# Improved sleep quality is independently associated with decision-making recovery in panic disorder: a longitudinal study

## TL;DR

Better sleep quality is linked to improved decision-making in people with panic disorder, suggesting sleep should be a focus in treatment.

## Contribution

This study shows improved sleep quality independently predicts better decision-making recovery in panic disorder patients.

## Key findings

- Panic disorder patients had worse sleep quality and cognitive performance than healthy controls.
- Improvements in sleep quality were independently associated with better decision-making performance.
- Executive function improvements were not significantly linked to sleep quality changes.

## Abstract

Cognitive impairments are frequently observed in patients with panic disorder (PD), yet the relationship between sleep quality and cognitive recovery remains underexplored. This study investigated whether improvements in sleep quality during routine psychiatric care are prospectively associated with changes in decision-making in PD. Eighty-one patients with PD and 81 healthy controls were assessed using standardized clinical and cognitive measures, including the Pittsburgh Sleep Quality Index and Iowa Gambling Task. After three months of naturalistic follow-up, 38 patients were reassessed. Patients with PD initially exhibited significantly poorer sleep quality, more severe symptoms, and greater cognitive impairment than controls. Over the follow-up period, both clinical symptoms and sleep quality improved. Notably, improvements in sleep quality were independently associated with better performance on the Iowa Gambling Task, suggesting a relationship with decision-making performance. Changes in executive function showed only a non-significant trend in relation to sleep improvement. These findings suggest that improved sleep quality is independently associated with cognitive improvements, particularly decision-making, in PD. Addressing sleep disturbances in clinical care may be crucial for optimizing cognitive outcomes in patients with panic disorder.

The online version contains supplementary material available at 10.1038/s41598-026-37946-5.