Objective: To assess sleep quality in patients with XDP using the Pittsburgh Sleep Quality Index (PSQI), determine the prevalence of poor sleep quality, and examine its association with clinicodemographic and clinical characteristics.

Background: X-linked dystonia-parkinsonism (XDP), or Lubag disease, is a rare adult-onset neurodegenerative disorder endemic to the Philippines that primarily affects males. Although both motor and non-motor manifestations are recognized, sleep disturbance in XDP remains insufficiently characterized.

Method: This cross-sectional study included patients with XDP recruited from the XDP registry and Movement Disorders Clinic at Makati Medical Center. Data were collected through Zoom or Viber interviews. Sleep quality was assessed using the PSQI, while anxiety and depressive symptoms were measured using the Hospital Anxiety and Depression Scale–Pilipino (HADS-P). Disease severity was evaluated using the XDP-MDSP Rating Scale; rigidity and postural instability were excluded during remote assessments. Logistic regression was performed to identify factors associated with poor sleep quality.

Results: A total of 34 male participants were included [Table 1]. Mean age was 44.0 ± 6.1 years, mean disease duration was 5.9 ± 3.5 years, and 82.4% had cervical dystonia [Table 1]. Mean global PSQI score was 8.09 ± 4.43 [Table 1, Table 2]. Using a PSQI cutoff of >5, 23 patients (67.6%) had poor sleep quality and 11 (32.4%) had good sleep quality [Table 2]. Compared with those with good sleep quality, patients with poor sleep quality more often had cervical dystonia and had higher HADS-P anxiety and depression scores [Table 3]. In multivariable logistic regression, cervical dystonia (adjusted OR 5.62, 95% CI 1.25-10.33), higher HADS-P anxiety scores (adjusted OR 1.15, 95% CI 1.03-1.23), and higher HADS-P depression scores (adjusted OR 1.20, 95% CI 1.03-1.37) were independently associated with poor sleep quality [Figure 1].

Conclusion: Poor sleep quality is highly prevalent in XDP and represents an important non-motor burden. Cervical dystonia and higher anxiety and depressive symptom scores were independently associated with worse sleep. Routine sleep assessment should be incorporated into the clinical evaluation of patients with XDP.

Clinical Characteristics of XDP Patients

Sleep Quality Scores in XDP Patients

Clinical Factors by Sleep Quality

Predictors of Poor Sleep Quality in XDP

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