CLINICAL FEATURES AND UNDERLYING FACTORS OF INSOMNIA IN PATIENTS WITH NEUROLOGICAL DISORDERS

Аннотация

Insomnia is a common yet often underdiagnosed condition among patients with neurological disorders, significantly affecting their overall quality of life and disease progression. This study aimed to evaluate the clinical presentation, underlying causes, and management outcomes of insomnia across different neurological conditions, including Parkinson’s disease, epilepsy, multiple sclerosis, and post-stroke states. Eighty patients aged 25 to 55 were clinically assessed using the Insomnia Severity Index (ISI), structured interviews, and, for a subset, overnight polysomnography. Participants were divided into four diagnostic groups to analyze the prevalence and severity of insomnia symptoms, contributing factors such as medication side effects, anxiety, neuropathic pain, and seizure activity. The findings revealed that sleep disturbances were widespread, with significant intergroup variations. Polysomnography confirmed substantial alterations in sleep architecture. Among the therapeutic interventions, cognitive behavioral therapy (CBT) proved to be the most effective. The study highlights the importance of comprehensive and tailored approaches to insomnia management in neurological patients, underscoring the need for integrated neurological and psychological care. Keywords: insomnia, neurological disorders, sleep disturbance, ISI, polysomnography, Parkinson’s disease, epilepsy, multiple sclerosis, stroke, cognitive behavioral therapy Introduction Insomnia is a prevalent and often debilitating condition that significantly impairs the quality of life, especially among individuals with neurological disorders. The bidirectional relationship between sleep disturbances and neurological diseases has been well documented, with insomnia not only exacerbating the symptoms of the underlying condition but also acting as a potential risk factor for disease progression. Sleep disturbances are commonly reported in disorders such as Parkinson's disease, multiple sclerosis, epilepsy, and cerebrovascular diseases. Despite increasing recognition of the impact of insomnia in neurology, there remains a need for comprehensive clinical evaluation of its manifestation and contributing factors. This study aims to assess the clinical presentation of insomnia and identify its underlying causes in patients with various neurological disorders. Materials and Methods This clinical study was carried out over a six-month period in three tertiary-level neurology centers. A total of 80 patients, aged between 25 https://scientific-jl.com/new 55 22 Volume–82_Issue-1_August-2025 JOURNAL OF NEW CENTURY INNOVATIONS and 55 years, who had confirmed diagnoses of neurological disorders and reported symptoms consistent with chronic insomnia, were recruited for this investigation. The inclusion criteria consisted of patients with at least three months of sleep-related complaints such as difficulty falling asleep, frequent night awakenings, or early morning awakenings, coupled with daytime impairment. Patients with psychiatric disorders unrelated to the neurological condition, acute illnesses, or recent use of sleep- altering substances were excluded. Each participant underwent a comprehensive neurological evaluation followed by a structured clinical interview designed to gather demographic information, sleep history, psychological symptoms (e.g., anxiety and depression), medication intake, and lifestyle habits (including caffeine consumption and physical activity). To assess the severity of insomnia, the Insomnia Severity Index (ISI) questionnaire was administered. Based on their neurological diagnoses, participants were divided into four groups: Group I – Parkinson’s disease (n = 20), Group II – Epilepsy (n = 20), Group III – Multiple sclerosis (n = 20), and Group IV – Post-stroke patients (n = 20). To further investigate physiological sleep parameters, 30% of patients in each group were randomly selected to undergo overnight polysomnography in sleep laboratories equipped for neurological monitoring. This allowed the objective evaluation of total sleep time, sleep efficiency, sleep onset latency, and REM sleep percentages. Data were processed using SPSS software, and statistical significance was assessed using ANOVA and chi-square tests. Ethical approval was obtained from the institutional ethics committees, and all participants provided informed consent. Results The analysis of clinical and instrumental data provided a detailed picture of how insomnia presents and evolves in the context of different neurological conditions. The primary aim of the study was to delineate the frequency, severity, and causes of insomnia across neurological subtypes to guide appropriate interventions. All participants reported symptoms of insomnia, with varying degrees of severity. ISI scoring categorized the majority of patients as having moderate to severe insomnia. Table 1 illustrates the prevalence of specific insomnia symptoms (difficulty initiating sleep, nighttime awak