The association of sleep quality with decision making and executive functi̇ons in patients with panic disorder followed for three months

Aim: The aim of our study is to evaluate the relationship between sleep quality disorders and cognitive dysfunctions accompanying panic disorder (PD). Additionally, we aim to investigate whether cognitive dysfunction persists despite the symptomatic improvement of panic attacks after treatment and to assess the impact of improvements in sleep quality on the recovery of cognitive functions. Method: The study included 81 volunteer patients diagnosed with PD who met the inclusion criteria and 81 healthy volunteers matched with the patient group in terms of age, gender, and educational level. At the initial assessments, Sociodemographic Data Form, Pittsburgh Sleep Quality Index (PSQI), Panic Disorder Severity Scale (PDSS), Montgomery-Asberg Depression Rating Scale (MADRS), Wisconsin Card Sorting Test (WCST), and Iowa Gambling Task (IGT) were administered to the patients. During the three-month psychiatric treatment and follow-up period, 43 patients dropped out due to various reasons. As a result, 38 patients continued the treatment and follow-up, and PSQI, PDSS, MADRS, WCST, and IGT were re-administered to these patients. Results: Correlation analyses revealed a positive relationship between PSQI and MADRS scores as well as between MADRS and PDSS scores (p<0.001). In the WCST, the total number of correct responses increased, while the total number of errors and perseverative error rates significantly decreased after treatment (p<0.001). IGT scores also showed improvement after treatment. The analysis indicated that a one-point reduction in PSQI scores corresponded to a 0.156-point increase in IGT scores (p=0.013). Conclusion: The study found that the severity of panic disorder negatively affects cognitive functions. Additionally, poor sleep quality was observed to increase depression severity, which in turn elevated the severity of panic disorder. The findings suggest a reciprocal interaction between depression severity and panic disorder severity, indicating a close relationship between the two conditions. Post-treatment evaluations demonstrated that improvements in sleep quality positively influenced decision-making abilities and highlighted the critical role of managing sleep disorders and co-occurring depression in the treatment of panic disorder. Furthermore, the GEE analysis revealed that the significant effect of sleep quality on IGT scores was independent of other variables. This finding emphasizes that sleep management not only improves general mental health but also plays a fundamental role in cognitive functions and decision-making processes. This study underscores the importance of incorporating sleep management and depression treatment into PD treatment plans and serves as a guide for future research and clinical interventions. Keywords: Cognitive functions, Depression, Decision-making, Panic disorder, Sleep quality