What is the prevalence of sleep disturbances among people with Huntington disease and pre-manifest genetic expansion carriers? A systematic review and meta-analysis.

Anecdotally, sleep disturbances are common among manifest and pre-manifest Huntington disease genetic expansion carriers (HDGECs), but their prevalence has not been systematically studied. To address this gap, we systematically searched MEDLINE, EMBASE, PsychINFO, CINAHL-Plus, and PubMed (inception to October 2025), using exploded headings and text-words based on sleep-related terms intersected with "Huntington disease". We meta-analysed data where four or more studies used the same measure. 28 articles were included, with study design including case-series and case-control studies (sample sizes 6-14,791). Measures of sleep disturbances were objective (n = 10), including polysomnography (n = 8) or circadian biomarkers (n = 2), or subjective (n = 20); with studies including multiple measures or heterogenous populations. Meta-analysed prevalence of objectively-measured sleep disturbances include: 35% for periodic limb movements (PLM index>15/hour), 3% for REM sleep behaviour disorder, 5% for REM sleep without atonia, and 9% for sleep-disordered breathing (AHI>5/hour); and of self-reported measures: 29% for use of sleep medications, 59% for poor sleep quality (Pittsburgh sleep quality index), and 15% for excessive daytime sleepiness (Epworth sleepiness scale). Periodic limb movements during sleep, use of sleep medications, and poor sleep quality were prevalent. Further research is crucial for characterising changes in sleep which may inform sleep interventions improving quality of life among HDGECs.