الفهرس 
IntroductionOnly 14 pages are availabe for public view
 |  | from | 244 |  |  |
| | | from | 244 | | |
Abstract
Sleep disturbances are pervasive in MS patients, however there is little attention in research towards them, because patients with decreased sleep quality only observe its sequales, as fatigue and low energy. Sleep disturbances are 2-3 times more common in MS patients than the general population, leading to decreased sleep quality. Moreover, ≥ 50% of MS patients complain of sleep disorders and poor sleep quality, causing EDS, exacerbation of fatigue, depression and reduced pain threshold.
MS patients have both subjective and objective poor sleep quality, with polysomnographic assessment denoting increased number of awakenings and wake after sleep onset leading to decreased sleep efficiency. Individuals with MS are at risk of increased comorbidity associated with sleep problems. Prevalence of sleep problems in MS range from 25 to 54% in most studies.MS patients can be affected by different primary sleep disorders including, insomnia, hypersomnia or narcolepsy, nocturnal movement disorders, SDB, and RBD. There is a bidirectional relation between MS and sleep disorders (i.e. MS worsens sleep disturbances and reverse is true). Common symptoms associated with secondary sleep disturbances include, bladder incontinence, muscle stiffness, spasticity, or spasms and paralysis due to more frequent arousals during night.Patients and Methods: To assess the subjective and objective parameters of sleep in MS patients and to determine factors contributing to poor sleep in MS patients attending Mansoura university hospitals, this study was conducted on 50 patients, with age range between 23 and 52 years who were diagnosed with either RRMS or SPMS with no psychiatric comorbidities and 25 age matched healthy controls not diagnosed with sleep disorders. Demographic and clinical characteristics were collected. All participants completed standardized self-report questionnaires including PSQI, ESS, FSS, BDI, BAI scales and also underwent history taking, general, neurological examination and nocturnal polysomnography evaluation. The characteristics of the patients were investigated as possible correlation between MS and sleep disturbances. These factors included information from patients’ history, examination, sleep questionnaires, brain MRI and PSG.Results: Patients with MS experienced poor sleep quality as evident through higher scores more than five in PSQI in 82% of them, and 50% of them met the criteria of excessive daytime sleepiness. Thirty six patients (72%) had middle insomnia, 46% had initial insomnia. Nine patients (18%) had higher AHI versus none of controls. Seventeen patients (34%) had RLS and ten (20%) had higher PLMI versus none of controls. MS patients also showed abnormalities in the PSG parameters including significant reduction in sleep efficiency, TST, REM sleep%, increase in WASO, N1, N2 sleep%, PLMI and TAI, compared with controls. Second, depression, anxiety, pain, nocturia, fatigue, DMT(immunotherapy), high disability and poor quality of life were significantly associated with poor sleep and considered as independent predictors for it.Conclusion: Patients with MS attending Mansoura university OPC frequently complaining poor sleep quality according to this study. Overall, 82% of MS patients had evidence of one or more sleep disturbances. Our study confirms that MS causes sleep fragmentation in terms of both macro and microstructure. Depression, anxiety, pain, nocturia, fatigue, DMT (immunotherapy), high disability and poor quality of life were the commonest predisposing factors to poor sleep quality. Measures should be taken to improve quality of sleep in these patients including proper diagnosis, identification and management of factors contributing to poor sleep quality.