Disability and Non-Motor Symptoms in Multiple Sclerosis: Exploring Associations and Predictive Factors

The relationship between multiple sclerosis (MS) disability and co-occurring non-motor symptomatology is not well understood. This study examined the association between disability status and non-motor symptoms-sleep quality, depression, anxiety, and fatigue-in people with multiple sclerosis (MS), as well as the contribution of sleep quality to the prediction of fatigue, depression, and anxiety in MS.

A cross-sectional study included 469 MS and 369 control subjects. Disability status of MS subjects was assessed with the Expanded Disability Status Scale (EDSS), while fatigue, depression, anxiety, and sleep quality were evaluated with the Fatigue Severity Scale (FSS), the Hospital Anxiety and Depression Scale (HADS), and the Pittsburgh Sleep Quality Index (PSQI), respectively. Statistical analyses encompassed group comparisons, Pearson correlations, and hierarchical regression models adjusted for age, sex, and EDSS.

The results show that MS subjects exhibited higher FSS, HADS-D, and PSQI scores than controls, with intercorrelations and only weak associations with EDSS severity (r = 0.15-0.29). Moreover, PSQI global and HADS-D scores increased with higher EDSS severity, while FSS scores peaked in the moderate EDSS range (4.5-6.5). Global PSQI score independently predicted FSS, HADS-D, and HADS-A. Daytime dysfunction, sleep disturbances, and sleep medication use significantly predicted FSS, HADS-D, and HADS-A scores.

Study findings highlight the role of sleep quality in exacerbating depression, anxiety, and fatigue in MS.