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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.<\/jats:p>","DOI":"10.1038\/s41598-026-37946-5","type":"journal-article","created":{"date-parts":[[2026,2,4]],"date-time":"2026-02-04T06:06:44Z","timestamp":1770185204000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Improved sleep quality is independently associated with decision-making recovery in panic disorder: a longitudinal study"],"prefix":"10.1038","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0009-0002-4653-0114","authenticated-orcid":false,"given":"Hediye Hilal","family":"Okucu","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5889-691X","authenticated-orcid":false,"given":"Deniz","family":"Al\u00e7\u0131","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2026,2,4]]},"reference":[{"key":"37946_CR1","doi-asserted-by":"publisher","first-page":"103936","DOI":"10.1016\/j.nsa.2024.103936","volume":"3","author":"L Palagini","year":"2024","unstructured":"Palagini, L. et al. 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