1373 Deep Brain Stimulation Artifacts

Abstract Introduction Sleep concerns are common in patients with Parkinson’s disease including insomnia, sleep fragmentation, daytime sleepiness, nightmares, periodic limb movements of sleep, and rapid eye movement (REM) sleep behavior disorder (1). Currently, Parkinson’s medications can manage early motor symptoms, but an alternative treatment such as deep brain stimulation (DBS) is needed for more progressive motor symptoms (1). DBS is continuously activated throughout the night and has been shown to improve subjective sleep quality, increase total sleep time, and sleep efficiency in Parkinson’s disease (1). However, the high frequency stimulation pulses from DBS in the brain can cause artifacts during polysomnography and even limit accurate sleep staging (2). Report of case(s) A 66 year-old man with a history of tremor-dominant Parkinson’s disease (diagnosed in 1999) complicated by REM sleep behavior disorder status post bilateral subthalamic nucleus deep brain stimulator (5/2018) for motor fluctuations and dyskinesias presented to sleep clinic with daytime fatigue, daytime sleepiness, and snoring. He was taking carbidopa/levodopa 25/100 mg four times per day. He was previously on melatonin, but this caused vivid dreams and ropinirole was associated with impulsive behavior. He was evaluated for obstructive sleep apnea with an in-lab polysomnography. Polysomnography did not demonstrate obstructive sleep apnea with an apnea-hypopnea index of 3.7 events an hour, but REM sleep without atonia and DBS artifacts were seen. His DBS was set to 200 Hz and can be seen as a narrow band of periodic artifacts in the electroencephalogram. Options to reduce DBS artifact include matched filtering and frequency-domain Hampel filtering as well as turning off the DBS, but this can cause increased tremor artifacts instead. Another option would be to switch the DBS to bipolar option to reduce interference (3). Patient denied recent nighttime movements or injuries and given a history of vivid dreams with melatonin, he was instructed on bed safety and monitoring of symptoms before a re-trial of melatonin. Conclusion It is important to understand polysomnography artifacts from patient-related electrical devices for an accurate sleep disorder diagnosis. Specifically with Parkinson’s disease as these patients have an increased frequency of sleep related disorders. Support (if any)