Investigating Sleep Concerns in Cervical Dystonia

Background Heterogenous, small cohorts, and co‐occurrence of pain and psychiatric burden complicate understanding of sleep in dystonia. Objective To investigate sleep concerns in cervical dystonia (CD). Methods Longitudinal data from CD‐PROBE on subjects who were toxin‐naïve, new to practice, or without injections for at least 16 weeks were analyzed. Cervical Dystonia Impact Profile captured sleep disturbances. Impact of OnabotulinumtoxinA on sleep was assessed using multilevel mixed models, controlling for demographics, dystonia severity, mood, and pain. Results 56% (n = 1037) reported concerns with sleep initiation, restfulness, maintenance, and total time. Initial injection led to a clear improvement in sleep. ( P < 0.001) Motor severity (β: 0.20, P < 0.001), mood (β: 0.36, P < 0.001), and pain (β: 0.58, P < 0.001) predicted sleep improvement (n = 502) over three OnabotulinumtoxinA cycles. Conclusions Sleep concerns are common in CD, with initial and subsequent improvement with OnabotulinumtoxinA. Impact of mood and pain on sleep highlights the importance of non‐motor features.