Improved sleep quality is independently associated with better decision-making performance in panic disorder patients over a three-month naturalistic follow-up, suggesting that addressing sleep disturbances in clinical care may be crucial for optimizing cognitive outcomes.
Key Findings
Results
Patients with panic disorder exhibited significantly poorer sleep quality, more severe symptoms, and greater cognitive impairment than healthy controls at baseline.
Sample consisted of 81 patients with PD and 81 healthy controls assessed at baseline
Assessments included the Pittsburgh Sleep Quality Index (PSQI) for sleep quality
Cognitive assessment included the Iowa Gambling Task (IGT) to measure decision-making
Standardized clinical and cognitive measures were used for all comparisons
Results
Over three months of naturalistic follow-up, both clinical symptoms and sleep quality improved in patients with panic disorder.
38 of the original 81 patients were reassessed at the three-month follow-up
Follow-up was described as 'naturalistic,' reflecting routine psychiatric care rather than a controlled intervention
Both sleep quality and clinical symptom severity showed improvement over the follow-up period
Results
Improvements in sleep quality were independently associated with better performance on the Iowa Gambling Task, indicating a relationship with decision-making recovery.
The association between sleep quality improvement and Iowa Gambling Task performance was described as independent, suggesting it held after accounting for other variables
The Iowa Gambling Task was used as the primary measure of decision-making
This finding was the primary result highlighted in the study
Results
Changes in executive function showed only a non-significant trend in relation to sleep quality improvement.
Executive function was assessed alongside decision-making as a cognitive outcome
The relationship between sleep improvement and executive function did not reach statistical significance
This contrasts with the significant association found for decision-making specifically
Methods
The study design was a longitudinal, naturalistic follow-up over three months using standardized measures.
Pittsburgh Sleep Quality Index was used to measure sleep quality
Iowa Gambling Task was used to assess decision-making
The naturalistic design reflects real-world psychiatric care conditions rather than a randomized controlled trial
Attrition was notable, with only 38 of 81 patients completing follow-up assessment
What This Means
This research suggests that people with panic disorder not only struggle with anxiety symptoms but also experience measurable problems with sleep and decision-making compared to people without the disorder. The researchers followed a group of panic disorder patients receiving routine psychiatric care over three months and found that both sleep quality and symptoms tended to improve during that time. Importantly, patients whose sleep improved the most also showed the greatest recovery in their ability to make good decisions, as measured by a standardized cognitive test called the Iowa Gambling Task.
The study found this link between sleep improvement and better decision-making was independent of other factors, meaning it wasn't simply explained by overall symptom improvement alone. By contrast, another type of cognitive skill — executive function — showed only a weak, non-significant trend in relation to sleep improvement, suggesting that decision-making may be particularly sensitive to changes in sleep quality.
This research suggests that sleep problems in panic disorder are not just a side effect to manage separately, but may be directly connected to how well patients recover their cognitive abilities during treatment. Clinicians treating panic disorder might benefit from paying close attention to sleep quality as part of a comprehensive care approach, as improving sleep could play a meaningful role in helping patients regain normal thinking and decision-making abilities.
Okucu H, Alçı D. (2026). Improved sleep quality is independently associated with decision-making recovery in panic disorder: a longitudinal study.. Scientific reports. https://doi.org/10.1038/s41598-026-37946-5