This polysomnography study shows that ORP measures of sleep depth—particularly the overnight change in ORP (ORPdiff)—differ between PD and OSA groups and that smaller ORPdiff (less restorative sleep) is associated with worse cognition and greater non-motor symptoms in Parkinson's disease.

Suggests ORP-derived sleep-depth metrics could serve as objective biomarkers of cognitive vulnerability and non-motor burden in PD and highlights sleep restoration as a potentially modifiable target for therapeutic strategies, although causal mechanisms and intervention data are lacking.

BACKGROUND: Obstructive sleep apnea (OSA) is linked to cognitive dysfunction in Parkinson's disease (PD) and the general population. Sleep depth, measured by Odds Ratio Product (ORP), may offer novel insights into this relationship. We characterized sleep depth across PD and OSA groups and examined associations with cognitive function. METHODS: We analyzed polysomnography and Montreal Cognitive Assessment (MoCA) data from individuals with PD (n = 217) and controls (n = 633). Participants were grouped as: PD+OSA+, PD+OSA-, PD-OSA+, PD-OSA-. ORP metrics included: ORPTRT (average across total recording time), ORPN2, ORPNREM and ORPREM (during sleep stages), ORP-9 (post-arousal), ORPdiff (difference beginning to end of sleep), ORPWAKE (during wake epochs), and ORPicc (interhemispheric coherence). Linear and LASSO regression assessed associations with MoCA. Exploratory analyses examined associations with PD symptoms. RESULTS: ORPTRT was higher in PD groups and in PD-OSA+ vs. PD-OSA-. ORPN2, ORPREM, and ORP-9 were lowest in PD-OSA-. ORPdiff was highest in PD-OSA- and lowest in PD+OSA+. ORPREM, ORPWAKE, and ORPdiff were associated with MoCA in the whole sample. Subgroup analyses identified an association between ORPdiff and MoCA in PD only, with a significant interaction between ORPdiff and PD. ORPdiff was also inversely associated with PD non-motor symptoms. CONCLUSION: Both PD and OSA affect sleep depth, with PD exerting a greater impact. Specific sleep depth measures are associated with cognitive function. Non-restorative sleep (lower ORP difference across the night) relates to cognitive function in PD only, and to greater non-motor PD symptoms. ORP may help distinguish PD- from OSA-related sleep changes, and impact on cognitive vulnerability.