# Prevalence and Associations of Poor Sleep in Patients with Relapsing-Remitting Multiple Sclerosis on Disease-Modifying Therapy

## TL;DR

This study finds that nearly half of relapsing-remitting multiple sclerosis patients on treatment experience poor sleep, with insomnia and anxiety being the main contributors.

## Contribution

The study identifies insomnia severity and anxiety as key independent factors associated with poor sleep in RRMS patients, rather than demographic or disease-related variables.

## Key findings

- Poor sleep was reported by 42% of the RRMS patients on disease-modifying therapy.
- Insomnia severity and anxiety were independently associated with poor sleep quality.
- Demographic or disease-related characteristics were not significantly linked to poor sleep in multivariable analysis.

## Abstract

Background: Sleep disturbances in the multiple sclerosis (MS) population are increasingly recognized, but the factors driving this association remain understudied. This study aimed to determine the prevalence and associations of poor sleep quality in the relapsing–remitting MS (RRMS) population receiving disease-modifying therapy (DMT). Methods: We conducted a cross-sectional study that enrolled 399 individuals diagnosed with RRMS on DMT. Data on patient demographics, clinical presentation, and treatment were systematically evaluated. Sleep-related outcomes were assessed using validated questionnaires—the Pittsburgh Sleep Quality Index (PSQI), Insomnia Severity Index (ISI), Epworth Sleepiness Scale (ESS), Fatigue Severity Scale (FSS), STOP-Bang questionnaire, and Hamilton Anxiety Rating Scale (HAM-A). Independent associations of poor sleep were examined using log-binomial regression to estimate risk ratios (RR). Results: Poor sleep was reported in 42% of the participants in our cohort. In multivariable analysis, only insomnia severity (RR = 1.07; 95% CI 1.05–1.09, p < 0.001) and anxiety (RR = 1.02; 95% CI 1.01–1.04, p = 0.001) remained independently associated with poor sleep. Conclusions: Sleep disturbances are common among patients with RRMS. Insomnia severity and anxiety, rather than demographic or disease-related characteristics, showed independent associations with impaired sleep. Routine screening and targeted interventions addressing insomnia and anxiety may improve sleep quality and, consequently, overall quality of life in this population.