Modifiable Predictors of Sleep Quality in Multiple Sclerosis: A Prospective Cohort Study
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Background
Poor sleep quality is common in people with multiple sclerosis (pwMS) and reduces quality of life.
Objectives
To examine associations between modifiable factors and sleep quality in pwMS.
Methods
In a prospective clinic cohort (2017–2023), we evaluated whether baseline measures of disability, depression, fatigue, and pain were associated with poor sleep quality (Pittsburgh Sleep Quality Index, PSQI) cross-sectionally using covariate-adjusted linear regression, structural equation modeling (SEM), and LASSO logistic regression, and longitudinally using mixed-effects models.
Results
In this cohort (n=750; mean age 48.9 years; 80.3% women, 88.7% relapsing type), higher body mass index (β [95% CI]: 0.06 [0.01, 0.12], p=.001) and area deprivation index (6.78 [2.17, 11.39], p<.001) were associated with worse baseline PSQI scores. In adjusted analyses (n=730), disability, depression, fatigue, and pain were each associated with worse sleep. In SEM, pain had a moderate direct effect on sleep (β [95% CI]: 0.56 [0.48, 0.64], p<.001). LASSO models that included pain outperformed the benchmark (AUROC 0.741 vs 0.517). Longitudinally (n=382), time and higher baseline pain predicted worse sleep (β [95% CI]: time in months 0.04 [0.02, 0.06], p<.001; pain 0.36 [0.31, 0.41], p<.001).
Conclusion
Pain is a key, potentially modifiable driver of poor sleep quality in pwMS.
Key Messages
Sleep disturbance is common in people with MS and often worsens over time.
Higher baseline pain severity was consistently associated with worse sleep quality, both cross-sectionally and longitudinally.
Pain is a key modifiable driver of sleep disturbance and a potentially important therapeutic target for improving overall quality of life.
