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Volume 15 No. 09
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Accepted Papers

Scientific Investigations

Presleep Cognitive Arousal and Insomnia Comorbid to Parkinson Disease: Evidence for a Serial Mediation Model of Sleep-Related Safety Behaviors and Dysfunctional Beliefs About Sleep

Cindy Lebrun, MS1; Marie-Christine Gély-Nargeot, PhD1; Khaalid Hassan Maudarbocus, MS1; Alexia Rossignol, MS2; Christian Geny, MD2; Sophie Bayard, PhD1
1Univ Paul Valéry Montpellier 3, Univ Montpellier, Montpellier, France; 2Centre Expert Maladie de Parkinson, Service de Neurologie, Hôpital Gui de Chauliac, Montpellier, France

Study Objectives:

Insomnia disorder (ID) is highly associated with Parkinson disease (PD) with great negative effect on health-related quality of life. Nonetheless, the relevance of psychological processes involved in the maintenance of insomnia is yet to be established in the context of this neurological condition. Our aim was to examine a serial meditation model of sleep-related safety behaviors and dysfunctional beliefs about sleep in association with presleep cognitive arousal and ID in patients with PD.


A total of 68 patients with PD completed self-report measures including the Sleep-Related Behaviors Questionnaire (SRBQ-20), Dysfunctional Beliefs and Attitudes about Sleep (DBAS-16), and the cognitive subscale of the Presleep Arousal Scale (PSAS-C). ID was assessed according to Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition criteria. Bootstrapped serial mediation analyses were conducted to test indirect effects.


Overall, 55.6% of patients with PD met diagnostic criteria for ID. The association between presleep cognitive arousal (PSAS-C) and ID was serially mediated by sleep-related safety behaviors (SRBQ-20) and strong endorsement of dysfunctional beliefs about sleep (DBAS-16) (bias-corrected 95% confidence interval for the indirect effect = 0.013, 0.093). An alternate serial mediation model in which dysfunctional beliefs about sleep precede sleep-related safety behaviors was not statistically significant (bias-corrected 95% confidence interval for the indirect effect = −0.001, 0.046).


ID comorbid to PD is associated with the classic psychological factors perpetuating ID in neurological disease-free individuals with insomnia. Target-oriented interventions for instance cognitive behavioral therapy for chronic insomnia should be considered as a treatment approach for ID comorbid to PD.


Lebrun C, Gély-Nargeot M-C, Maudarbocus KH, Rossignol A, Geny C, Bayard S. Presleep cognitive arousal and insomnia comorbid to parkinson disease: evidence for a serial mediation model of sleep-related safety behaviors and dysfunctional beliefs about sleep. J Clin Sleep Med. 2019;15(9):1217–1224.

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