Excessive daytime sleepiness in cervical dystonia

Few investigations have examined sleep in cervical dystonia (CD) patients. We assessed 43 consecutive CD patients, 19 patients with other focal movement disorders, and 49 healthy, age- and gender-matched controls for the presence of excessive daytime sleepiness (as measured by the Epworth Sleepiness Scale, ESS). All patients were receiving botulinum toxin. We found that a higher percentage of CD patients had abnormal ESS scores of >11 than did either of the two control groups (21% vs. 0% vs. 4%, p < 0.05 for each pairwise comparison with the CD group). Use of anticholinergic medications accounted for some but not all of this increase in sleepiness in the CD group. Age, gender, race, scores on the Toronto Western Spasmodic Torticollis Rating Scale (TWSTRS) or its subscores (severity, disability, and pain), and other common medication use (benzodiazepines, antidepressants) were not associated with increased ESS scores. This preliminary finding of excessive daytime sleepiness in a substantial portion of CD patients suggests that further investigation into disordered sleep in CD is warranted.