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MS Associated With Poor Sleep Quality, Anxiety, Depression


More than half of patients with multiple sclerosis (MS) in the BETASLEEP study indicated poor sleep quality, which was linked to fatigue and reduced quality of life over time.

Comorbid conditions are common among the 2 million patients worldwide with multiple sclerosis (MS) and may contribute to disability. Of these comorbidities is poor sleep quality, which has a high prevalence in the population and often leads to fatigue and reduced quality of life over time, according to new research.

Poor sleep quality among the population is also associated with daytime sleepiness, depression, and anxiety, researchers of the BETASLEEP study have found. The results, they said, highlight the importance of interventions targeted at improving sleep quality in these patients.

The prospective, observational study recruited 128 patients from 25 neurological offices and clinics specializing in MS treatment between December 2012 and January 2015. Researchers followed patients for 2 years, with documented visits at baseline, 6 months, 12 months, 18 months, and 2 years. Patients included in the study had relapsing-remitting MS or clinically isolated syndrome and were being treated with interferon beta-1b for less than 6 months.

Read more on comorbidities among patients with MS.

Among the participants, more than half (55.47%) reported poor seep quality at the beginning of the study, compared with 37.7% at the completion of the study. According to the researchers, the decrease may be attributed to the decreasing number of patients with an evaluable sleep score throughout the study. They noted that it could also be attributable to a stable course of disease achieved from treatment with interferon beta-1b.

Participants who indicated poor sleep quality were more likely to report experiencing fatigue compared to those who reported good sleep quality. Researchers also detected poorer functional health status among poor sleepers—indicating lower quality of life—and higher rates of depression, anxiety, and daytime sleepiness.

While the underlying cause of poor sleep quality and fatigue are not fully understood, the researchers noted that restless leg syndrome may play a large role as it’s more common in patients with MS. Restless leg syndrome has also been associated with poor sleep quality.

During the study, researchers observed that, while restless leg syndrome was low (n = 6), all participants with the syndrome were poor sleepers. “This proportion is much lower compared to other studies, where diagnosis of restless leg syndrome was mostly based on questionnaires and standardized questionnaire-based interview,” wrote the researchers.

In the current study, restless leg syndrome was determined by treating physicians, who might not have routinely asked about restless leg syndromes, they note.

At 1-year follow-up, sleep quality and daytime sleepiness at baseline were able to predict poor sleep quality. Meanwhile, no variable predicted sleep quality at the 2-year follow-up.


Kotterba S, Neusser T, Norenberg C, et al. Sleep quality, daytime sleepiness, fatigue, and quality of life in patients with multiple sclerosis treated with intervention interferon beta-1b: results from a prospective observational cohort study [published online August 24, 2018]. BMC Neurology. doi: https://doi.org/10.1186/s12883-018-1113-5.

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