Abstract
BackgroundSleep disorders and fatigue are common in multiple sclerosis (MS). The underlying causes are not fully understood, and prospective studies are lacking. Therefore, we conducted a prospective, observational cohort study investigating sleep quality, fatigue, quality of life, and comorbidities in patients with MS.MethodsPatients with relapsing-remitting MS or clinically isolated syndrome treated with interferon beta-1b were followed over two years. The primary objective was to investigate correlations between sleep quality (PSQI), fatigue (MFIS), and functional health status (SF-36). Secondary objectives were to investigate correlations of sleep quality and daytime sleepiness (ESS), depression (HADS-D), anxiety (HADS-A), pain (HSAL), and restless legs syndrome (RLS). We applied descriptive statistics, correlation and regression analyses.Results139 patients were enrolled, 128 were available for full analysis. The proportion of poor sleepers (PSQI≥5) was 55.47% at the beginning and 37.70% by the end of the study (106 and 41 evaluable questionnaires, respectively). Poor sleepers performed worse in MFIS, SF-36, ESS, HADS-D, and HADS-A scores. The prevalence of patients with RLS was low (4.5%) and all were poor sleepers. Poor sleep quality was positively correlated with fatigue and low functional health status. These relationships were corroborated by multivariable-adjusted regression analyses. ESS values and poor sleep quality at baseline seem to predict sleep quality at the one-year follow-up. No variable predicted sleep quality at the two-year follow-up.ConclusionsOur results confirm the high prevalence of poor sleep quality among patients with MS and its persistent correlation with fatigue and reduced quality of life over time. They highlight the importance of interventions to improve sleep quality.Trial registrationThe study was registered at clinicaltrials.gov: NCT01766063 (registered December 7, 2012). Registered retrospectively (first patient enrolled December 6, 2012).
Highlights
Sleep disorders and fatigue are common in multiple sclerosis (MS)
Outcome variables Primary outcome variables were sleep quality assessed with the Pittsburgh Sleep Quality Index (PSQI), fatigue assessed with the Modified Fatigue Impact Scale (MFIS), and functional health status assessed with the Short Form 36 (SF-36)
Secondary outcome variables were daytime sleepiness measured with the Epworth Sleepiness Scale (ESS), depression and anxiety assessed with the Hospital Anxiety and Depression Scale (HADS), pain measured with the Hamburg Pain Adjective List (HSAL, Hamburger Schmerz Adjektiv Liste), and the severity of restless legs syndrome (RLS) assessed through the International RLS Study Group (IRLSSG) rating scale
Summary
Sleep disorders and fatigue are common in multiple sclerosis (MS). We conducted a prospective, observational cohort study investigating sleep quality, fatigue, quality of life, and comorbidities in patients with MS. MS is a frequent cause of nontraumatic neurological disability in young adults [1]. Comorbid conditions are common in MS and may contribute to disability. Many patients with MS report sleep disorders [2], more frequently than in the general population, with prevalence estimates ranging from 25 to 54% [3]. Poor sleep quality in MS has been associated with negative outcomes, such as decreased quality of life [4], exacerbation rate and disease severity [5], and with other comorbidities such as fatigue, depression, anxiety, and pain [6, 7]
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