Impact of sleep quality on cognitive function and overall quality of life in Egyptian patients with multiple sclerosis
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Background
Patients with multiple sclerosis (MS) are more likely to experience sleep disturbances due to risk factors related to the nature of the disease.
Objectives
To investigate sleep quality in Egyptian MS patients and its relation to the disease's characteristics. Additionally, to assess how sleep disturbances can affect cognitive function and the overall quality of life in those patients.
Subject and method
A total of 162 cases with definite MS based on McDonald’s criteria were recruited from Kafr Elsheikh Neurology Department in collaboration with Zagazig University. The Expanded Disability Status Scale (EDSS) was used, and the patients completed reliable and valid Arabic versions of the PSQI and MSQOL-54 questionnaires. The cognitive function was assessed using the Brief International Cognitive Assessment for Multiple Sclerosis (BICAMS).
Results
The study included 162 patients, demonstrating a strong female predominance (77.2%). The cohort was characterized by a mean age of 31.22 years and a mean age of disease onset of 25.36 years. The disease duration was highly variable, ranging from one to 33 years. Eighty-five percent of patients, especially men, were classified as poor sleepers, with a median score of 7.5 on the global PSQI score, which ranged from 0 to 19. Age, longer disease duration, higher relapse rate (< 0.001**), sensory symptoms, sphincteric affection, secondary progression, greater EDSS, and brain stem lesions (< 0.001**) are all linked to poor sleep quality. As evidenced by MS patients' lower scores on the SDMT and CVLT, inadequate sleep has a negative impact on several cognitive domains (< 0.001**). Sleep duration and latency, sleep disruption, daytime dysfunction, and global PSQI score have all demonstrated negative correlations with physical and mental health components of the MSQOL-54 questionnaire. Age, total PSQI disease activity, and disease duration were independent predictors of both physical and mental health in regression analysis.
Conclusion
These findings confirm that poor sleep quality is highly prevalent in Egyptian MS patients, particularly males. Poor sleep quality was associated with some disease metrics such as longer duration, higher relapse rates, and the presence of sensory symptoms, sphincteric affection, SPMS, and higher EDSS, and significantly correlated with impaired cognitive function and a reduced overall quality of life. Sleep disturbances represent a substantial and often overlooked burden in the management of MS. Therefore, clinicians managing MS patients should consistently assess for sleep quality.
