Sleep quality worse for MS patients than healthy people, study finds
Sleep problems tied to fatigue, anxiety; should be addressed by clinicians
While people with multiple sclerosis (MS) seem to get a similar quantity of sleep relative to individuals without the disease, MS patients have significantly worse sleep quality than their healthy counterparts, according to a new review of several published studies.
The findings show that MS may affect a person’s subjective sleep quality — one’s “individual satisfaction with the sleep experience” — and healthcare professionals should consider this when addressing or preventing sleep-related issues such as anxiety, depression, and fatigue, the researchers suggested.
“Special consideration by clinicians in this regard may lead to a significant improvement in patients’ quality of life, due to the great influence of sleep quality in MS-related symptoms,” the team wrote.
Among such interventions, the researchers noted, are getting 7-9 hours of sleep each night, maintaining a consistent sleep/wake schedule, incorporating routine exercise into one’s daily schedule, and making use of “a contemplative practice,” such as meditation.
The review study, “Sleep quality in multiple sclerosis: A systematic review and meta-analysis based on Pittsburgh Sleep Quality Index,” was published in the journal Multiple Sclerosis and Related Disorders.
Quality but not quantity of sleep affected in MS, per study
Sleep disturbances are common in people with MS, and may arise due to a range of reasons, from medication side effects to changes in the circadian rhythm brought on by nerve damage, to disease symptoms such as pain or bladder issues.
As poor sleep can often impact a person’s ability to carry out daily tasks and participate in social interactions, such issues can have a significant effect on day-to-day life. Still, while many studies have explored differences in sleep quality between MS patients and healthy people, the results have been inconsistent.
To shed light on this, a team of researchers in Iran conducted a meta-analysis of published studies comparing the caliber of sleep and sleep efficiency in MS patients and healthy people. The analysis covered a total of 13 studies, published between 2004 and 2022, and involving 1,481 patients and 2,755 healthy people, who served as controls.
All of the studies measured subjective sleep satisfaction using a self-reported questionnaire called the Pittsburgh Sleep Quality Index (PSQI), which assesses sleep and sleep disturbances over one month. The PSQI comprises 19 questions across seven sleep components, including sleep duration, sleep disturbance, sleep latency — how long it takes for a person to fall asleep — and daytime dysfunction due to sleepiness. The tool also assesses sleep efficiency, meaning the percentage of time spent asleep while in bed, overall sleep satisfaction, and use of sleep medications.
Altogether, the pooled data from 10 studies revealed a significantly higher PSQI score for those with MS than for healthy controls, indicating worse sleep quality among patients. Among the five studies that involved individual components of PSQI, the caliber of sleep, sleep onset latency, the use of sleep medications, and daytime dysfunction were all significantly worse among MS patients.
“These findings suggest that while the quantity of sleep including sleep duration and sleep efficiency may be normal, the quality aspects of sleep are substantially compromised in patients with MS,” the team wrote.
As the quality of sleep can greatly influence the quality of life of MS [patients] and as it is found to be in correlation with MS complications, it’s worthy of clinician’s attention to come up with interventions … to improve [patients’] sleep hygiene and satisfaction.
Two studies split their participants by the presence or absence of fatigue, but the data indicated that sleep satisfaction was always worse in patients than in the healthy controls, regardless of fatigue status.
A total of four studies had available data for the proportion of people with poor sleep quality, defined as a PSQI score of more than five. Findings indicated that MS patients tended to be twice as likely to have poor sleep satisfaction, but the results did not reach significance.
Poor sleep has been linked to the worsening of symptoms such as fatigue, cognitive dysfunction, and mental health issues, the researchers noted. Given that, the team called on healthcare providers to better address sleep satisfaction in people with MS.
“As the quality of sleep can greatly influence the quality of life of MS [patients] and as it is found to be in correlation with MS complications, it’s worthy of clinician’s attention to come up with interventions … to improve [patients’] sleep hygiene and satisfaction,” the researchers wrote. Some suggestions from the researchers “include but are not limited to the cessation of caffeine consumption before sleeping” and supplements.
“The limited available evidence suggests that subjective sleep quality is affected by MS and it should be considered by the clinicians for prevention of sleep-related symptoms such as depression and anxiety,” the team concluded.
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