title: Poor sleep in patients with multiple sclerosis.
abstract: 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.
authors.affiliation: The Norwegian Multiple Sclerosis Competence Centre, Department of Neurology, Haukeland University Hospital, Bergen, Norway. hmbl75@gmail.com
authors.forename: Hanne Marie
authors.initials: HM
authors.lastname: Bøe Lunde
authors.forename: Tommy F
authors.initials: TF
authors.lastname: Aae
authors.forename: William
authors.initials: W
authors.lastname: Indrevåg
authors.forename: Jan
authors.initials: J
authors.lastname: Aarseth
authors.forename: Bjørn
authors.initials: B
authors.lastname: Bjorvatn
authors.forename: Kjell-Morten
authors.initials: KM
authors.lastname: Myhr
authors.forename: Lars
authors.initials: L
authors.lastname: Bø
mesh_terms: D000328:Adult; D000367:Age Factors; D005260:Female; D006801:Humans; D007167:Immunotherapy / Q000009:adverse effects; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009103:Multiple Sclerosis / Q000150:complications* / Q000276:immunology / Q000523:psychology / Q000628:therapy; D015999:Multivariate Analysis; D009664:Norway / Q000453:epidemiology; D016017:Odds Ratio; D015995:Prevalence; D012307:Risk Factors; D012737:Sex Factors; D012893:Sleep Wake Disorders / Q000453:epidemiology* / Q000209:etiology*; D011795:Surveys and Questionnaires