The Relationship Between Sleep Disturbance And Freezing Of Gait In Parkinson’s Disease

Objective To analyze clinical characteristics of freezing of gait.To investigate the association of sleep disturbance with freezing of gait in PD and conduct a predictive model of developing freezing of gait.Methods Totally 163 participants with PD were assessed at cross-sectional study.They were continuously recruited from the Department of Neurology,Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine between August 2017-September 2019.All patients were divided into two groups(freezers and nonfreezers)to analyze clinical characteristics of freezing of gait.18-month follow-up was conducted among 52 patients who were willing to complete further study.Using sleep disorder as the exposure factor and development freezing of gait as the terminate event to explore the effect of sleep disturbance in PD.Then Cox proportional hazards regression model was used to estimate the hazard ratios(HRs)and 95% CIs for developing FOG,a Forward Stepwise(Likelihood Ratio)binary logistic regression model was used to conduct predictive model of developing freezing of gait.Results The 163 participants included 89 men(55%)with a mean(SD)age of67.8(7.2)years,totally contained 64(39%)freezers.Freezers had longer disease duration,higher motor symptoms scores,higher nonmotor symptoms scores and higher sleep disturbance scores compared to nonfreezers.These all were statically difference.The 52 participants included 30 men(58%)with a mean(SD)age of 67.13(5.89)years,totally contained 18(35%)freezers.More patients had developed FOG in group of sleep disturbance compared to control group(p=.008).PDSS1(HR=4.23,95%CI 1.64-10.92,P=.003)and LEDD(HR=4.18,95%CI 1.62-10.75,P=.003)were independent risk factor of developing freezing of gait.A logistic regression model that could classify with the percentage accuracy of 76.9% of developing freezing of gait.Conclusions The results indicate that sleep disturbance not only promotes the development of freezing of gait,but also shorts the onset time of FOG.It is possible that identify the majority of PD patients that will develop freezing of gait with this model,allowing targeted interventions to delay the onset of freezing of gait.