POVEZANOST KVALITETA SPAVANJA I DEPRESIVNIH OBELEŽJA KOD PACIJENATA OBOLELIH OD MULTIPLE SKLEROZE
Sažetak
Uvod: Promena kvaliteta spavanja i depresivnost su učestali kod pacijenata obolelih od multiple skleroze (MS). Kvalitet spavanja može biti povezan sa mnogobrojnim afektivnim i telesnim simptomima kao i sociodemografskim karakteristikama u okviru MS-a.
Cilj: Cilj studije je bio da se utvrdi učestalost promena kvaliteta spavanja, depresije, anksioznosti i stresa kod pacijenata obolelih od MS-a, primenom sledećih skrining testova: Picburški indeks kvaliteta spavanja – PSQI test (engl. Pittsburgh Sleep Quality Index) i Skala depresivnosti, anksioznosti i stresa 21 – DASS-21 test (engl. Depression, Anxiety, and Stress Scale), uzimajući u obzir sociodemografske karakteristike, dužinu trajanja bolesti, kao i skor na Proširenoj skali stanja invaliditeta u MS-u – EDSS skor (engl. Expanded Disability Status Scale). Takođe je cilj bio i da se utvrdi povezanost ukupnog PSQI skora i sociodemografskih obeležja, kao i EDSS skora i dužine trajanja bolesti, te da se ispita korelacija između ukupnog PSQI skora i DASS-21 podskorova.
Materijali i metode: U istraživanje je bilo uključeno 53 bolesnika, starosti 19 – 56 godina, obolelih od MS-a relapsno-remitentnog toka, lečenih interferonom beta. Primenjeni su: PSQI indeks, koji procenjuje kvalitet spavanja, te DASS-21 skala za procenu depresije, anksioznosti i stresa, dok je težina bolesti izražena EDSS skorom. U programu SPSS (Statistical Package for the Social Sciences) korišćeni su osnovni statistički parametri, bivarijantna korelaciona analiza i linearna regresija.
Rezultati: Poremećaj kvaliteta spavanja je postojao kod 44,4% ispitivanog uzorka. Utvrđena je pozitivna korelacija između PSQI skora i podskorova DASS-21 skale, a linearnom bivarijantnom regresijom, depresija (p = 0,001), anksioznost (p < 0,001) i stres (p < 0,001) su se pokazali prediktorima lošijeg kvaliteta spavanja. Utvrđena je statistički značajna korelacija između godina ispitanika i kvaliteta spavanja (p = 0,047).
Zaključak: Kod obolelih od MS-a relapsno-remitentnog toka, koji su na imunomodulatornoj terapiji, utvrđena je značajna povezanost kvaliteta spavanja i afektivnog statusa. Od ispitivanih sociodemografskih karakteristika, utvrđena je jedino povezanost starosne strukture i kvaliteta spavanja, merenog PSQI skorom.
Reference
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.
