1
|
Gammoh O, Ennab W. Depression, anxiety, insomnia and dysmenorrhea in stressed fingolimod-treated women with multiple sclerosis. Int J Psychiatry Med 2024; 59:50-64. [PMID: 37465938 DOI: 10.1177/00912174231190455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/20/2023]
Abstract
OBJECTIVE This study examined the prevalence and correlates of depression, anxiety, insomnia, and dysmenorrhea in stressed fingolimod-treated women with multiple sclerosis. METHODS This cross-sectional study recruited female patients diagnosed with multiple sclerosis and high stress scores from Al-Bashir Hospital in Jordan. Depression was assessed by the Patient Health Questionnaire (PHQ-9); anxiety by the Generalized Anxiety Disorder (GAD-7) scale; insomnia by the Insomnia Severity Index (ISI-A) scale; and dysmenorrhea severity by a measure assessing working ability, location, intensity, days of pain, and miscellaneous dysmenorrhea symptoms (WaLIDD). RESULTS A total of 129 patients were recruited for the study. Severe depression was reported in 55.8%, severe anxiety in 62.0%, severe insomnia in 36.4%, and severe dysmenorrhea in 23.3%. Multivariate analyses revealed that depressive symptoms were associated with dysmenorrhea (OR = 3.55, 95% CI = 1.56-8.12, p = 0.003); anxiety symptoms with "not using dysmenorrhea analgesics" (OR = 2.74, 95% CI = 1.16-6.46, p = 0.02) and dysmenorrhea symptoms (OR = 4.74, 95% CI = 1.94-11.59, p = 0.001); insomnia symptoms with age above 30 years (OR = 4.34, 95% CI = 1.64-11.51, p = 0.003); and dysmenorrhea symptoms with the presence of chronic diseases (OR = 4.21, 95% CI = 1.28-13.92, p = 0.02), anxiety symptoms (OR = 3.03, 95% CI = 1.18-7.73, p = 0.02), and insomnia symptoms (OR = 3.00, 95% CI = 1.18-7.64, p = 0.02). CONCLUSION Stressed women with multiple sclerosis in Jordan experience high rates of depression, anxiety, insomnia, and dysmenorrhea. Characteristics related to these conditions may help clinicians to identify those at risk. Longitudinal studies are needed to determine the causal nature of these associations.
Collapse
Affiliation(s)
- Omar Gammoh
- Department of Clinical Pharmacy and Pharmacy Practice, Faculty of Pharmacy, Yarmouk University, Irbid, Jordan
| | - Wail Ennab
- Department of Neurology, Al-Bashir Hospital, Amman, Jordan
| |
Collapse
|
2
|
Zhang GX, Zhang WT, Gao SS, Zhao RZ, Yu WJ, Izquierdo G. Sleep disorders in patients with multiple sclerosis in Spain. Neurologia 2024; 39:29-35. [PMID: 38161070 DOI: 10.1016/j.nrleng.2021.03.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Accepted: 03/01/2021] [Indexed: 01/03/2024] Open
Abstract
OBJECTIVE This study assesses the presence of sleep disturbances and their relationship with clinical and demographic variables in patients with MS, with a view to establishing correlations between the different variables and the frequency of sleep disturbances. METHODS The Pittsburgh Sleep Quality Index (PSQI) was used to detect sleep disorders. We contacted patients treated at the MS unit and distributed a questionnaire (PSQI) to 221 patients, receiving 142 usable questionnaires between 8 and 30 September 2019. RESULTS The prevalence of patients with sleep disturbances in our study was 74.7% (73.7% in women and 76.8% in men). Therefore, sleep disorders are pervasive in patients with MS, with 3 out of 4 patients experiencing them, a higher rate than that observed in the population without the disease. The frequency of sleep disorders gradually increased in line with age. In the 2 age groups analyzed, 44-54 years and 55-68 years, the proportion of moderate and severe sleep disorders was 42.8% and 53.9%, respectively. Moderate and severe sleep disturbances were observed in 27.5%, 44.7%, and 58.3% of patients with Expanded Disability Status Scale scores of 0-3, 3-6, and >6, respectively. CONCLUSION Our results indicate that sleep disorders are more common in patients with MS than in other populations. Patients with secondary progressive forms of MS more frequently present sleep disturbances, while patients with primary progressive forms report them less frequently. Age and degree of disability were positively correlated with the prevalence and severity of sleep disorders in MS patients.
Collapse
Affiliation(s)
- G X Zhang
- Multiple Sclerosis Unit, Neurology Service, Vithas Nisa Hospital, Seville, Spain; Department of Neurology, Yan'an University Medical College No. 3 Affiliated Hospital, Shaanxi, China; International Doctoral School, University of Seville, Spain
| | - W T Zhang
- International Doctoral School, University of Seville, Spain
| | - S S Gao
- International Doctoral School, University of Seville, Spain
| | - R Z Zhao
- Department of Ophthalmology, Hermanos Ameijeiras Hospital, Habana, Cuba
| | - W J Yu
- Department of Neurology, Yan'an University Medical College No. 3 Affiliated Hospital, Shaanxi, China
| | - G Izquierdo
- Multiple Sclerosis Unit, Neurology Service, Vithas Nisa Hospital, Seville, Spain.
| |
Collapse
|
3
|
Zeng X, Dorstyn DS, Edwards G, Kneebone I. The prevalence of insomnia in multiple sclerosis: A meta-analysis. Sleep Med Rev 2023; 72:101842. [PMID: 37660580 DOI: 10.1016/j.smrv.2023.101842] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 07/11/2023] [Accepted: 08/21/2023] [Indexed: 09/05/2023]
Abstract
Insomnia is a common complaint for adults with multiple sclerosis and can severely impact health-related quality of life. Point prevalence estimates of insomnia are, however, difficult to determine in this population due to the use of different measurement tools as well as the highly variable clinical presentation of multiple sclerosis. This review consolidates the current evidence base to provide a global estimate of insomnia disorders and symptoms in multiple sclerosis, with consideration of both measurement and sample issues. A comprehensive review of the PUBMED, EMBASE, PsycINFO and CINAHL databases from database inception until January 31st, 2023 identified 1649 records, of which 34 (7636 participants total) were eligible for inclusion. Findings were meta-analysed using a random-effects model. Estimates based on self-reported symptoms (52%, CI: 44%-59%) were significantly higher than those obtained by diagnostic tools (22%, CI: 16%-29%). Gender was identified as a potential moderator, with women more likely to report insomnia than men. One in two adults with multiple sclerosis endorse symptoms of poor sleep quality and daytime sleepiness, with 1 in 5 diagnosed with an insomnia disorder. Future research is needed to enhance understanding of these comorbid conditions, including the trajectory of insomnia with disease progression. PROSPERO registration number CRD42021281524.
Collapse
Affiliation(s)
- Xiaojun Zeng
- Discipline of Clinical Psychology, Graduate School of Health, University of Technology Sydney, Australia
| | | | | | - Ian Kneebone
- Discipline of Clinical Psychology, Graduate School of Health, University of Technology Sydney, Australia.
| |
Collapse
|
4
|
de Bergeyck R, Geoffroy PA. Insomnia in neurological disorders: Prevalence, mechanisms, impact and treatment approaches. Rev Neurol (Paris) 2023; 179:767-781. [PMID: 37620177 DOI: 10.1016/j.neurol.2023.08.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Accepted: 08/03/2023] [Indexed: 08/26/2023]
Abstract
Insomnia is more prevalent in neurological disorders compared to the general population, with rates ranging from 11 to 74.2% in neurodegenerative disorders, 20 to 37% in vascular diseases, 13.3 to 50% in inflammatory diseases, 28.9 to 74.4% in epilepsy, and nearly 70% in migraines. Insomnia in neurological disorders stems from a variety of factors, encompassing physical and neuropsychiatric factors, behavioral patterns, and disruptions in the biological clock and circadian rhythm. There are bidirectional connections between neurological disorders and insomnia. Insomnia in neurological disorders worsens symptoms, resulting in heightened depressive symptoms, elevated mortality rates, reduced quality of life, and intensified acute symptoms. Managing comorbid sleep disorders, especially in the presence of psychiatric comorbidities, is crucial. Cognitive behavioral therapy for insomnia (CBT-I) is the first-line recommendation for insomnia management in neurological disorders. Other treatments are second-line strategies. Melatonin may demonstrate effectiveness in addressing insomnia, with soporific and chronobiotic effects. Furthermore, it has the potential to alleviate "sundowning" and behavioral disturbances, while generally being well-tolerated. Other treatment options that may be of interest include morning bright light therapy, sedative antidepressants, new orexin dual antagonists and levodopa specifically indicated for Parkinson's disease. Benzodiazepines and z-drugs can be used primarily during acute phases to prevent pharmacotolerance and minimize side effects. However, they should be avoided in patients with neurological disorders and not used in patients over 75 years old due to the risk of falls and confusion. In neurological disorders, insomnia has a profound impact on daytime functioning, making its management crucial. Effective treatment can result in improved outcomes, and additional research is necessary to investigate alternative therapeutic options and enhance patient care.
Collapse
Affiliation(s)
- R de Bergeyck
- Centre ChronoS, GHU Paris - Psychiatry Neurosciences, 1, rue Cabanis, 75014 Paris, France.
| | - P A Geoffroy
- Centre ChronoS, GHU Paris - Psychiatry Neurosciences, 1, rue Cabanis, 75014 Paris, France; Département de psychiatrie et d'addictologie, DMU Neurosciences, GHU Paris Nord, hôpital Bichat-Claude-Bernard, AP-HP, 75018 Paris, France; Université Paris Cité, NeuroDiderot, Inserm U1141, 75019 Paris, France; CNRS UPR 3212, Institute for Cellular and Integrative Neurosciences, 5, rue Blaise-Pascal, 67000 Strasbourg, France
| |
Collapse
|
5
|
Guarnaccia JB, Njike VY, Dutton A, Ayettey RG, Treu JA, Comerford BP, Sinha R. A pilot, randomized, placebo-controlled study of mindfulness meditation in treating insomnia in multiple sclerosis. BMC Neurol 2023; 23:263. [PMID: 37434109 PMCID: PMC10334613 DOI: 10.1186/s12883-023-03309-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Accepted: 06/27/2023] [Indexed: 07/13/2023] Open
Abstract
OBJECTIVE Mindfulness is an established approach to reduce distress and stress reactivity by improving awareness and tolerability of thoughts and emotions. This study compares mindfulness training to sleep hygiene in persons with multiple sclerosis (PWMS) who report chronic insomnia, examining sleep efficiency (SE), self-reported sleep quality and quality of life. METHODS Fifty-three PWMS were randomized (1:1) in a single-blinded, parallel group design to ten, two-hour weekly sessions of Mindfulness Based Stress Intervention for Insomnia (MBSI-I) over a span of ten weeks or a single, one hour sleep hygiene (SH) session over one day. The primary outcome measure was SE, measured by the Fitbit™ Charge 2 wrist device, at 10 and 16 weeks from the start of study interventions. Self-report outcomes included the Pittsburg Sleep Quality Rating Scale (PSQI), Insomnia Severity Index (ISI) and the Multiple Sclerosis Quality of Life Inventory (MSQLI). Nineteen participants in the MBSI-I group and 24 in the SH group completed the primary study. Subsequently, ten participants in the original SH group participated in the 10-week MSBI-I course and their data was added to the MBSI-I cohort (eMSBI-I). RESULTS While neither SE nor the PSQI showed significant differences between MBSI-I, eMBSI-I and SH groups, ISI improved in both the MSBI-I and eMBSI-I vs SH at 10 weeks (p = 0.0014 and p = 0.0275) but not 16 weeks. However, pre and post assessments within the MBSI-I and eMBSI-I cohorts did show significant improvement in the PSQI and ISI at 10 and 16 weeks, while SH was significant in the ISI only at 16 weeks. Several quality of life measurements, including fatigue, mental health and cognitive function favored the mindfulness cohorts. CONCLUSION This pilot study demonstrates beneficial effects of MBSR on insomnia, sleep quality and quality of life in PWMS. TRIAL REGISTRATION NCT03949296. 14 May 2019.
Collapse
Affiliation(s)
- Joseph B Guarnaccia
- Multiple Sclerosis Treatment Center, Griffin Hospital, 350 Seymour Ave., Suite 1C, Derby, Connecticut, 06418, USA.
| | - Valentine Y Njike
- Yale-Griffin Prevention Research Center, Griffin Hospital, 130 Division St., Derby, Connecticut, 06418, USA
| | - Anne Dutton
- Department of Psychiatry, Yale Stress Center, Yale University, New Haven, Connecticut, 06510, USA
| | - Rockiy G Ayettey
- Yale-Griffin Prevention Research Center, Griffin Hospital, 130 Division St., Derby, Connecticut, 06418, USA
| | - Judith A Treu
- Yale-Griffin Prevention Research Center, Griffin Hospital, 130 Division St., Derby, Connecticut, 06418, USA
| | - Beth P Comerford
- Yale-Griffin Prevention Research Center, Griffin Hospital, 130 Division St., Derby, Connecticut, 06418, USA
| | - Rajita Sinha
- Department of Psychiatry, Yale Stress Center, Yale University, New Haven, Connecticut, 06510, USA
| |
Collapse
|
6
|
Grubić Kezele T, Trope Z, Ahel V, Ružić N, Omrčen H, Đudarić L, Fužinac-Smojver A. Upper-lower limb and breathing exercise program for improving sleep quality and psychological status in multiple sclerosis: a pilot randomized controlled trial. BRAIN IMPAIR 2023; 24:86-102. [PMID: 38167585 DOI: 10.1017/brimp.2021.17] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
PURPOSE To examine the feasibility and possible effect of an 8-week exercise program on sleep quality, insomnia and psychological distress in individuals with multiple sclerosis (MS). METHODS Twenty-four individuals with MS were recruited into a controlled pre-post feasibility study and divided into 2 groups: exercise (n = 13; Expanded Disability Status Scale (EDSS): 1.0-7.5) and a related control group with no exercise (n = 11; EDSS: 1.0-7.0). The exercise group performed combined upper limb, lower limb and breathing exercises in a controlled group (2d/week, 60 min/session) for 8 weeks. Participants were administered measures to evaluate sleep quality (Pittsburgh Sleep Quality Index, PSQI), insomnia severity (Insomnia Severity Index, ISI), psychological distress (Clinical Outcomes in Routine Evaluation-Outcome Measure, CORE-OM) and additionally impact of fatigue (Modified Fatigue Impact Scale, MFIS) after 8-weeks. RESULTS Insomnia severity measured with ISI (F(1;22)=5.95, p = 0.023, η p 2 = 0.213, 90% CI = 0.02-0.42) and psychological distress measured with the CORE-OM (F(1;22)=4.82, p = 0.039, η p 2 = 0.179, 90% CI = 0.01-0.40) showed statistically significant group-by-time interaction. Sleep quality measured with the PSQI showed statistically significant group-by-time interaction only in an aspect of daytime sleep dysfunction (F(1;22)=5.33, p = 0.031, η p 2 = 0.195, 90% CI = 0.01-0.40). The fatigue impact measured with the MFIS showed statistically significant group-by-time interaction in physical (F(1;22)=6.80, p = 0.016, η p 2 = 0.236, 90% CI = 0.02-0.44) and cognitive aspects (F(1;22)=9.12, p = 0.006, η p 2 = 0.293, 90% CI = 0.05-0.49), and total score (F(1;22)=11.29, p = 0.003, η p 2 = 0.339, 90% CI = 0.08-0.52). CONCLUSIONS Our 8-week program reduced insomnia severity, psychological distress and some aspects of fatigue (physical; cognitive; total), and improved sleep quality in an aspect of daytime sleep dysfunction in a small group of individuals with MS. Good feasibility and significant positive changes from baseline warrant further exploratory work.
Collapse
Affiliation(s)
- Tanja Grubić Kezele
- Department of Physiology and Immunology, University of Rijeka, Faculty of Medicine, Rijeka, Croatia
| | - Zrinka Trope
- University of Rijeka Faculty of Health Studies, Rijeka, Croatia
| | - Valentina Ahel
- University of Rijeka Faculty of Health Studies, Rijeka, Croatia
| | - Natali Ružić
- University of Rijeka Faculty of Health Studies, Rijeka, Croatia
| | - Hrvoje Omrčen
- Department of Anatomy, University of Rijeka, Faculty of Medicine, Rijeka, Croatia
| | - Luka Đudarić
- Department of Radiology, General Hospital Pula, Pula, Croatia
| | - Ariana Fužinac-Smojver
- Department of Basic Sciences, University of Rijeka, Faculty of Health Studies, Rijeka, Croatia
| |
Collapse
|
7
|
Marrie RA, Fisk JD, Walld R, Bolton JM, Sareen J, Patten SB, Singer A, Lix LM, Hitchon CA, El-Gabalawy R, Katz A, Marriott JJ, Bernstein CN. Use of Benzodiazepines and Z-Drugs in Multiple Sclerosis. Front Neurol 2022; 13:874724. [PMID: 35493810 PMCID: PMC9049992 DOI: 10.3389/fneur.2022.874724] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2022] [Accepted: 03/22/2022] [Indexed: 11/30/2022] Open
Abstract
Objective Use of benzodiazepines and Z-drugs (non-benzodiazepine sedative hypnotics) is controversial due to adverse health outcomes in the general population. However, little is known about their use in people with multiple sclerosis (MS). We estimated the incidence and prevalence of benzodiazepine and Z-drug use (jointly BZD) in the MS population as compared to an age-, sex- and geographically-matched population without MS, and examined the association of mood/anxiety disorders with the use of BZD over a twenty-year period. Methods Using administrative data from Manitoba, Canada, we identified 2,985 persons with incident MS and 14,891 persons without MS matched 5:1 on sex, birth year and region. We applied validated case definitions to identify persons with any mood/anxiety disorder. Dispensations of BZD were identified. To assess the association between MS, mood/anxiety disorders and BZD use we constructed generalized linear models adjusting for age, sex, index year, socioeconomic status, urban/rural residence, physical comorbidities, and health care use. We also examined patterns of BZD use. Results In 2016, the crude incidence of benzodiazepine use in the MS cohort was 2.10% (95%CI: 1.43–2.98%), 1.49-fold higher than in the non-MS cohort (1.41%; 95%CI: 1.18–1.67%). The crude incidence of Z-drug use in the MS cohort was 1.77% (95%CI: 1.20–2.51%), 1.78-fold higher than in the non-MS cohort (0.99%; 95%CI: 0.81–1.21%). After adjusting for covariates, among individuals without an active mood/anxiety disorder, the MS cohort had a 39% increased incidence rate of benzodiazepine use and a 72% increased incidence rate of Z-drug use as compared to the non-MS cohort. Among individuals with an active mood/anxiety disorder, the incidence of BZD use did not differ between the MS and non-MS cohorts. A higher proportion of people with MS used BZD for ≥6 months than people without MS. Conclusion Use of BZD is more common in people with MS than in general population controls, and use of these agents is in persons with MS is often chronic.
Collapse
Affiliation(s)
- Ruth Ann Marrie
- Department of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
- Department of Community Health Sciences, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
- *Correspondence: Ruth Ann Marrie
| | - John D. Fisk
- Nova Scotia Health and the Departments of Psychiatry, Psychology and Neuroscience, and Medicine, Dalhousie University, Halifax, NS, Canada
| | - Randy Walld
- Manitoba Centre for Health Policy, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - James M. Bolton
- Department of Psychiatry, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Jitender Sareen
- Department of Psychiatry, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Scott B. Patten
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Alexander Singer
- Department of Family Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Lisa M. Lix
- Department of Community Health Sciences, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Carol A. Hitchon
- Department of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Renée El-Gabalawy
- Department of Clinical Health Psychology, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
- Department of Anesthesiology, Perioperative Medicine and Pain, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Alan Katz
- Nova Scotia Health and the Departments of Psychiatry, Psychology and Neuroscience, and Medicine, Dalhousie University, Halifax, NS, Canada
- Manitoba Centre for Health Policy, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
- Department of Family Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - James J. Marriott
- Department of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Charles N. Bernstein
- Department of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | | |
Collapse
|
8
|
Kołtuniuk A, Kazimierska-Zając M, Pogłódek D, Chojdak-Łukasiewicz J. Sleep Disturbances, Degree of Disability and the Quality of Life in Multiple Sclerosis Patients. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19063271. [PMID: 35328966 PMCID: PMC8950227 DOI: 10.3390/ijerph19063271] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 03/04/2022] [Accepted: 03/08/2022] [Indexed: 02/04/2023]
Abstract
Sleep disturbances are pervasive in patients with multiple sclerosis (MS), with incidence about four times higher compared to the general population. The most frequent primary sleep problems include insomnia, restless leg syndrome, sleep-related movement disorders, and sleep-disordered breathing. This study aims to assess the relationships between sleeping problems and the quality of life (QoL) in MS patients. This cross-sectional study was conducted among 152 MS patients (mean age: 36.27 ± 9.60) between November 2018 and February 2019 at a neurological health center in Wroclaw, Poland. The study was based on a questionnaire that included questions concerning sociodemographic and clinical data in addition to the following standardized questionnaires: Athens Insomnia Scale (AIS), Epworth Sleepiness Scale (ESS), and Multiple Sclerosis International Quality of Life (MusiQoL). The degree of physical disability was evaluated following the Expanded Disability Status Scale (EDSS). Analysis of the research material showed that 66.45% of MS patients had insomnia, and 41.45% presented with daytime sleepiness. The QoL of respondents was assessed as average (50.73). Univariate linear regression model analysis showed the effects of professional status, daytime sleepiness, insomnia, and degree of disability on the QoL of MS patients. Sleep disturbances are widespread in MS patients. The presence of sleep disturbances (insomnia and daytime sleepiness) significantly affects the QoL of MS patients.
Collapse
Affiliation(s)
- Aleksandra Kołtuniuk
- Department of Nursing and Obstetrics, Wroclaw Medical University, 51-618 Wroclaw, Poland;
- Correspondence: ; Tel.: +48-71-784-18-05
| | | | - Dominika Pogłódek
- Department of Nursing and Obstetrics, Wroclaw Medical University, 51-618 Wroclaw, Poland;
| | | |
Collapse
|
9
|
Ditmer M, Gabryelska A, Turkiewicz S, Białasiewicz P, Małecka-Wojciesko E, Sochal M. Sleep Problems in Chronic Inflammatory Diseases: Prevalence, Treatment, and New Perspectives: A Narrative Review. J Clin Med 2021; 11:67. [PMID: 35011807 PMCID: PMC8745687 DOI: 10.3390/jcm11010067] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Revised: 12/15/2021] [Accepted: 12/19/2021] [Indexed: 12/12/2022] Open
Abstract
Epidemiological studies have shown that individuals with sleep problems are at a greater risk of developing immune and chronic inflammatory diseases. As sleep disorders and low sleep quality in the general population are frequent ailments, it seems important to recognize them as serious public health problems. The exact relation between immunity and sleep remains elusive; however, it might be suspected that it is shaped by others stress and alterations of the circadian rhythm (commonly caused by for example shift work). As studies show, drugs used in the therapy of chronic inflammatory diseases, such as steroids or monoclonal antibodies, also influence sleep in more complex ways than those resulting from attenuation of the disease symptoms. Interestingly, the relation between sleep and immunity appears to be bidirectional; that is, sleep may influence the course of immune diseases, such as inflammatory bowel disease. Thus, proper diagnosis and treatment of sleep disorders are vital to the patient's immune status and, in effect, health. This review examines the epidemiology of sleep disorders and immune diseases, the associations between them, and their current treatment and novel perspectives in therapy.
Collapse
Affiliation(s)
- Marta Ditmer
- Department of Sleep Medicine and Metabolic Disorders, Medical University of Lodz, 92-215 Lodz, Poland; (M.D.); (A.G.); (S.T.); (P.B.)
| | - Agata Gabryelska
- Department of Sleep Medicine and Metabolic Disorders, Medical University of Lodz, 92-215 Lodz, Poland; (M.D.); (A.G.); (S.T.); (P.B.)
| | - Szymon Turkiewicz
- Department of Sleep Medicine and Metabolic Disorders, Medical University of Lodz, 92-215 Lodz, Poland; (M.D.); (A.G.); (S.T.); (P.B.)
| | - Piotr Białasiewicz
- Department of Sleep Medicine and Metabolic Disorders, Medical University of Lodz, 92-215 Lodz, Poland; (M.D.); (A.G.); (S.T.); (P.B.)
| | - Ewa Małecka-Wojciesko
- Department of Digestive Tract Diseases, Medical University of Lodz, 92-215 Lodz, Poland;
| | - Marcin Sochal
- Department of Sleep Medicine and Metabolic Disorders, Medical University of Lodz, 92-215 Lodz, Poland; (M.D.); (A.G.); (S.T.); (P.B.)
| |
Collapse
|
10
|
Zhang GX, Zhang WT, Gao SS, Zhao RZ, Yu WJ, Izquierdo G. Sleep disorders in patients with multiple sclerosis in Spain. Neurologia 2021; 39:S0213-4853(21)00080-3. [PMID: 34103173 DOI: 10.1016/j.nrl.2021.03.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Accepted: 03/01/2021] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE This study assesses the presence of sleep disturbances and their relationship with clinical and demographic variables in patients with MS, with a view to establishing correlations between the different variables and the frequency of sleep disturbances. METHODS The Pittsburgh Sleep Quality Index (PSQI) was used to detect sleep disorders. We contacted patients treated at the MS unit and distributed a questionnaire (PSQI) to 221 patients, receiving 142 usable questionnaires between 8 and 30 September 2019. RESULTS The prevalence of patients with sleep disturbances in our study was 74.7% (73.7% in women and 76.8% in men). Therefore, sleep disorders are pervasive in patients with MS, with 3 out of 4 patients experiencing them, a higher rate than that observed in the population without the disease. The frequency of sleep disorders gradually increased in line with age. In the 2 age groups analyzed, 44-54 years and 55-68 years, the proportion of moderate and severe sleep disorders was 42.8% and 53.9%, respectively. Moderate and severe sleep disturbances were observed in 27.5%, 44.7%, and 58.3% of patients with Expanded Disability Status Scale scores of 0-3, 3-6, and >6, respectively. CONCLUSION Our results indicate that sleep disorders are more common in patients with MS than in other populations. Patients with secondary progressive forms of MS more frequently present sleep disturbances, while patients with primary progressive forms report them less frequently. Age and degree of disability were positively correlated with the prevalence and severity of sleep disorders in MS patients.
Collapse
Affiliation(s)
- G-X Zhang
- Multiple Sclerosis Unit, Neurology Service, Vithas Nisa Hospital, 41950 Seville, Spain; Department of Neurology, Yan'an University Medical College No. 3 Affiliated Hospital, 712000 Shaanxi, China; International Doctoral School, University of Seville, 41013, Spain
| | - W-T Zhang
- International Doctoral School, University of Seville, 41013, Spain
| | - S-S Gao
- International Doctoral School, University of Seville, 41013, Spain
| | - R-Z Zhao
- Department of Ophthalmology, Hermanos Ameijeiras Hospital, 10400 Habana, Cuba
| | - W-J Yu
- Department of Neurology, Yan'an University Medical College No. 3 Affiliated Hospital, 712000 Shaanxi, China
| | - G Izquierdo
- Multiple Sclerosis Unit, Neurology Service, Vithas Nisa Hospital, 41950 Seville, Spain.
| |
Collapse
|
11
|
Drerup M, Roth A, Kane A, Sullivan AB. Therapeutic Approaches to Insomnia and Fatigue in Patients with Multiple Sclerosis. Nat Sci Sleep 2021; 13:201-207. [PMID: 33623461 PMCID: PMC7896778 DOI: 10.2147/nss.s256676] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Accepted: 01/15/2021] [Indexed: 12/19/2022] Open
Abstract
The prevalence of sleep disorders in individuals with multiple sclerosis (MS) is 3-5 times higher compared to the general population. Insomnia Disorder, defined as difficulty falling asleep, maintaining sleep or waking up too early, can lead to significant fatigue, the most common and disabling symptom of MS. In addition, fatigue and insomnia in patients with MS also can overlap with and exacerbate other psychological and physical symptoms. Cognitive behavioral therapy for insomnia (CBT-I) has been shown as an effective treatment for chronic insomnia and burgeoning research has demonstrated the effectiveness of this treatment for insomnia in individuals with a variety of comorbid medical conditions including MS. The purpose of the current review will explore the literature surrounding the prevalence and impact of sleep disorders and fatigue in MS. Additionally, this review will address practical ways to help individuals with MS manage fatigue as well as how to modify typical standard behavioral treatments for insomnia to take into account special considerations for individuals with MS based on the level of disability and other comorbid issues that impact sleep.
Collapse
Affiliation(s)
- Michelle Drerup
- Sleep Disorders Center, Cleveland Clinic, Cleveland, OH, USA
| | - Alicia Roth
- Sleep Disorders Center, Cleveland Clinic, Cleveland, OH, USA
| | - Alexa Kane
- Mellen Center for MS, Cleveland Clinic, Cleveland, OH, USA
| | - Amy B Sullivan
- Mellen Center for MS, Cleveland Clinic, Cleveland, OH, USA
| |
Collapse
|
12
|
Sakkas GK, Giannaki CD, Karatzaferi C, Manconi M. Sleep Abnormalities in Multiple Sclerosis. Curr Treat Options Neurol 2019; 21:4. [DOI: 10.1007/s11940-019-0544-7] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
|