Abstract
Sleep disturbances constitute one of the important yet underestimated aspects of functioning of patients with multiple sclerosis (MS). The objective of this study was to evaluate sleep disturbances in patients with MS, with regard to demographic factors, disease-related variables, co-existing conditions and fatigue. In 100 MS patients, Epworth Sleepiness Scale (ESS) and a questionnaire about sleep disturbances (SlD) were implemented. ESS and SlD results were analyzed with regard to age, gender, duration of MS, type of its course, degree of disability in Expanded Disability Status Scale (EDSS), MS therapies, coexisting diseases, results of Fatigue Severity Scale (FSS) and Modified Fatigue Impact Scale (MFIS). ESS score indicated increased daytime sleepiness in 19 patients. In SlD, 49 subjects reported sleep disturbances and 35 more than one of their kind (most commonly terminal and middle insomnia). No relationships were found between ESS and SlD scores and age, gender, MS duration, type of its course, EDSS or coexisting diseases. In 36 patients, somatic complaints interfered with sleep. The patients with depression had significantly lower ESS result and those currently treated with immunomodulation had significantly lower SlD score. SlD score correlated positively with FSS and MFIS. Sleep disturbances in MS patients may occur independently from demographic and disease-related variables, but they are often influenced by the symptoms of MS and therapies used. Sleep disturbances may contribute to fatigue in the course of MS.
Highlights
Multiple sclerosis (MS) is a chronic disease of the central nervous system, with disseminated inflammatory/demyelinative lesions and axonal loss leading to multifocal signs of neurological deficit
Thirty-two patients were currently being treated with interferon beta (IFNb) and one with glatiramer acetate (GA)
Almost 50 % of the multiple sclerosis (MS) patients in the studied group complained of sleep disturbances, with 35 % reporting more than one kind
Summary
Multiple sclerosis (MS) is a chronic disease of the central nervous system, with disseminated inflammatory/demyelinative lesions and axonal loss leading to multifocal signs of neurological deficit. Sleep disturbances, reported by 24–50 % of MS patients, constitute one such aspect [1,2,3]. Circadian rhythm disorders with compromised melatonin secretion [4], reduced input to the suprachiasmatic nucleus due to impaired visual pathways [5] as well as increased levels of proinflammatory cytokines [6] have been suggested as possible pathomechanisms shared by MS and sleep disturbances. Problems with sleep may be associated with symptoms and signs of the disease, side effects of MS therapies, psychological problems secondary to the disease (including depression and anxiety) or other diseases coexisting with MS. The background of sleep disturbances in MS patients seems complex and multifactorial
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