-, 3A-, 3B-, 3C-, c+\u003c/p\u003e\n \u003cp\u003eR: 2ABC-, c+\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 48px;\"\u003e\n \u003cp\u003eL: 4.0\u003c/p\u003e\n \u003cp\u003eR: 3.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 48px;\"\u003e\n \u003cp\u003e60\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 42px;\"\u003e\n \u003cp\u003e185\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e10 \u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 48px;\"\u003e\n \u003cp\u003eSTN\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003e147\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 48px;\"\u003e\n \u003cp\u003e750\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003e29\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 42px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003eMelatonin 12mg\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003eBSCN 2202\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 90px;\"\u003e\n \u003cp\u003eL: 2ABC-, c+\u003c/p\u003e\n \u003cp\u003eR: 2ABC-, c+\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 48px;\"\u003e\n \u003cp\u003eL: 1.5\u003c/p\u003e\n \u003cp\u003eR: 2.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 48px;\"\u003e\n \u003cp\u003e60\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 42px;\"\u003e\n \u003cp\u003e130\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e11 \u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 48px;\"\u003e\n \u003cp\u003eSTN\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003e106\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 48px;\"\u003e\n \u003cp\u003e100\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003e21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 42px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003eABT 6172\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 90px;\"\u003e\n \u003cp\u003eL: 3B-, c+\u003c/p\u003e\n \u003cp\u003eR: 10ABC-, c+\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 48px;\"\u003e\n \u003cp\u003eL: 2.25\u003c/p\u003e\n \u003cp\u003eR: 2.95\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 48px;\"\u003e\n \u003cp\u003e60\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 42px;\"\u003e\n \u003cp\u003e130\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e*Duration from DBS lead implantation surgery to start of post-operative sleep study\u003c/p\u003e\n\u003cp\u003eDBS = Deep brain stimulation; LEDD = levodopa equivalent daily dose; UPDRS-III = Movement Disorders Society-Unified Parkinson Disease Rating Scale, part III (on-medication); H\u0026amp;Y = Hoehn and Yahr stage (on-medication); Amp. = Amplitude; PW = Pulse width; Freq. = Frequency; STN = subthalamic nucleus; GPi = globus pallidum interna: BSCN = Boston Scientific; ABT = Abbott; MDT = Medtronic.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 3.\u003c/strong\u003e Subjective sleep outcomes before and after DBS implantation. Paired samples \u003cem\u003et\u003c/em\u003e-tests were used to determine significance.\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eOutcome\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003ePre DBS (Mean [SD])\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003ePost DBS (Mean [SD])\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003ep-\u003c/em\u003e\u003c/strong\u003e\u003cstrong\u003evalue\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003ePSQI\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e9.78 [4.68]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e8.50 [3.10]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.542\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eESS\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e8.56 [3.84]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e6.20 [5.75]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.229\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eFSS\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e3.58 [1.56]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e2.25 [0.90]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.007\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003ePDSS-2\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e27.3 [10.5]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e14.3 [7.54]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.034\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003ePSQI = Pittsburgh Sleep Quality Index; ESS = Epworth Sleepiness Scale; FSS = Fatigue Severity Scale; PDSS-2 = Parkinson Disease Sleep Scale, version 2\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 4.\u0026nbsp;\u003c/strong\u003eLinear mixed effects model results for the effect of DBS condition and medication state on sleep continuity and architecture outcomes.\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"642\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eOutcome\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 120px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFixed Effect\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 48px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eF\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 120px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003e\u0026beta;\u003c/em\u003e\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;[95% CI]\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 54px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003ep\u003c/em\u003e\u003c/strong\u003e\u003cstrong\u003e-value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 156px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDirection / Interpretation\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal Sleep Time (TST)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 120px;\"\u003e\n \u003cp\u003eDBS (post \u0026ndash; pre)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 48px;\"\u003e\n \u003cp\u003e20.62\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 120px;\"\u003e\n \u003cp\u003e+141.9 [79.7, 204.0]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 54px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 156px;\"\u003e\n \u003cp\u003e\u0026uarr; TST with DBS\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 144px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 120px;\"\u003e\n \u003cp\u003eMedication (on \u0026ndash; off)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 48px;\"\u003e\n \u003cp\u003e5.03\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 120px;\"\u003e\n \u003cp\u003e+71.0 [8.0, 133.9]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 54px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.028\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 156px;\"\u003e\n \u003cp\u003e\u0026uarr; TST ON meds\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 144px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 120px;\"\u003e\n \u003cp\u003eDBS \u0026times; Medication\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 48px;\"\u003e\n \u003cp\u003e7.87\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 120px;\"\u003e\n \u003cp\u003e+175.5 [51.0, 299.9]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 54px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.006\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 156px;\"\u003e\n \u003cp\u003eDBS effect larger OFF meds\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 144px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 120px;\"\u003e\n \u003cp\u003eDBS effect OFF meds\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 48px;\"\u003e\n \u003cp\u003e17.90\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 120px;\"\u003e\n \u003cp\u003e+229.6 [121.5, 338.0]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 54px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 156px;\"\u003e\n \u003cp\u003eSignificant \u0026uarr; TST\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 144px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 120px;\"\u003e\n \u003cp\u003eDBS effect ON meds\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 48px;\"\u003e\n \u003cp\u003e3.04\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 120px;\"\u003e\n \u003cp\u003e\u0026mdash;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 54px;\"\u003e\n \u003cp\u003e0.085\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 156px;\"\u003e\n \u003cp\u003eNS\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSleep Onset Latency (SOL)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 120px;\"\u003e\n \u003cp\u003eDBS (post \u0026ndash; pre)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 48px;\"\u003e\n \u003cp\u003e31.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 120px;\"\u003e\n \u003cp\u003e\u0026minus;45.8 [\u0026minus;62.0, \u0026minus;29.6]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 54px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 156px;\"\u003e\n \u003cp\u003eFaster sleep onset with DBS\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 144px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 120px;\"\u003e\n \u003cp\u003eMedication (on \u0026ndash; off)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 48px;\"\u003e\n \u003cp\u003e56.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 120px;\"\u003e\n \u003cp\u003e\u0026minus;61.7 [\u0026minus;78.1, \u0026minus;45.3]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 54px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 156px;\"\u003e\n \u003cp\u003eFaster sleep onset ON meds\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 144px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 120px;\"\u003e\n \u003cp\u003eDBS \u0026times; Medication\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 48px;\"\u003e\n \u003cp\u003e43.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 120px;\"\u003e\n \u003cp\u003e\u0026minus;107.6 [\u0026minus;140.0, \u0026minus;75.2]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 54px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 156px;\"\u003e\n \u003cp\u003eDBS effect larger OFF meds\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 144px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 120px;\"\u003e\n \u003cp\u003eDBS effect OFF meds\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 48px;\"\u003e\n \u003cp\u003e49.65\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 120px;\"\u003e\n \u003cp\u003e\u0026minus;99.6 [\u0026minus;127.8, \u0026minus;71.5]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 54px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 156px;\"\u003e\n \u003cp\u003eMarkedly shorter SOL\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 144px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 120px;\"\u003e\n \u003cp\u003eDBS effect ON meds\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 48px;\"\u003e\n \u003cp\u003e0.97\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 120px;\"\u003e\n \u003cp\u003e\u0026mdash;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 54px;\"\u003e\n \u003cp\u003e0.33\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 156px;\"\u003e\n \u003cp\u003eNS\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eWakefulness Duration\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 120px;\"\u003e\n \u003cp\u003eDBS (post \u0026ndash; pre)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 48px;\"\u003e\n \u003cp\u003e22.81\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 120px;\"\u003e\n \u003cp\u003e\u0026minus;85.1 [\u0026minus;120.6, \u0026minus;49.7]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 54px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 156px;\"\u003e\n \u003cp\u003e\u0026darr; Wake time with DBS\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 144px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 120px;\"\u003e\n \u003cp\u003eMedication (on \u0026ndash; off)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 48px;\"\u003e\n \u003cp\u003e25.26\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 120px;\"\u003e\n \u003cp\u003e\u0026minus;91.2 [\u0026minus;127.3, \u0026minus;55.1]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 54px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 156px;\"\u003e\n \u003cp\u003e\u0026darr; Wake time ON meds\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 144px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 120px;\"\u003e\n \u003cp\u003eDBS \u0026times; Medication\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 48px;\"\u003e\n \u003cp\u003e6.66\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 120px;\"\u003e\n \u003cp\u003e\u0026minus;92.2 [\u0026minus;163.3, \u0026minus;21.1]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 54px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.012\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 156px;\"\u003e\n \u003cp\u003eGreater DBS effect OFF meds\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 144px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 120px;\"\u003e\n \u003cp\u003eDBS effect OFF meds\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 48px;\"\u003e\n \u003cp\u003e17.98\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 120px;\"\u003e\n \u003cp\u003e\u0026minus;131.2 [\u0026minus;192.9, \u0026minus;69.6]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 54px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 156px;\"\u003e\n \u003cp\u003eLarge reduction\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 144px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 120px;\"\u003e\n \u003cp\u003eDBS effect ON meds\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 48px;\"\u003e\n \u003cp\u003e4.84\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 120px;\"\u003e\n \u003cp\u003e\u0026minus;39.1 [\u0026minus;74.4, \u0026minus;3.7]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 54px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.031\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 156px;\"\u003e\n \u003cp\u003eModest reduction\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSleep Efficiency\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 120px;\"\u003e\n \u003cp\u003eDBS (post \u0026ndash; pre)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 48px;\"\u003e\n \u003cp\u003e27.32\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 120px;\"\u003e\n \u003cp\u003e+24.2 [15.0, 33.4]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 54px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 156px;\"\u003e\n \u003cp\u003e\u0026uarr; efficiency with DBS\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 144px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 120px;\"\u003e\n \u003cp\u003eMedication (on \u0026ndash; off)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 48px;\"\u003e\n \u003cp\u003e11.87\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 120px;\"\u003e\n \u003cp\u003e+16.1 [6.8, 25.5]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 54px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 156px;\"\u003e\n \u003cp\u003e\u0026uarr; efficiency ON meds\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 144px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 120px;\"\u003e\n \u003cp\u003eDBS \u0026times; Medication\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 48px;\"\u003e\n \u003cp\u003e6.28\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 120px;\"\u003e\n \u003cp\u003e+23.2 [4.8, 41.7]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 54px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.014\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 156px;\"\u003e\n \u003cp\u003eGreater DBS effect OFF meds\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 144px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 120px;\"\u003e\n \u003cp\u003eDBS effect OFF meds\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 48px;\"\u003e\n \u003cp\u003e19.84\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 120px;\"\u003e\n \u003cp\u003e+35.8 [19.8, 51.8]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 54px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 156px;\"\u003e\n \u003cp\u003eLarge improvement\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 144px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 120px;\"\u003e\n \u003cp\u003eDBS effect ON meds\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 48px;\"\u003e\n \u003cp\u003e7.47\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 120px;\"\u003e\n \u003cp\u003e+12.6 [3.4, 21.7]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 54px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.008\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 156px;\"\u003e\n \u003cp\u003eModerate improvement\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eN2 Duration\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 120px;\"\u003e\n \u003cp\u003eDBS (post \u0026ndash; pre)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 48px;\"\u003e\n \u003cp\u003e17.19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 120px;\"\u003e\n \u003cp\u003e+81.9 [42.6, 121.2]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 54px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 156px;\"\u003e\n \u003cp\u003e\u0026uarr; N2 with DBS\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 120px;\"\u003e\n \u003cp\u003eMedication (on \u0026ndash; off)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 48px;\"\u003e\n \u003cp\u003e2.60\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 120px;\"\u003e\n \u003cp\u003e\u0026mdash;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 54px;\"\u003e\n \u003cp\u003e0.11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 156px;\"\u003e\n \u003cp\u003eNS\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 120px;\"\u003e\n \u003cp\u003eDBS \u0026times; Medication\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 48px;\"\u003e\n \u003cp\u003e8.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 120px;\"\u003e\n \u003cp\u003e+111.8 [33.2, 190.5]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 54px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.006\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 156px;\"\u003e\n \u003cp\u003eGreater DBS effect OFF meds\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 120px;\"\u003e\n \u003cp\u003eDBS effect OFF meds\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 48px;\"\u003e\n \u003cp\u003e16.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 120px;\"\u003e\n \u003cp\u003e+137.8 [69.4, 206.2]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 54px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 156px;\"\u003e\n \u003cp\u003eSignificant \u0026uarr; N2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 120px;\"\u003e\n \u003cp\u003eDBS effect ON meds\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 48px;\"\u003e\n \u003cp\u003e1.76\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 120px;\"\u003e\n \u003cp\u003e\u0026mdash;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 54px;\"\u003e\n \u003cp\u003e0.19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 156px;\"\u003e\n \u003cp\u003eNS\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eN3 Duration\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 120px;\"\u003e\n \u003cp\u003eDBS (post \u0026ndash; pre)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 48px;\"\u003e\n \u003cp\u003e13.74\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 120px;\"\u003e\n \u003cp\u003e+28.9 [13.4, 44.5]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 54px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 156px;\"\u003e\n \u003cp\u003e\u0026uarr; N3 with DBS\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 120px;\"\u003e\n \u003cp\u003eMedication (on \u0026ndash; off)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 48px;\"\u003e\n \u003cp\u003e6.50\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 120px;\"\u003e\n \u003cp\u003e+20.2 [4.4, 36.0]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 54px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.013\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 156px;\"\u003e\n \u003cp\u003e\u0026uarr; N3 ON meds\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 120px;\"\u003e\n \u003cp\u003eDBS \u0026times; Medication\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 48px;\"\u003e\n \u003cp\u003e1.42\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 120px;\"\u003e\n \u003cp\u003e\u0026mdash;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 54px;\"\u003e\n \u003cp\u003e0.24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 156px;\"\u003e\n \u003cp\u003eNS\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal NREM Duration\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 120px;\"\u003e\n \u003cp\u003eDBS (post \u0026ndash; pre)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 48px;\"\u003e\n \u003cp\u003e21.52\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 120px;\"\u003e\n \u003cp\u003e+116.2 [66.4, 166.0]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 54px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 156px;\"\u003e\n \u003cp\u003e\u0026uarr; NREM with DBS\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 120px;\"\u003e\n \u003cp\u003eMedication (on \u0026ndash; off)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 48px;\"\u003e\n \u003cp\u003e4.97\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 120px;\"\u003e\n \u003cp\u003e+56.2 [6.1, 106.3]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 54px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.029\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 156px;\"\u003e\n \u003cp\u003e\u0026uarr; NREM ON meds\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 120px;\"\u003e\n \u003cp\u003eDBS \u0026times; Medication\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 48px;\"\u003e\n \u003cp\u003e8.28\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 120px;\"\u003e\n \u003cp\u003e+144.3 [44.5, 244.1]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 54px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.005\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 156px;\"\u003e\n \u003cp\u003eGreater DBS effect OFF meds\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 120px;\"\u003e\n \u003cp\u003eDBS effect OFF meds\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 48px;\"\u003e\n \u003cp\u003e18.69\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 120px;\"\u003e\n \u003cp\u003e+188.3 [101.6, 275.1]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 54px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 156px;\"\u003e\n \u003cp\u003eSignificant \u0026uarr; NREM\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 120px;\"\u003e\n \u003cp\u003eDBS effect ON meds\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 48px;\"\u003e\n \u003cp\u003e3.16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 120px;\"\u003e\n \u003cp\u003e\u0026mdash;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 54px;\"\u003e\n \u003cp\u003e0.08\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 156px;\"\u003e\n \u003cp\u003eNS\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eNS = not significant.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 5.\u0026nbsp;\u003c/strong\u003eLinear mixed effects model results for the effect of DBS on spectral power across wakefulness, N2, N3, and REM sleep.\u0026nbsp;\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eSleep Stage\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eFrequency Band\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eDBS Effect (post\u0026ndash;pre) \u003cem\u003e\u0026beta;\u003c/em\u003e [95% CI]\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003ep\u003c/em\u003e\u003c/strong\u003e\u003cstrong\u003e-value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eDirection / Interpretation\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eWakefulness\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eDelta\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e+0.045 [0.016, 0.074]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e0.003\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026uarr; Delta power post DBS\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eTheta\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e+0.038 [0.009, 0.068]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e0.011\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026uarr; Theta power post DBS\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eBeta\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026minus;0.071 [\u0026minus;0.100, \u0026minus;0.041]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026darr; Beta power post DBS\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eGamma\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026minus;0.067 [\u0026minus;0.090, \u0026minus;0.031]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026darr; Gamma power post DBS\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eN2\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eAll bands\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026mdash;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026gt;0.05\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eNS\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eN3\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eAll bands\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026mdash;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026gt;0.05\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eNS\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eREM\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eAll bands\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026mdash;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026gt;0.05\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eNS\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eREM\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eSlow/fast frequencies ratio\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e+0.018 [0.005, 0.031]\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.013\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026uarr; Slow relative to fast activity post DBS\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eNS = not significant \u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 6.\u0026nbsp;\u003c/strong\u003eLinear mixed effects model results for the effect of DBS condition and medication state on sleep spindles and slow waves.\u0026nbsp;\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"648\" class=\"fr-table-selection-hover\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 90px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eOutcome\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 43px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSleep Stage\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 131px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFixed Effect\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 48px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eF\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 120px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003e\u0026beta;\u003c/em\u003e\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;[95% CI]\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003ep\u003c/em\u003e\u003c/strong\u003e\u003cstrong\u003e-value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 156px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDirection / Interpretation\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 90px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSlow Wave (SW) Density\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 43px;\"\u003e\n \u003cp\u003eN2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 131px;\"\u003e\n \u003cp\u003eDBS (post \u0026ndash; pre)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 48px;\"\u003e\n \u003cp\u003e8.41\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 120px;\"\u003e\n \u003cp\u003e+3.50 [1.10, 5.89]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.005\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 156px;\"\u003e\n \u003cp\u003e\u0026uarr; SW density after DBS\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 90px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 43px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 131px;\"\u003e\n \u003cp\u003eMedication (on \u0026ndash; off)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 48px;\"\u003e\n \u003cp\u003e4.16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 120px;\"\u003e\n \u003cp\u003e+2.52 [0.06, 4.98]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.045\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 156px;\"\u003e\n \u003cp\u003e\u0026uarr; SW density ON medication\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 90px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 43px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 131px;\"\u003e\n \u003cp\u003eDBS \u0026times; Medication\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 48px;\"\u003e\n \u003cp\u003e0.41\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 120px;\"\u003e\n \u003cp\u003e\u0026mdash;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e0.52\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 156px;\"\u003e\n \u003cp\u003eNS\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 90px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 43px;\"\u003e\n \u003cp\u003eN3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 131px;\"\u003e\n \u003cp\u003eDBS (post \u0026ndash; pre)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 48px;\"\u003e\n \u003cp\u003e0.56\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 120px;\"\u003e\n \u003cp\u003e\u0026mdash;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e0.46\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 156px;\"\u003e\n \u003cp\u003eNS\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 90px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 43px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 131px;\"\u003e\n \u003cp\u003eMedication (on \u0026ndash; off)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 48px;\"\u003e\n \u003cp\u003e0.75\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 120px;\"\u003e\n \u003cp\u003e\u0026mdash;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e0.39\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 156px;\"\u003e\n \u003cp\u003eNS\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 90px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 43px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 131px;\"\u003e\n \u003cp\u003eDBS \u0026times; Medication\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 48px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 120px;\"\u003e\n \u003cp\u003e\u0026mdash;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e0.99\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 156px;\"\u003e\n \u003cp\u003eNS\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 90px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSW Duration\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 43px;\"\u003e\n \u003cp\u003eN2\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 131px;\"\u003e\n \u003cp\u003eDBS (post \u0026ndash; pre)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 48px;\"\u003e\n \u003cp\u003e26.38\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 120px;\"\u003e\n \u003cp\u003e-0.019 [-0.027, -0.012]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 156px;\"\u003e\n \u003cp\u003e\u0026darr; SW duration after DBS\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 90px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 43px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 131px;\"\u003e\n \u003cp\u003eMedication (on \u0026ndash; off)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 48px;\"\u003e\n \u003cp\u003e3.15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 120px;\"\u003e\n \u003cp\u003e\u0026mdash;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e0.076\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 156px;\"\u003e\n \u003cp\u003eNS\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 90px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 43px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 131px;\"\u003e\n \u003cp\u003eDBS \u0026times; Medication\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 48px;\"\u003e\n \u003cp\u003e0.15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 120px;\"\u003e\n \u003cp\u003e\u0026mdash;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e0.70\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 156px;\"\u003e\n \u003cp\u003eNS\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 90px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 43px;\"\u003e\n \u003cp\u003eN3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 131px;\"\u003e\n \u003cp\u003eDBS (post \u0026ndash; pre)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 48px;\"\u003e\n \u003cp\u003e1.86\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 120px;\"\u003e\n \u003cp\u003e\u0026mdash;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e0.17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 156px;\"\u003e\n \u003cp\u003eNS\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 90px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 43px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 131px;\"\u003e\n \u003cp\u003eMedication (on \u0026ndash; off)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 48px;\"\u003e\n \u003cp\u003e0.97\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 120px;\"\u003e\n \u003cp\u003e\u0026mdash;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e0.33\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 156px;\"\u003e\n \u003cp\u003eNS\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 90px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 43px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 131px;\"\u003e\n \u003cp\u003eDBS \u0026times; Medication\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 48px;\"\u003e\n \u003cp\u003e0.49\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 120px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e0.49\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 156px;\"\u003e\n \u003cp\u003eNS\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 90px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSW Amplitude\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 43px;\"\u003e\n \u003cp\u003eN2\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 131px;\"\u003e\n \u003cp\u003eDBS (post \u0026ndash; pre)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 48px;\"\u003e\n \u003cp\u003e0.39\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 120px;\"\u003e\n \u003cp\u003e\u0026mdash;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e0.53\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 156px;\"\u003e\n \u003cp\u003eNS\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 90px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 43px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 131px;\"\u003e\n \u003cp\u003eMedication (on \u0026ndash; off)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 48px;\"\u003e\n \u003cp\u003e0.64\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 120px;\"\u003e\n \u003cp\u003e\u0026mdash;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e0.42\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 156px;\"\u003e\n \u003cp\u003eNS\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 90px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 43px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 131px;\"\u003e\n \u003cp\u003eDBS \u0026times; Medication\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 48px;\"\u003e\n \u003cp\u003e11.78\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 120px;\"\u003e\n \u003cp\u003e+25.41 [10.9, 39.91]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 156px;\"\u003e\n \u003cp\u003eDBS effect significant only ON medication\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 90px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 43px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 131px;\"\u003e\n \u003cp\u003eDBS Effect OFF Meds\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 48px;\"\u003e\n \u003cp\u003e2.27\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 120px;\"\u003e\n \u003cp\u003e\u0026mdash;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e0.13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 156px;\"\u003e\n \u003cp\u003eNS\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 90px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 43px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 131px;\"\u003e\n \u003cp\u003eDBS Effect ON Meds\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 48px;\"\u003e\n \u003cp\u003e32.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 120px;\"\u003e\n \u003cp\u003e+15.0 [9.83, 20.18]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 156px;\"\u003e\n \u003cp\u003e\u0026uarr; SW amplitude\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 90px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 43px;\"\u003e\n \u003cp\u003eN3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 131px;\"\u003e\n \u003cp\u003eDBS (post \u0026ndash; pre)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 48px;\"\u003e\n \u003cp\u003e0.16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 120px;\"\u003e\n \u003cp\u003e\u0026mdash;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e0.69\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 156px;\"\u003e\n \u003cp\u003eNS\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 90px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 43px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 131px;\"\u003e\n \u003cp\u003eMedication (on \u0026ndash; off)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 48px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 120px;\"\u003e\n \u003cp\u003e\u0026mdash;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e0.98\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 156px;\"\u003e\n \u003cp\u003eNS\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 90px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 43px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 131px;\"\u003e\n \u003cp\u003eDBS \u0026times; Medication\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 48px;\"\u003e\n \u003cp\u003e6.79\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 120px;\"\u003e\n \u003cp\u003e+62.62 [15.5. 109.7]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.009\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 156px;\"\u003e\n \u003cp\u003eDBS effect significant only ON medication\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 90px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 43px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 131px;\"\u003e\n \u003cp\u003eDBS Effect OFF Meds\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 48px;\"\u003e\n \u003cp\u003e2.33\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 120px;\"\u003e\n \u003cp\u003e\u0026mdash;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e0.13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 156px;\"\u003e\n \u003cp\u003eNS\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 90px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 43px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 131px;\"\u003e\n \u003cp\u003eDBS Effect ON Meds\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 48px;\"\u003e\n \u003cp\u003e33.10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 120px;\"\u003e\n \u003cp\u003e+26.6 [17.5, 35.6]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 156px;\"\u003e\n \u003cp\u003e\u0026uarr; SW amplitude\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 90px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSW Slope\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 43px;\"\u003e\n \u003cp\u003eN2\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 131px;\"\u003e\n \u003cp\u003eDBS (post \u0026ndash; pre)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 48px;\"\u003e\n \u003cp\u003e4.07\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 120px;\"\u003e\n \u003cp\u003e+17.14 [0.48, 33.8]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.044\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 156px;\"\u003e\n \u003cp\u003e\u0026uarr; SW slope after DBS\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 90px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 43px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 131px;\"\u003e\n \u003cp\u003eMedication (on \u0026ndash; off)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 48px;\"\u003e\n \u003cp\u003e0.26\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 120px;\"\u003e\n \u003cp\u003e\u0026mdash;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e0.61\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 156px;\"\u003e\n \u003cp\u003eNS\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 90px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 43px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 131px;\"\u003e\n \u003cp\u003eDBS \u0026times; Medication\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 48px;\"\u003e\n \u003cp\u003e10.79\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 120px;\"\u003e\n \u003cp\u003e+56.07 [22.61, 89.5]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 156px;\"\u003e\n \u003cp\u003eDBS effect significant only ON medication\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 90px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 43px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 131px;\"\u003e\n \u003cp\u003eDBS Effect OFF Meds\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 48px;\"\u003e\n \u003cp\u003e0.47\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 120px;\"\u003e\n \u003cp\u003e\u0026mdash;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e0.49\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 156px;\"\u003e\n \u003cp\u003eNS\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 90px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 43px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 131px;\"\u003e\n \u003cp\u003eDBS Effect ON Meds\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 48px;\"\u003e\n \u003cp\u003e55.01\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 120px;\"\u003e\n \u003cp\u003e+45.2 [33.2, 57.1]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 156px;\"\u003e\n \u003cp\u003e\u0026uarr; SW slope\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 90px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 43px;\"\u003e\n \u003cp\u003eN3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 131px;\"\u003e\n \u003cp\u003eDBS (post \u0026ndash; pre)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 48px;\"\u003e\n \u003cp\u003e0.06\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 120px;\"\u003e\n \u003cp\u003e\u0026mdash;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e0.80\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 156px;\"\u003e\n \u003cp\u003eNS\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 90px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 43px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 131px;\"\u003e\n \u003cp\u003eMedication (on \u0026ndash; off)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 48px;\"\u003e\n \u003cp\u003e0.46\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 120px;\"\u003e\n \u003cp\u003e\u0026mdash;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e0.50\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 156px;\"\u003e\n \u003cp\u003eNS\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 90px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 43px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 131px;\"\u003e\n \u003cp\u003eDBS \u0026times; Medication\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 48px;\"\u003e\n \u003cp\u003e4.51\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 120px;\"\u003e\n \u003cp\u003e+121.11 [9.30, 232.9]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.034\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 156px;\"\u003e\n \u003cp\u003eDBS effect significant only ON medication\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 90px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 43px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 131px;\"\u003e\n \u003cp\u003eDBS Effect OFF Meds\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 48px;\"\u003e\n \u003cp\u003e0.91\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 120px;\"\u003e\n \u003cp\u003e\u0026mdash;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e0.34\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 156px;\"\u003e\n \u003cp\u003eNS\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 90px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 43px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 131px;\"\u003e\n \u003cp\u003eDBS Effect ON Meds\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 48px;\"\u003e\n \u003cp\u003e38.19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 120px;\"\u003e\n \u003cp\u003e+67.8 [46.3, 89.3]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 156px;\"\u003e\n \u003cp\u003e\u0026uarr; SW slope\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 90px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSpindle (SP) Density\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 43px;\"\u003e\n \u003cp\u003eN2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 131px;\"\u003e\n \u003cp\u003eDBS (post \u0026ndash; pre)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 48px;\"\u003e\n \u003cp\u003e1.54\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 120px;\"\u003e\n \u003cp\u003e\u0026mdash;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e0.22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 156px;\"\u003e\n \u003cp\u003eNS\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 90px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 43px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 131px;\"\u003e\n \u003cp\u003eMedication (on \u0026ndash; off)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 48px;\"\u003e\n \u003cp\u003e0.08\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 120px;\"\u003e\n \u003cp\u003e\u0026mdash;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e0.78\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 156px;\"\u003e\n \u003cp\u003eNS\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 90px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 43px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 131px;\"\u003e\n \u003cp\u003eDBS \u0026times; Medication\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 48px;\"\u003e\n \u003cp\u003e0.15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 120px;\"\u003e\n \u003cp\u003e\u0026mdash;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e0.70\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 156px;\"\u003e\n \u003cp\u003eNS\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 90px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 43px;\"\u003e\n \u003cp\u003eN3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 131px;\"\u003e\n \u003cp\u003eDBS (post \u0026ndash; pre)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 48px;\"\u003e\n \u003cp\u003e2.51\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 120px;\"\u003e\n \u003cp\u003e\u0026mdash;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e0.12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 156px;\"\u003e\n \u003cp\u003eNS\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 90px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 43px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 131px;\"\u003e\n \u003cp\u003eMedication (on \u0026ndash; off)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 48px;\"\u003e\n \u003cp\u003e1.22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 120px;\"\u003e\n \u003cp\u003e\u0026mdash;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e0.27\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 156px;\"\u003e\n \u003cp\u003eNS\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 90px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 43px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 131px;\"\u003e\n \u003cp\u003eDBS \u0026times; Medication\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 48px;\"\u003e\n \u003cp\u003e0.59\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 120px;\"\u003e\n \u003cp\u003e\u0026mdash;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e0.45\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 156px;\"\u003e\n \u003cp\u003eNS\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 90px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSP Oscillation Frequency\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 43px;\"\u003e\n \u003cp\u003eN2\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 131px;\"\u003e\n \u003cp\u003eDBS (post \u0026ndash; pre)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 48px;\"\u003e\n \u003cp\u003e9.59\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 120px;\"\u003e\n \u003cp\u003e-0.048 [-0.080, -0.018\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.002\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 156px;\"\u003e\n \u003cp\u003e\u0026darr; SP frequency after DBS\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 90px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 43px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 131px;\"\u003e\n \u003cp\u003eMedication (on \u0026ndash; off)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 48px;\"\u003e\n \u003cp\u003e8.75\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 120px;\"\u003e\n \u003cp\u003e+0.048 [0.016, 0.080]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.003\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 156px;\"\u003e\n \u003cp\u003e\u0026uarr; SP frequency ON medication\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 90px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 43px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 131px;\"\u003e\n \u003cp\u003eDBS \u0026times; Medication\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 48px;\"\u003e\n \u003cp\u003e0.24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 120px;\"\u003e\n \u003cp\u003e\u0026mdash;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e0.63\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 156px;\"\u003e\n \u003cp\u003eNS\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 90px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 43px;\"\u003e\n \u003cp\u003eN3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 131px;\"\u003e\n \u003cp\u003eDBS (post \u0026ndash; pre)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 48px;\"\u003e\n \u003cp\u003e0.62\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 120px;\"\u003e\n \u003cp\u003e\u0026mdash;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e0.43\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 156px;\"\u003e\n \u003cp\u003eNS\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 90px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 43px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 131px;\"\u003e\n \u003cp\u003eMedication (on \u0026ndash; off)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 48px;\"\u003e\n \u003cp\u003e4.65\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 120px;\"\u003e\n \u003cp\u003e-0.047 [-0.091, -0.004]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.03\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 156px;\"\u003e\n \u003cp\u003e\u0026darr; SP frequency ON medication\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 90px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 43px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 131px;\"\u003e\n \u003cp\u003eDBS \u0026times; Medication\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 48px;\"\u003e\n \u003cp\u003e10.26\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 120px;\"\u003e\n \u003cp\u003e-0.134 [-0.216, -0.052]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 156px;\"\u003e\n \u003cp\u003eDBS effect larger off medication\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 90px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 43px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 131px;\"\u003e\n \u003cp\u003eDBS Effect OFF Meds\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 48px;\"\u003e\n \u003cp\u003e4.63\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 120px;\"\u003e\n \u003cp\u003e-0.084 [-0.161, -0.008]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.031\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 156px;\"\u003e\n \u003cp\u003e\u0026darr; SP frequency after DBS\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 90px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 43px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 131px;\"\u003e\n \u003cp\u003eDBS Effect ON Meds\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 48px;\"\u003e\n \u003cp\u003e8.92\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 120px;\"\u003e\n \u003cp\u003e+0.050 [0.018, 0.083]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.003\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 156px;\"\u003e\n \u003cp\u003e\u0026uarr; SP amplitude after DBS\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 90px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSP Amplitude\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 43px;\"\u003e\n \u003cp\u003eN2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 131px;\"\u003e\n \u003cp\u003eDBS (post \u0026ndash; pre)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 48px;\"\u003e\n \u003cp\u003e143.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 120px;\"\u003e\n \u003cp\u003e+20.99 [17.56, 24.43]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 156px;\"\u003e\n \u003cp\u003e\u0026uarr; SP amplitude after DBS\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 90px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 43px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 131px;\"\u003e\n \u003cp\u003eMedication (on \u0026ndash; off)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 48px;\"\u003e\n \u003cp\u003e17.36\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 120px;\"\u003e\n \u003cp\u003e-7.58 [-11.14, -4.01]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;\u003c/strong\u003e\u003cstrong\u003e0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 156px;\"\u003e\n \u003cp\u003e\u0026darr; SP amplitude ON medication\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 90px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 43px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 131px;\"\u003e\n \u003cp\u003eDBS \u0026times; Medication\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 48px;\"\u003e\n \u003cp\u003e4.73\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 120px;\"\u003e\n \u003cp\u003e+7.60 [0.75, 14.46]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.03\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 156px;\"\u003e\n \u003cp\u003eDBS effect larger off medication\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 90px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 43px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 131px;\"\u003e\n \u003cp\u003eDBS Effect OFF Meds\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 48px;\"\u003e\n \u003cp\u003e62.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 120px;\"\u003e\n \u003cp\u003e+24.8 [18.6, 31.0]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 156px;\"\u003e\n \u003cp\u003eLarger \u0026uarr; SP amplitude\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 90px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 43px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 131px;\"\u003e\n \u003cp\u003eDBS Effect ON Meds\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 48px;\"\u003e\n \u003cp\u003e126.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 120px;\"\u003e\n \u003cp\u003e+14.6 [14.2, 20.2]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 156px;\"\u003e\n \u003cp\u003eModerate \u0026uarr; SP amplitude\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 90px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 43px;\"\u003e\n \u003cp\u003eN3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 131px;\"\u003e\n \u003cp\u003eDBS (post \u0026ndash; pre)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 48px;\"\u003e\n \u003cp\u003e24.91\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 120px;\"\u003e\n \u003cp\u003e+13.1 [7.96, 18.27]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 156px;\"\u003e\n \u003cp\u003e\u0026uarr; SP amplitude after DBS\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 90px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 43px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 131px;\"\u003e\n \u003cp\u003eMedication (on \u0026ndash; off)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 48px;\"\u003e\n \u003cp\u003e13.83\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 120px;\"\u003e\n \u003cp\u003e-10.1 [-15.37, -4.76]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 156px;\"\u003e\n \u003cp\u003e\u0026darr; SP amplitude ON medication\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 90px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 43px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 131px;\"\u003e\n \u003cp\u003eDBS \u0026times; Medication\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 48px;\"\u003e\n \u003cp\u003e4.38\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 120px;\"\u003e\n \u003cp\u003e+10.7 [0.68, 20.73]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.04\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 156px;\"\u003e\n \u003cp\u003eDBS effect larger off medication\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 90px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 43px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 131px;\"\u003e\n \u003cp\u003eDBS Effect OFF Meds\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 48px;\"\u003e\n \u003cp\u003e15.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 120px;\"\u003e\n \u003cp\u003e+18.47 [9.17, 27.8]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 156px;\"\u003e\n \u003cp\u003eLarger \u0026uarr; SP amplitude\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 90px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 43px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 131px;\"\u003e\n \u003cp\u003eDBS Effect ON Meds\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 48px;\"\u003e\n \u003cp\u003e13.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 120px;\"\u003e\n \u003cp\u003e+7.76 [3.65, 11.9]\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 156px;\"\u003e\n \u003cp\u003eModerate \u0026uarr; SP amplitude\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eNS = not significant \u003cstrong\u003e\u003c/strong\u003e\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"npj-parkinsons-disease","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"npjparkd","sideBox":"Learn more about [npj Parkinson's Disease](http://www.nature.com/npjparkd/)","snPcode":"41531","submissionUrl":"https://submission.springernature.com/new-submission/41531/3","title":"npj Parkinson's Disease","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"NPJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"","lastPublishedDoi":"10.21203/rs.3.rs-8642012/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8642012/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eSleep disturbances are among the most common non-motor Parkinson\u0026rsquo;s disease (PD) symptoms. Deep brain stimulation (DBS) may improve sleep, though methodological inconsistencies in prior studies have produced inconsistent results. We sought to investigate the effect of DBS on sleep, including both sleep architecture and physiological features such as sleep spindles and slow waves. We prospectively enrolled PD patients undergoing DBS surgery and performed in-home sleep monitoring over multiple nights both pre-operatively and post-operatively. After DBS implantation, improvements were seen in several parameters, including both subjective measures (Parkinson Disease Sleep Scale, version 2) and objective measures (total sleep time, N2 duration, N3 duration, and sleep efficiency). Slow wave density and duration, as well as sleep spindle frequency and amplitude, were affected by DBS. This study provides the most comprehensive evaluation of the effect of DBS on sleep in PD, and the first to prospectively study the effect of DBS on sleep physiological features, including slow waves and sleep spindles.\u003c/p\u003e","manuscriptTitle":"Deep Brain Stimulation Alters Sleep Physiology and Architecture in Parkinson’s Disease: A Prospective, Multi-Night, Naturalistic Polysomnography Study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-02-09 16:39:50","doi":"10.21203/rs.3.rs-8642012/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2026-04-14T17:23:31+00:00","index":"","fulltext":""},{"type":"reviewerAgreed","content":"256211555059217941874093028922888790686","date":"2026-04-14T01:19:02+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-04-10T23:40:08+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"44287408964131149088218156729618369303","date":"2026-04-10T12:55:19+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-02-22T03:42:04+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"316082646135464794500854520623810748825","date":"2026-02-18T23:42:40+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"206211414629607184343431777278314258270","date":"2026-02-06T00:39:00+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-02-04T18:41:40+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-01-24T15:20:53+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-01-24T07:41:45+00:00","index":"","fulltext":""},{"type":"submitted","content":"npj Parkinson's Disease","date":"2026-01-19T17:20:22+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"npj-parkinsons-disease","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"npjparkd","sideBox":"Learn more about [npj Parkinson's Disease](http://www.nature.com/npjparkd/)","snPcode":"41531","submissionUrl":"https://submission.springernature.com/new-submission/41531/3","title":"npj Parkinson's Disease","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"NPJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"9fb8d193-a2d3-4730-bebd-11731abb4b8e","owner":[],"postedDate":"February 9th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"in-revision","subjectAreas":[{"id":62415866,"name":"Health sciences/Neurology"},{"id":62415867,"name":"Biological sciences/Neuroscience"}],"tags":[],"updatedAt":"2026-04-14T17:38:47+00:00","versionOfRecord":[],"versionCreatedAt":"2026-02-09 16:39:50","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8642012","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8642012","identity":"rs-8642012","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}