Wearable Evidence Linking Dyskinesia Burden to Sleep Quality in Parkinson Disease

Background Sleep disturbances affect up to 60-80% of people with Parkinsons disease (PD) and are associated with worse clinical outcomes and reduced quality of life. Dyskinesia is a common motor complication of dopaminergic therapy, but its relationship with sleep quality remains incompletely defined. Methods Forty-seven people with PD (median age 68 years; 44.7% female; median disease duration 5 years; 38.3% from non-White ethnic background) were assessed for sleep quality on Pittsburgh Sleep Quality Index (PSQI). Dyskinesia was assessed using Movement Disorder Society-Unified Parkinsons Disease Rating Scale (MDS-UPDRS) Part IV items 4.1 and 4.2, and 7-day wearable monitoring with the Parkinsons KinetiGraph (PKG) to derive median dyskinesia score (DK_50) and fluctuation dyskinesia score (FDS). All analyses were conducted using multivariate regression. Associations with sleep quality were adjusted for age, sex, and disease severity (MDS-UPDRS Part III) in Model A; additionally for levodopa equivalent daily dose (LEDD) in Model B; and further for disease duration in Model C. Results In Model A, all four dyskinesia measures were significantly associated with sleep quality. After adjusting for LEDD in Model B, only DK_50 remained a significant predictor of worse sleep (B=0.18, 95CI: 0.003-0.357, P=0.047). With additional adjustment for disease duration in Model C, the association for DK_50 was attenuated (B=0.18, 95%CI: -0.001 to 0.356, P=0.051). Conclusions Wearable-derived continuous dyskinesia burden was independently associated with worse sleep quality, whereas clinician-rated dyskinesia was not, highlighting the added clinical value of objective motor monitoring in PD. Disease duration may partly confound this relationship. Larger prospective studies are warranted.