Poor Sleep in Patients with Multiple Sclerosis

Background: Poor sleep is a frequent symptom in patients with multiple sclerosis (MS). Sleep may be influenced by MS-related symptoms and adverse effects from immunotherapy and symptomatic medications. We aimed to study the prevalence of poor sleep and the influence of socio-demographic and clinical factors on sleep quality in MS- patients. Methods: A total of 90 MS patients and 108 sex-and age- matched controls were included in a questionnaire survey. Sleep complaints were evaluated by Pittsburgh Sleep Quality Index (PSQI) and a global PSQI score was used to separate good sleepers (≤5) from poor sleepers (>5). Excessive daytime sleepiness, the use of immunotherapy and antidepressant drugs, symptoms of pain, depression, fatigue and MS-specific health related quality of life were registered. Results were compared between patients and controls and between good and poor sleepers among MS patients. Results: MS patients reported a higher mean global PSQI score than controls (8.6 vs. 6.3, p = 0.001), and 67.1% of the MS patients compared to 43.9% of the controls (p = 0.002) were poor sleepers. Pain (p = 0.02), fatigue (p = 0.001), depression (p = 0.01) and female gender (p = 0.04) were associated with sleep disturbance. Multivariate analyses showed that female gender (p = 0.02), use of immunotherapy (p = 005) and a high psychological burden of MS (p = 0.001) were associated with poor sleep among MS patients. Conclusions: Poor sleep is common in patients with MS. Early identification and treatment of modifiable risk factors may improve sleep and quality of life in MS

Multivariate analysis of factors associated with employment in MS^*.

<p>*n = 172.</p><p>**p value≤0.05 calculated from binary regression analysis.</p

Employment rates (full time and part time) in 2010 among the general population and MS-patients in Sogn og Fjordane County.

<p>Employment rates (full time and part time) in 2010 among the general population and MS-patients in Sogn og Fjordane County.</p

Univariate analysis of factors associated with employment in MS.

<p>*P-values (crude) were calculated from analysis of variance, a = 0.05.</p><p>**P-values (crude) were calculated from chi-square analysis (Fischer exact test), a = 0.05.</p

Socio-demographic and clinical characteristics in multiple sclerosis (MS); Relapsing-remitting MS, Secondary progressive MS and primary progressive MS.

<p>^*P-values (crude) were calculated from analysis of variance (ANOVA), α = 0.05.</p><p>^**P-values (crude) were calculated from chi-square analysis (Fischer exact test), α = 0.05.</p><p>^***P-values (crude) were calculated from Kruskal Wallis; α = 0.05.</p><p>Missing observations#; n (number of missing values) ranging from 0–44.</p><p>FSS: Fatigue Severity Scale; EDSS: Expanded Disability Status Scale; BDI: Beck Depression Inventory, RRMS: relapsing-remitting MS, SPMS: secondary progressive MS, PPMS: primary progressive MS.</p

Clinical and socio-demographic parameters among patients and controls.

<p>ESS = Epworth Sleepiness Scale; FQ = Fatigue Questionnaire; BDI = Beck. Depression Inventory; MSIS-29 = Multiple Sclerosis Impact Scale.</p>*<p>Number of patients range from 76–90;</p>**<p>Number of controls range from 96–108. Immunotherapy (IFNB, glatiramer acetate, natalizumab).</p

Pittsburgh Sleep Quality Index (PSQI) scores among patients and controls.

*<p>Data are displayed as mean standard deviation;</p>**<p>Number of patients range from 76–90;</p>***<p>Number of controls range from 96–108.</p

Comparisons of clinical and socio-demographic parameters in MS patients categorized as good sleepers versus poor sleepers.

<p>MSIS-29: Multiple Sclerosis Impact Scale. ESS: Excessive daytime sleepiness.</p><p>FQ: Fatigue questionnaire, BDI: Beck Depression Inventory.</p

Independent factors associated with poor sleep in patients with MS.

<p>MSIS-29 = Multiple Sclerosis Impact Scale-29;</p>*<p>OR = 1.12 denotes OR for each increasing point achieved in MSIS-29 psychological subscale.</p