Sleep Quality in MS Impacted by Comorbidities, Study Finds

In multiple sclerosis (MS), comorbidities are linked to worse sleep quality. A recent study published in Multiple Sclerosis Journal underscore the importance of managing comorbidities for bettering sleep quality in patients with MS.¹

According to the National Multiple Sclerosis Society, over 50% of individuals affected by MS also have a sleeping disorder such as narcolepsy, sleep apnea, or insomnia.² Poor sleep quality can aggravate MS symptoms, and sleep disorders can be brought about by multiple factors, including medications, associated symptoms, or MS itself.

Woman Struggling to Sleep | Image credit: New Africa - stock.adobe.com

In a prior study by the present authors, people living with MS (PwMS) had substantially higher rates of poor sleep quality than the general population (67% vs 33%-45%). PwMS who recently experienced a relapse, or higher levels of disability or “symptom clusters” (depression, anxiety, etc), among other factors, were more likely to have sleep problems as well. Yet, in this study, the relationship between comorbidities and sleep quality was not assessed. Although a limited amount of research has given attention to the influence of comorbidities in PwMS, it has been difficult to quantify the true burden of comorbidities on individual sleep. To expand on this literature, the current authors conducted their new study to investigate these associations in a large Australian cohort with MS.

Data were collected from the Australian Multiple Sclerosis Longitudinal Study, the MS Nurses and Sleep Survey that took place between February and April of 2020, and the Lifestyle and Environment Surveys (October-December of 2016, 2018, and 2020) to gather comorbidity information. A total of 1597 participants were included who provided both comorbidity data and completed the Pittsburgh Sleep Quality Index (PSQI), a 19-item questionnaire about sleep quality over the last month).

The analysis revealed that higher PSQI scores correlated with a greater number of total comorbidities. Having 2 to 3 (95% CI, 1.22-2.89) or 4 or more (95% CI, 3.03-4.68) of any comorbidities, as well as having 1 (95% CI, 0.29-1.84), 2 to 3 (95% CI, 1.32-2.69), or 4 or more (95% CI, 3.03-4.41) doctor-diagnosed comorbidities was significantly associated with higher PSQI scores (P < .001). Among the comorbidities significantly linked to greater PSQI scores were autoimmune diseases, anxiety, depression, myocardial infarction, anemia, rheumatoid arthritis, type 2 diabetes, inflammatory bowel disease, heart disease, eye diseases, allergies, migraines, hypertension, and high cholesterol.

As the authors conclude, they emphasize how “mental health disorders emerged as the most prominent comorbidity group, accounting for nearly half of the overall effect, underscoring the substantial influence of mental health disorders on sleep quality. Although the specific impact of comorbidity groups on sleep quality in MS has not been examined in previous studies, evidence supports that psychological burdens, including depression, exerting a deleterious effect on sleep in MS.”

They add that prior research has indicated that sleep may impact depression and that examining this bidirectional relationship could be a fruitful venture in future research.

In light of these findings, the researchers argue the value of managing or treating comorbidities in PwMS as a means to better sleep outcomes in affected patients.

References

1. Dagnew B, Laslett LL, Honan CA, et al. The association of comorbidities with sleep quality among Australians with multiple sclerosis: Insights from the Australian Multiple Sclerosis Longitudinal Study. Mult Scler. 2024:13524585241248278. doi:10.1177/13524585241248278

2. Sleep and multiple sclerosis. National Multiple Sclerosis Society. Accessed May 13, 2024. https://www.nationalmssociety.org/managing-ms/living-with-ms/diet-exercise-and-healthy-behaviors/sleep#:~:text=Research%20shows%20that%20more%20than,and%20even%20the%20disease%20itself