Exploring the Relationship Between Sleep Quality and Fatigue, Quality of Life, Daytime Sleepiness, and Anxiety-depression Levels in Patients with Multiple Sclerosis

INTRODUCTION: Multiple sclerosis (MS) is a chronic neurological disorder often linked with fatigue and poor sleep quality, both of which significantly affect quality of life and mental health. This study aimed to explore the relationship between sleep quality and fatigue, quality of life, daytime sleepiness, and anxiety-depression in patients with MS (pwMS).
METHODS: A cross-sectional study was conducted with 52 pwMS (16 with poor sleep quality, 36 without), recruited from a neurology clinic. Sleep quality was assessed using the Pittsburgh sleep quality index (PSQI), fatigue with the modified fatigue impact scale (MFIS), daytime sleepiness with the Epworth sleepiness scale (ESS), anxiety and depression using the hospital anxiety and depression scale (HADS), and quality of life with the preference-based multiple sclerosis index (PBMSI). Participants were categorized into two groups based on PSQI scores: Those with poor sleep quality and those without. The groups were compared based on patient-reported outcomes, and correlations between these variables and clinical characteristics (e.g., expanded disability status scale scores, disease duration) were examined.
RESULTS: Participants with poor sleep quality reported higher MFIS scores across the physical, cognitive, and psychosocial domains compared to those without poor sleep quality, though these differences were not statistically significant. Anxiety was significantly higher in the poor sleep quality group (p=0.043), and there was a positive correlation between poor sleep quality and increased anxiety (r=0.336, p<0.05). No significant differences were found in ESS or PBMSI scores between the groups. Additionally, a significant correlation was observed between the number of relapses, and the MFIS-physical, MFIS-cognitive, MFIS-total scores, and the PSQI score.
DISCUSSION AND CONCLUSION: This study underscores the relationship between sleep quality, fatigue, anxiety, and the number of relapses in pwMS. Improving sleep quality may help reduce fatigue and anxiety, thereby improving overall well-being. The results suggest that these factors should be evaluated and addressed together in managing MS.