Poor sleep quality among patients with Parkinson's disease: a meta-analysis and systematic review Running head: poor sleep quality among patients with Parkinson's disease

Tong Leong Si^1*Yue-Ying Wang²Jia-Xin Li³Wei Bai⁴He-Li Sun²Shu-Ying Rao²Han-Yu Zhu⁵Gabor Ungvari⁶Zhaohui Su⁷Teris Cheung⁸Chee H Ng⁹Yu-Tao Xiang¹⁰Gang Wang¹¹

• ¹Macao Observatory for Social Development, University of Saint Joseph, Rua de Londres, Macao, SAR China
• ²Unit of Psychiatry, Department of Public Health and Medicinal Administration, & Institute of Translational Medicine, Faculty of Health Sciences, University of Macau, Taipa, Macau Region, China
• ³Centre for Cognitive and Brain Sciences, University of Macau, Taipa, Macau Region, China
• ⁴Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, Changchun, Hebei Province, China
• ⁵Unit of Psychiatry, Department of Public Health and Medicinal Administ, University of Macau, Taipa, Macau Region, China
• ⁶Section of Psychiatry, University of Notre Dame Australia, Fremantle, Australia
• ⁷School of Public Health, Southeast University, Nanjing, Jiangsu Province, China
• ⁸School of Nursing, Hong Kong Polytechnic University, Kowloon, Hong Kong, SAR China
• ⁹Department of Psychiatry, The Melbourne Clinic and St Vincent's Hospital, The University of Melbourne, Parkville, Victoria, Australia
• ¹⁰Unit of Psychiatry, Department of Public Health and Medicinal Administration, & Institute of Translational Medicine, Faculty of Health Sciences,, University of Macau, Taipa, Macau Region, China
• ¹¹Beijing Key Laboratory of Mental Disorders, National Clinical Research Center for Mental Disorders & National Center for Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, Beijing Municipality, China

Objective: Poor sleep quality is common among patients with Parkinson's disease (PD), although the reported prevalence rates vary between studies. This meta-analysis examined the overall prevalence of poor sleep quality in patients with PD and identified potential factors contributing to the differences in prevalence across studies. Methods: Both PRISMA and MOOSE guidelines were applied in this meta-analysis. A systematic search was conducted in PubMed, EMBASE, PsycINFO, Web of Science, CNKI and Wangfang from their inception to November 4, 2023. Studies were selected based on predefined PICOS criteria (i.e., PD patients, prevalence of poor sleep quality, cross-sectional/cohort designs). Study quality/risk of bias was assessed using a standardized 8-item tool. Pooled prevalence was calculated using a random-effects model and sources of heterogeneity (e.g., age, sex, depression, anxiety, cognition scores, disease severity, and medication dose) were explored via subgroup and meta-regression analyses. A random-effects model was utilized to calculate the overall prevalence and corresponding 95% confidence intervals (CIs).Results: In total, 63 studies involving 9,382 PD patients were included. The overall prevalence of poor sleep quality was 58.07% (95% CI: 54.26–61.88%). Higher rates were related to various factors including studies from Europe & Central Asia, lower-middle-income countries, mixed patient sources, lower diagnostic cutoffs, and Movement Disorder Society PD criteria. Meta-regression analysis showed that late onset PD was associated with poorer sleep quality in patients with PD. Conclusion: Poor sleep quality is common in PD patients. Regular monitoring of sleep quality and promotion of sleep hygiene should be prioritized in the management of patients with PD. Additionally, further research on sleep and PD is warranted in low- and middle-income countries to ensure the applicability of findings across diverse populations.