High rates of fatigue and sleep disturbances in dystonia.
BACKGROUND
Nonmotor symptoms in dystonia are increasingly recognized to impair the quality of life. The primary objective of this study was to determine the prevalence of fatigue and sleep disturbances in dystonia and to ascertain their impact on quality of life using standardized questionnaires.


METHODS
Dystonia patients presenting to a Botulinum toxin clinic were prospectively administered Fatigue Severity Scale (FSS), Multidimensional Fatigue Inventory (MFI), Epworth Sleepiness Scale (ESS) and Parkinson's Disease Sleep Scale (PDSS) for assessment of fatigue and sleep disturbances. Health-related Quality of life (HRQOL) was determined using MOS SF-36 scale and depressive symptoms were assessed using the Beck Depression Inventory II.


RESULTS
Ninety-one patients with dystonia participated (66 women, 25 men, mean age 60 ± 17 years). Nine subjects had generalized dystonia, 18 segmental dystonia and 64 had focal dystonia. Moderate to severe fatigue was present in 43% of the cohort (FSS), excessive daytime somnolence in 27% (ESS) and other sleep disturbances in 26% (PDSS). FSS and MFI scores correlated significantly with HRQOL even when controlled for depression and sleep disturbances. Excessive daytime somnolence and nocturnal sleep disturbances correlated significantly with the HRQOL; however, these effects were not seen for daytime somnolence when controlled for depression. Psychometric testing found adequate reliabilities and convergent validities for both fatigue and sleep scales.


CONCLUSIONS
Fatigue and sleep disturbances revealed high prevalence rates in this large, first of its dystonia study. They negatively impacted the quality of life even when controlled for comorbid depression.
a 1 Department of Neurology , University of Florida , Gainesville , FL , USA.
A
A
Wagle Shukla
b 2 Department of Neurology , University of Colorado , Aurora , CO , USA.
R
R
Brown
b 2 Department of Neurology , University of Colorado , Aurora , CO , USA.
K
K
Heese
c 3 Department of Clinical Health Psychology , University of Florida , Gainesville , FL , USA.
J
J
Jones
a 1 Department of Neurology , University of Florida , Gainesville , FL , USA.
R L
RL
Rodriguez
a 1 Department of Neurology , University of Florida , Gainesville , FL , USA.
I M
IM
Malaty
a 1 Department of Neurology , University of Florida , Gainesville , FL , USA.
M S
MS
Okun
b 2 Department of Neurology , University of Colorado , Aurora , CO , USA.
B M
BM
Kluger
D000328:Adult; D000368:Aged; D015331:Cohort Studies; D006970:Disorders of Excessive Somnolence / Q000453:epidemiology / Q000209:etiology; D020821:Dystonic Disorders / Q000150:complications* / Q000453:epidemiology; D005221:Fatigue / Q000453:epidemiology / Q000209:etiology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011788:Quality of Life; D012893:Sleep Wake Disorders / Q000453:epidemiology / Q000209:etiology*
daytime somnolence; dystonia; fatigue; sleep disturbances