Poor sleep quality and other symptoms affecting quality of life in patients with multiple sclerosis

This study focuses on poor sleep quality and other neuropsychiatric manifestations of multiple sclerosis (MS). Emphasis is put on symptoms of MS, such as pain, depression, anxiety or fatigue, and how they are related to poor sleep quality in MS. Second, the thesis also focuses on bladder, bowel and sexual dysfunction and their relation with sleep quality and health-related quality of life . We found that bladder dysfunction has a negative impact on quality of life in patients with MS irrespective of disease duration. Sexual dysfunction decreases the mental quality of life in patients with shorter disease duration. Regarding sleep quality we found that anxiety, depression, pain and fatigue are frequent symptoms which are related to poor sleep in MS patients. However, their influence on sleep quality differs by disease duration and by gender. Anxiety was the main contributor to poor sleep in patients with shorter disease duration, whereas pain and depression did so in patients with a disease duration of more than 5 years. Regarding gender differences, we found that mood disorders were the main contributors to poor sleep in women, whereas pain worsened sleep in men. Fatigue was found to be the frequent consequence of poor sleep, but we also found other consequences, such as worsening of depression and of pain severity. Finally, via these symptoms functional disability can worsen indirectly. Poor sleep quality is a frequent symptom of MS with multiple causes and consequences, which should be taken into account when treating patients with MS.