ASSOCIATION BETWEEN SLEEP QUALITY AND DEPRESSIVE SYMPTOMATOLOGY IN PATIENTS WITH MULTIPLE SCLEROSIS

  • Isidora R. Semnic Univerzitet u Novom Sadu, Medicinski fakultet
  • Ksenija Gebauer Bukurov
Keywords: MS, sleep, interferon beta, depressive mood

Abstract


Introduction: Sleep quality deterioration and depressive mood are common in patients with multiple sclerosis (MS). The pattern of sleep can be changed due to many psychological and physical symptoms, as well as sociodemographic characteristics occurring within MS. 

Aim: The study aim was to examine the frequency of changes in sleep quality, depression, anxiety and stress, in MS patients, using the following screening tools: the Pittsburgh Sleep Quality Index – PSQI test and the Depression, Anxiety, and Stress Scale – DASS test, whilst taking into account socio-demographic features, disease duration, as well as the score on the Expanded Disability Status Scale – EDSS score. The aim was also to determine the association between the global PSQI score and socio-demographic characteristics, the EDSS score and illness duration, as well as to examine the relation between the global PSQI score and the DASS subscores.

Materials and methods: The study involved 53 patients, aged 19 – 56, with relapsing-remitting MS, treated with interferon beta. The PSQI index, which evaluates sleep quality, the DASS scale for assessing depression, anxiety, and stress, as well as the EDSS score, which evaluates the severity of the disease, were used. The data was interpreted in the SPSS (Statistical Package for the Social Sciences) statistical program (standard statistical methods, bivariate correlation, linear regression).

Results: Sleep quality disorder was present in 44.4% of the examined sample. A positive correlation between the PSQI score and the DASS scale subcscores was established, and linear bivariate regression showed depression (p = 0.001), anxiety (p < 0.001), and stress (p <0.001) to be predictors of the deterioration of sleep quality. A statistically significant correlation between the age of the subjects and sleep quality was determined (p = 0.047).

Conclusion: In MS patients with the relapsing-remitting form of the disease, who are treated with immunomodulatory therapy, a significant association between sleep quality and depression, anxiety, and stress, was detected. Of the sociodemographic characteristics, the only established association was the relation between age structure and sleep quality, measured with the PSQI index.

References

1. Compston A, Coles A. Multiple sclerosis. Lancet. 2008 Oct 25;372(9648):1502-17. doi: 10.1016/S0140-6736(08)61620-7.

2. World Health Organization and Multiple Sclerosis International Federation. Atlas: multiple sclerosis resources in the world 2008. [Internet]. 2008. Available from: https://apps.who.int/iris/handle/10665/43968.

3. Poser S, Poser W, Schlaf G, Firnhaber W, Lauer K, Wolter M, et al. Prognostic indicators in multiple sclerosis. Acta Neurol Scand. 1986 Nov;74(5):387-92. doi: 10.1111/j.1600-0404.1986.tb03531.x.

4. Kostić V, Apostolski S, Bulat P, Bumbaširević L, Cerovac N, Dragašević N, et al. Neurologija za studente medicine. 2nd ed. Beograd: Medicinski fakultet u Beogradu; 2016. p397. 

5. Dyment DA, Ebers GC, Sadovnick AD. Genetics of multiple sclerosis. Lancet Neurol. 2004 Feb;3(2):104-10. doi: 10.1016/s1474-4422(03)00663-x.

6. Sotelo J, Martínez-Palomo A, Ordoñez G, Pineda B. Varicella-zoster virus in cerebrospinal fluid at relapses of multiple sclerosis. Ann Neurol. 2008 Mar;63(3):303-11. doi: 10.1002/ana.21316.

7. Marrie RA. Environmental risk factors in multiple sclerosis aetiology. Lancet Neurol. 2004 Dec;3(12):709-18. doi: 10.1016/S1474-4422(04)00933-0.

8. Ford H. Clinical presentation and diagnosis of multiple sclerosis. Clin Med (Lond). 2020 Jul;20(4):380-383. doi: 10.7861/clinmed.2020-0292.

9. Hubert H. Ultimate review for the neurology boards. New York: Demos Medical Publishing; 2006. p496.

10. Kutzelnigg A, Lucchinetti CF, Stadelmann C, Brück W, Rauschka H, Bergmann M, et al. Cortical demyelination and diffuse white matter injury in multiple sclerosis. Brain. 2005 Nov;128(Pt 11):2705-12. doi: 10.1093/brain/awh641. 

11. Manconi M, Rocca MA, Ferini-Strambi L, Tortorella P, Agosta F, Comi G, et al. Restless legs syndrome is a common finding in multiple sclerosis and correlates with cervical cord damage. Mult Scler. 2008 Jan;14(1):86-93. doi: 10.1177/1352458507080734.  

12. Braley TJ, Boudreau EA. Sleep Disorders in Multiple Sclerosis. Curr Neurol Neurosci Rep. 2016 May;16(5):50. doi: 10.1007/s11910-016-0649-2.

13. Nociti V, Losavio FA, Gnoni V, Losurdo A, Testani E, Vollono C, et al. Sleep and fatigue in multiple sclerosis: A questionnaire-based, cross-sectional, cohort study. J Neurol Sci. 2017 Jan 15;372:387-392. doi: 10.1016/j.jns.2016.10.040.

14. Wallin MT, Culpepper WJ, Campbell JD, Nelson LM, Langer-Gould A, Marrie RA, et al.; US Multiple Sclerosis Prevalence Workgroup. The prevalence of MS in the United States: A population-based estimate using health claims data. Neurology. 2019 Mar 5;92(10):e1029-e1040. doi: 10.1212/WNL.0000000000007035.

15. Krupp L. Fatigue is intrinsic to multiple sclerosis (MS) and is the most commonly reported symptom of the disease. Mult Scler. 2006 Aug;12(4):367-8. doi: 10.1191/135248506ms1373ed.

16. Berger JR, Pocoski J, Preblick R, Boklage S. Fatigue heralding multiple sclerosis. Mult Scler. 2013 Oct;19(11):1526-32. doi: 10.1177/1352458513477924.

17. Cameron MH, Peterson V, Boudreau EA, Downs A, Lovera J, Kim E, et al. Fatigue is associated with poor sleep in people with multiple sclerosis and cognitive impairment. Mult Scler Int. 2014;2014:872732. doi: 10.1155/2014/872732.

18. Veauthier C. Sleep disorders in multiple sclerosis. Review. Curr Neurol Neurosci Rep. 2015 May;15(5):21. doi: 10.1007/s11910-015-0546-0.

19. Braley TJ, Segal BM, Chervin RD. Obstructive sleep apnea and fatigue in patients with multiple sclerosis. J Clin Sleep Med. 2014 Feb 15;10(2):155-62. doi: 10.5664/jcsm.3442.

20. Foschi M, Rizzo G, Liguori R, Avoni P, Mancinelli L, Lugaresi A, et al. Sleep-related disorders and their relationship with MRI findings in multiple sclerosis. Sleep Med. 2019 Apr;56:90-97. doi: 10.1016/j.sleep.2019.01.010.

21. Patten SB, Marrie RA, Carta MG. Depression in multiple sclerosis. Int Rev Psychiatry. 2017 Oct;29(5):463-472. doi: 10.1080/09540261.2017.1322555.

22. Lamargue Hamel D, Deloire M, Ruet A, Charré-Morin J, Saubusse A, Ouallet JC, et al. Deciphering Depressive Mood in Relapsing-Remitting and Progressive Multiple Sclerosis and Its Consequence on Quality of Life. PLoS One. 2015 Nov 10;10(11):e0142152. doi: 10.1371/journal.pone.0142152.

23. Minden SL, Orav J, Reich P. Depression in multiple sclerosis. Gen Hosp Psychiatry. 1987 Nov;9(6):426-34. doi: 10.1016/0163-8343(87)90052-1.

24. Korostil M, Feinstein A. Anxiety disorders and their clinical correlates in multiple sclerosis patients. Mult Scler. 2007 Jan;13(1):67-72. doi: 10.1177/1352458506071161.

25. Mohr DC, Goodkin DE, Bacchetti P, Boudewyn AC, Huang L, Marrietta P, et al. Psychological stress and the subsequent appearance of new brain MRI lesions in MS. Neurology. 2000 Jul 12;55(1):55-61. doi: 10.1212/wnl.55.1.55.

26. Carroll WM. 2017 McDonald MS diagnostic criteria: Evidence-based revisions. Mult Scler. 2018 Feb;24(2):92-95. doi: 10.1177/1352458517751861.

27. Buysse DJ, Reynolds CF 3rd, Monk TH, Berman SR, Kupfer DJ. The Pittsburgh Sleep Quality Index: a new instrument for psychiatric practice and research. Psychiatry Res. 1989 May;28(2):193-213. doi: 10.1016/0165-1781(89)90047-4.

28. Merlino G, Fratticci L, Lenchig C, Valente M, Cargnelutti D, Picello M, et al. Prevalence of 'poor sleep' among patients with multiple sclerosis: an independent predictor of mental and physical status. Sleep Med. 2009 Jan;10(1):26-34. doi: 10.1016/j.sleep.2007.11.004.

29. Stanton BR, Barnes F, Silber E. Sleep and fatigue in multiple sclerosis. Mult Scler. 2006 Aug;12(4):481-6. doi: 10.1191/135248506ms1320oa.

30. Bøe Lunde HM, Aae TF, Indrevåg W, Aarseth J, Bjorvatn B, Myhr KM, et al. Poor sleep in patients with multiple sclerosis. PLoS One. 2012;7(11):e49996. doi: 10.1371/journal.pone.0049996.

31. Feinstein A. Multiple sclerosis and depression. Mult Scler. 2011 Nov;17(11):1276-81. doi: 10.1177/1352458511417835.

32. Lamargue Hamel D, Deloire M, Ruet A, Charré-Morin J, Saubusse A, Ouallet JC, et al. Deciphering Depressive Mood in Relapsing-Remitting and Progressive Multiple Sclerosis and Its Consequence on Quality of Life. PLoS One. 2015 Nov 10;10(11):e0142152. doi: 10.1371/journal.pone.0142152.

33. Galeazzi GM, Ferrari S, Giaroli G, Mackinnon A, Merelli E, Motti L, et al. Psychiatric disorders and depression in multiple sclerosis outpatients: impact of disability and interferon beta therapy. Neurol Sci. 2005 Oct;26(4):255-62. doi: 10.1007/s10072-005-0468-8.

34. Smith SJ, Young CA. The role of affect on the perception of disability in multiple sclerosis. Clin Rehabil. 2000 Feb;14(1):50-4. doi: 10.1191/026921500676724210.

35. Warren S, Greenhill S, Warren KG. Emotional stress and the development of multiple sclerosis: case-control evidence of a relationship. J Chronic Dis. 1982;35(11):821-31. doi: 10.1016/0021-9681(82)90047-9.

36. Feinstein A. Multiple sclerosis, disease modifying treatments and depression: a critical methodological review. Mult Scler. 2000 Oct;6(5):343-8. doi: 10.1177/135245850000600509.

37. Stojanov A, Vojinovic S, Stojanov J, Malobabic M, Stevic M, Milosevic V, et al. Quality of sleep and fatigue in patients with the relapsing-remitting multiple sclerosis during the coronavirus disease-2019 pandemic. Clin Neurol Neurosurg. 2021 Apr 14;205:106640. doi: 10.1016/j.clineuro.2021.106640.

38. Stojanov A, Malobabic M, Milosevic V, Stojanov J, Vojinovic S, Stanojevic G, et al. Psychological status of patients with relapsing-remitting multiple sclerosis during coronavirus disease-2019 outbreak. Mult Scler Relat Disord. 2020 Oct;45:102407. doi: 10.1016/j.msard.2020.102407.

39. Qiu J, Shen B, Zhao M, Wang Z, Xie B, Xu Y. A nationwide survey of psychological distress among Chinese people in the COVID-19 epidemic: implications and policy recommendations. Gen Psychiatr. 2020 Mar 6;33(2):e100213. doi: 10.1136/gpsych-2020-100213.

Published
2023/04/01
Section
Original articles