Sleep disturbances and their clinical and psychiatric correlates in pediatric-onset multiple sclerosis

Sleep disturbance is increasingly recognized as a contributor to disease burden in adult-onset multiple sclerosis (MS), and emerging pediatric studies suggest that sleep-related problems may also be prevalent early in pediatric-onset MS (POMS). However, the multidimensional nature of sleep disturbance and its clinical correlates in POMS remain insufficiently characterized. This study aimed to evaluate multidimensional sleep disturbances in children and adolescents with POMS and to examine their associations with emotional symptoms, fatigue, quality of life (QoL), and MRI features.

In this multicenter cross-sectional study, children and adolescents with POMS were compared with age- and sex-matched healthy controls. Sleep disturbance and daytime sleepiness were assessed using standardized questionnaires covering multiple sleep domains. Emotional symptoms, fatigue, and quality of life were evaluated using validated scales. Clinical characteristics and MRI data, including lesion distribution, were obtained from medical records. Associations were examined using correlation and hierarchical regression analyses.

Compared with healthy controls, patients with POMS demonstrated significantly higher global sleep disturbance and daytime sleepiness across several domains, including sleep initiation and maintenance difficulties, sleep-breathing symptoms, and altered sleep-wake transitions (all p < 0.05). Greater sleep disturbance was associated with higher depressive symptoms, increased fatigue, and lower QoL. In regression analyses, depressive symptoms emerged as the strongest independent correlate of sleep disturbance, while brainstem lesion involvement remained independently associated, together explaining approximately 30% of the variance in the POMS group, whereas this association was not observed in healthy controls.

Sleep disturbance represents an early, multidimensional, and clinically meaningful non-motor component of disease burden in POMS. Our findings support a biologically plausible framework in which sleep disturbance is associated with emotional distress and neurobiological factors contributing to reduced quality of life. Sleep may represent a potentially modifiable target for early screening and intervention in pediatric MS.