Hengzhang Ma, Zhixiong Zheng, Caihua Chen, Mingyuan Xu, Qiaohui Zhu, Shenkun He
Background Orthostatic hypotension (OH) is common in Parkinson’s disease (PD), but what is known of its clinical associations comes from ambulatory or population-based cohorts assessed under protocolised or tilt-table conditions. The patients whom a routine bedside screen identifies on a general ward have not been described. Objective To characterise the modified Hoehn–Yahr (H–Y) stage distribution of hospitalized PD patients with a positive bedside OH screen, and to describe how clinical burden is distributed across stage within that group. Methods Retrospective cross-sectional analysis of 125 consecutive adults admitted to a Chinese tertiary neurology department (January 2021 to March 2025) with idiopathic PD and a positive bedside OH screen, defined as a fall of ≥20 mmHg systolic or ≥10 mmHg diastolic at 1 or at 3 min upright. No OH-negative comparator was available. The primary outcome was the H–Y stage distribution; secondary outcomes were motor severity (MDS-UPDRS Part III), motor complications, fracture history, physician-documented sleep disturbance and length of stay. Stage groups were compared using rank-based tests with effect sizes, with multivariable and Firth penalized logistic regression for the two principal binary outcomes. Results Screen-positive inpatients spanned the whole H–Y spectrum: 42.4% (95% CI 34.1–51.2) were at H–Y 1.0–2.0, before postural instability. One third (33.6%, 95% CI 25.9–42.3) met the criterion at 1 min only and would not have been detected by a 3-min-only rule. Motor severity rose steeply across stage (median MDS-UPDRS Part III 18, 35 and 62.5; ε 2 = 0.65), as did motor complications ( ε 2 = 0.52), fracture history (5.3%, 37.9%, 30.0%) and length of stay ( ε 2 = 0.10). Physician-documented sleep disturbance instead peaked at the middle stage (30.3%, 58.6%, 45.0%), persisting after adjustment (odds ratio 2.44, 95% CI 1.01–5.92). Conclusion A bedside OH screen identifies a clinically heterogeneous inpatient group that is not confined to advanced disease, and a third of it is detectable only at 1 min. Because all participants were screen-positive, these comparisons describe that group and cannot establish that the screening result marks burden independently of stage.