Sleep and fatigue in multiple sclerosis: A questionnaire-based, cross-sectional, cohort study.
BACKGROUND
Fatigue and sleep disorders are frequently reported in patients affected by Multiple Sclerosis (MS) but the causes and the relationship are not yet fully understood. This study aimed at evaluating their prevalence, at determining the relationships between clinical findings of MS and the occurrence of sleep disorders and at investigating the relations between sleep disorders and fatigue.


METHODS
One hundred and two MS patients were enrolled in the study. They were analyzed on both their clinical features (type of MS, disease duration, clinical severity, type of treatment, presence of spinal demyelinating lesions) and specific scales scores (Expanded Disability Status Scale, Modified Fatigue Impact Scale - MFIS, Self-Administered Anxiety Scale - SAS, Beck's Depression Inventory - BDI, Pittsburgh Sleep Quality Index - PSQI, Epworth Sleepiness Scale - ESS, and the Berlin's questionnaire for Obstruction Sleep Apnea Syndrome - OSAS).


RESULTS
Patients with poor sleep quality are more frequently fatigued (p=0.001), have higher MFIS global scores (p<0.001), higher prevalence of RLS symptoms (p=0.049), and show higher scores at BDI (p=0.017) and SAS (p≤0.001). Conversely patients with fatigue show older age (p=0.005), higher prevalence of sleepiness (p=0.021), higher prevalence of RLS symptoms (p=0.030), higher prevalence of poor sleep quality (p<0.001) with higher PSQI scores (p<0.001), higher scores on the BDI (p<0.001) and SAS (p≤0.001).


CONCLUSIONS
This study shows that MS is associated with a high prevalence of sleep complaints, including subjectively poor sleep quality, excessive daytime sleepiness, RLS and symptoms of OSAS. Further, it demonstrated a strict relation between fatigue and sleep disorders. Finally, it underlines their relationship with anxiety and depression in MS patients.
Institute of Neurology, Department of Geriatrics, Neurosciences and Orthopedics, Catholic University, Rome, Italy; Don Carlo Gnocchi Foundation, Italy. Electronic address: viviana.nociti@policlinicogemelli.it.
Viviana
V
Nociti
Institute of Neurology, Department of Geriatrics, Neurosciences and Orthopedics, Catholic University, Rome, Italy.
Francesco Antonio
FA
Losavio
Institute of Neurology, Department of Geriatrics, Neurosciences and Orthopedics, Catholic University, Rome, Italy.
Valentina
V
Gnoni
Institute of Neurology, Department of Geriatrics, Neurosciences and Orthopedics, Catholic University, Rome, Italy.
Anna
A
Losurdo
Institute of Neurology, Department of Geriatrics, Neurosciences and Orthopedics, Catholic University, Rome, Italy.
Elisa
E
Testani
Institute of Neurology, Department of Geriatrics, Neurosciences and Orthopedics, Catholic University, Rome, Italy.
Catello
C
Vollono
Institute of Neurology, Department of Geriatrics, Neurosciences and Orthopedics, Catholic University, Rome, Italy.
Giovanni
G
Frisullo
Institute of Neurology, Department of Geriatrics, Neurosciences and Orthopedics, Catholic University, Rome, Italy.
Valerio
V
Brunetti
Institute of Neurology, Department of Geriatrics, Neurosciences and Orthopedics, Catholic University, Rome, Italy.
Massimiliano
M
Mirabella
Institute of Neurology, Department of Geriatrics, Neurosciences and Orthopedics, Catholic University, Rome, Italy.
Giacomo
G
Della Marca
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D004185:Disability Evaluation; D005221:Fatigue / Q000209:etiology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009103:Multiple Sclerosis / Q000150:complications*; D015995:Prevalence; D012893:Sleep Wake Disorders / Q000209:etiology*; D011795:Surveys and Questionnaires
Anxiety; Depression; Fatigue; Multiple Sclerosis; Sleep disorder