Sleep Disorders Reduce Health-Related Quality of Life in Multiple Sclerosis (Nottingham Health Profile Data in Patients with Multiple Sclerosis)
Abstract
:1. Introduction
2. Results
2.1. Patients
2.1.1. HRQoL in MS Patients with Sleep Disorders Compared to Patients without Sleep Disorders
NHP Global Score and Subscales | Average and Range | All Patients | Patients without Sleep Disorders | Patients with Sleep Disorders | Differences between the Two Subgroups |
---|---|---|---|---|---|
NHP-Total | Mean (±standard deviation) | 146.1 (±119.8) | 67.3 (±60.0) | 175.2 (±123.6) | p = 0.001 |
Min–Max | 0.0–78.7 | 0.0–188.6 | 0.0–413.7 | ||
25–75 | 0.0–32.6 | 21.8–120.5 | 61.3–273.3 | ||
median | 126.4 | 34.8 | 175.5 | ||
Physical abilities | Mean (±standard deviation) | 20.9 (±21.5) | 10.2 (±14.7) | 24.8 (±22.4) | p = 0.010 |
Min–Max | 0.0–78.7 | 0.0–54.5 | 0.0–78.7 | ||
25–75 | 0.0–32.6 | 0.0–22.0 | 10.8–36.5 | ||
median | 12.7 | 0.0 | 21.7 | ||
Social isolation | Mean (±standard deviation) | 11.7 (±19.6) | 3.6 (±8.0) | 14.7 (±21.8) | p = 0.048 |
Min–Max | 0.0–80.6 | 0.0–22.5 | 0.0–80.6 | ||
25–75 | 0.0–20.1 | 0.0–0.0 | 0.0–22.5 | ||
median | 0.0 | 0.0 | 0.0 | ||
Sleep | Mean (±standard deviation) | 29.3 (±29.5) | 10.6 (±15.1) | 36.2 (±30.6) | p = 0.001 |
Min–Max | 0.0–100.0 | 0.0–50.4 | 0.0–100.0 | ||
25–75 | 0.0–16.1 | 0.0–12.6 | 12.6–72.7 | ||
median | 50.4 | 0.0 | 28.7 | ||
Pain | Mean (±standard deviation) | 15.8 (±24.8) | 3.8 (±9.8) | 20.2 (±27.2) | p = 0.009 |
Min–Max | 0.0–100.0 | 0.0–32.3 | 0.0–100.0 | ||
25–75 | 0.0–0.0 | 0.0–0.0 | 0.0–30.6 | ||
median | 26.0 | 0.0 | 9.9 | ||
Energy | Mean (±standard deviation) | 48.9 (±40.9) | 29.9 (±35.5) | 55.8 (±40.9) | p = 0.016 |
Min–Max | 0.0–100.0 | 0.0–100.0 | 0.0–100.0 | ||
25–75 | 0.0–60.8 | 0.0–62.0 | 24.0–100.0 | ||
median | 100.0 | 0.0 | 62.0 | ||
Emotional | Mean (±standard deviation) | 19.6 (±18.8) | 9.3 (±12.2) | 23.5 (±19.5) | p = 0.006 |
Min–Max | 0.0–69.0 | 0.0–41.4 | 0.0–69.0 | ||
25–75 | 0.0–30.9 | 0.0–18.6 | 5.3–41.4 | ||
median | 16.8 | 0.0 | 21.0 |
2.1.2. Comparison of the Global NHP Values (Global HRQoL) in the Four Subgroups
NHP Values | Average and Range | All Patients | NSD | INS | OSA | PLM | Differences between the Two Subgroups |
---|---|---|---|---|---|---|---|
Total | Mean (SD) | 146.1 | 67.3 | 220.3 | 239.6 | 119.9 | NSD
vs. OSA p = 0.003 NSD vs. INS p < 0.0001 INS vs. PLM p = 0.002 OSA vs. PLM p = 0.042 NSD vs. PLM p = 0.210 OSA vs. INS p = 0.804 |
Standard deviation | 119.8 | 60.0 | 88.2 | 136.2 | 123.7 | ||
Min–Max | 0.0–78.7 | 0.0–188.6 | 60.7–369.9 | 24.7–413.7 | 0.0–408.61 | ||
25–75 | 0.0–32.6 | 21.8–120.5 | 147.0–276.0 | 180.8–393.3 | 29.7–174.4 | ||
Median | 126.4 | 34.8 | 212.3 | 194.9 | 75.8 |
2.1.3. Comparison of the NHP Subscales in the Four Subgroups
Kruskal–Wallis-Test
NHP Total | Physical Abilities | Social Isolation | Sleep | Pain | Energy | Emotional |
---|---|---|---|---|---|---|
p < 0.0001 | p = 0.007 | p = 0.054 | p = 0.001 | p = 0.034 | p < 0.0001 | p < 0.0001 |
Mann–Whitney-U-Test
Subscales | Average and Range | All Patients | NSD | INS | OSA | PLM | Differences between the Two Subgroups |
---|---|---|---|---|---|---|---|
Physical abilities | Mean (Standard deviation) | 20.9 (21.5) | 10.2 (14.7) | 27.4 (20.8) | 41.0 (24.3) | 17.7 (20.8) | NSD
vs. OSA p = 0.003 NSD vs. INS p = 0.009 INS vs. PLM p = 0.138 OSA vs. PLM p = 0.032 NSD vs. PLM p = 0.211 OSA vs. INS p = 0.260 |
Min–Max | 0.0–78.7 | 0.0–54.5 | 0.0–77.3 | 10.8–78.2 | 0.0–78.7 | ||
25–75 | 0.0–32.6 | 0.0–21.9 | 10.8–42.6 | 21.7–67.2 | 0.0–25.8 | ||
Median | 12.7 | 0.0 | 22.0 | 32.6 | 11.2 | ||
Social isolation | Mean (Standard deviation) | 11.7 (19.6) | 3.6 (8.0) | 12.8 (19.0) | 29.5 (31.0) | 11.6 (19.4) | For this subgroup no Mann–Whitney-U-Test was performed (see Table 2) |
Min–Max | 0.0–80.6 | 0.0–22.5 | 0.0–64.7 | 0.0–80.6 | 0.0–63.9 | ||
25–75 | 0.0–20.1 | 0.0–0.0 | 0.0–22.5 | 0.0–63.9 | 0.0–20.2 | ||
Median | 0.0 | 0.0 | 0.0 | 20.1 | 0.0 | ||
Sleep | Mean (Standard deviation) | 29.3 (29.5) | 10.6 (15.2) | 48.7 (26.7) | 26.8 (27.4) | 29.5 (32.4) | NSD
vs. OSA p = 0.087 NSD vs. INS p < 0.0001 INS vs. PLM p = 0.048 OSA vs. PLM p = 0.980 NSD vs. PLM p = 0.063 OSA vs. INS p = 0.075 |
Min–Max | 0.0–100.0 | 0.0–50.4 | 0.0–77.6 | 0.0–77.6 | 0.0–100 | ||
25–75 | 0.0–16.1 | 0.0–12.6 | 25.2–75.2 | 12.6–50.4 | 0.0–50.4 | ||
Median | 50.4 | 0.0 | 50.4 | 12.6 | 14.3 | ||
Pain | Mean (Standard deviation) | 15.8 (24.8) | 3.8 (9.8) | 21.9 (23.9) | 27.0 (31.4) | 16.6 (28.9) | NSD
vs. OSA p = 0.114 NSD vs. INS p = 0.012 INS vs. PLM p = 0.221 OSA vs. PLM p = 0.469 NSD vs. PLM p = 0.117 OSA vs. INS p = 0.804 |
Min–Max | 0.0–100.0 | 0.0–32.7 | 0.0–69.8 | 0.0–80.2 | 0.0–100.0 | ||
25–75 | 0.0–0.0 | 0.0–0.0 | 0.0–40.1 | 0.0–56.9 | 0.0–18.6 | ||
Median | 26.0 | 0.0 | 15.8 | 26.0 | 0.0 | ||
Energy | Mean (Standard deviation) | 48.9 (40.9) | 29.9 (35.5) | 78.5 (28.7) | 80.5 (38.0) | 30.5 (35.4) | NSD
vs. OSA p = 0.007 NSD vs. INS p < 0.0001 INS vs. PLM p < 0.0001 OSA vs. PLM p = 0.013 NSD vs. PLM p = 0.790 OSA vs. INS p = 0.710 |
Min–Max | 0.0–100.0 | 0.0–100.0 | 24.0–100.0 | 0.0–100.0 | 0.0–100.0 | ||
25–75 | 0.0–60.8 | 0.0–62.0 | 60.8–100.0 | 63.2–100.0 | 0.0–61.4 | ||
Median | 100.0 | 0.0 | 100.0 | 100.0 | 24.0 | ||
Emotional | Mean (Standard deviation) | 19.6 (18.8) | 9.3 (12.2) | 30.9 (19.8) | 34.8 (16.8) | 14.1 (15.9) | NSD
vs. OSA p = 0.001 NSD vs. INS p = 0.001 INS vs. PLM p = 0.007 OSA vs. PLM p = 0.008 NSD vs. PLM p = 0.392 OSA vs. INS p = 0.619 |
Min–Max | 0.0–69.0 | 0.0–41.4 | 0.0–69.0 | 13.6–55.9 | 0.0–48.5 | ||
25–75 | 0.0–30.9 | 0.0–18.6 | 14.1–47.1 | 17.0–52.0 | 0.0–22.7 | ||
Median | 16.8 | 0.0 | 30.9 | 30.9 | 10.9 |
2.1.4. Comparison of the Objective (PSG) Sleep Parameters and the NHP Sleep Items
Items | Average and Range | Sleep Efficiency | Awakenings | Arousal-Index | Sleep Latency | Wake after Sleep Onset |
---|---|---|---|---|---|---|
I sleep badly at night YES | Mean (±standard deviation) | 73.6 (±12.6) | 25.5 (±7.7) | 18.5 (±9.6) | ||
Min–Max | 50–94 | 9–41 | 3.9–43.9 | |||
25–75 | 63.7–83.5 | 20–30.5 | 12.2–22.9 | |||
median | 74.8 | 26.0 | 16.5 | |||
I sleep badly at night NO | Mean (±standard deviation) | 76.7 (±16.2) | 27.5 (±14.2) | 20.5 (±10.0) | ||
Min–Max | 8–93 | 8–72 | 1.1–47.1 | |||
25–75 | 73.0–87.1 | 17.8–33.3 | 14.4–24.9 | |||
median | 80.45 | 26.0 | 21.7 | |||
Differences between YES and NO | p = 0.148 | p = 0.860 | p = 0.255 | |||
I lie awake for most of the night YES | Mean (±standard deviation) | 76.2 (±15.0) | ||||
Min–Max | 8–93 | |||||
25–75 | 69.8–87.0 | |||||
median | 79.7 | |||||
I lie awake for most of the night NO | Mean (±standard deviation) | 71.1 (±13.5) | ||||
Min–Max | 50–94 | |||||
25–75 | 60.0–80.7 | |||||
median | 69.6 | |||||
Differences between YES and NO | p = 0.175 | |||||
It takes me a long time to get to sleep YES | Mean (±standard deviation) | 38.5 (±39.8) | ||||
Min–Max | 2–198 | |||||
25–75 | 15.3–49.5 | |||||
median | 29.0 | |||||
It takes me a long time to get to sleep NO | Mean (±standard deviation) | 26.4 (±31.1) | ||||
Min–Max | 0–190 | |||||
25–75 | 11.0–32.0 | |||||
median | 21.0 | |||||
Differences between YES and NO | p = 0.08 | |||||
I’m waking up in the early hours of the morning YES | Mean (±standard deviation) | 88.4 (±59.0) | ||||
Min–Max | 27–258 | |||||
25–75 | 43.0–73.0 | |||||
median | 73.0 | |||||
I’m waking up in the early hours of the morning NO | Mean (±standard deviation) | 69.8 (±41.4) | ||||
Min–Max | 20–173 | |||||
25–75 | 43.3–88.8 | |||||
median | 52.5 | |||||
Differences between YES and NO | p = 0.336 |
2.2. Correlation between NHP Values and Other Questionnaires
NHP and MFIS | NHP and BDI | NHP and PSQI |
---|---|---|
p < 0.0001 | p < 0.0001 | p < 0.0001 |
r = 0.737 | r = 0.836 | r = 0.612 |
Correlation between NHP Values and the MFIS Subscales
NHP and Cognitive MFIS-Subscale | NHP and Physical MFIS-Subscale | NHP and Psychosocial MFIS-Subscale |
---|---|---|
p < 0.0001 | p < 0.0001 | p < 0.0001 |
r = 0.635 | r = 0.726 | r = 0.548 |
3. Discussion
4. Experimental Section
4.1. Literature Search
4.2. Patients
4.3. Data Collection
4.4. Polysomnography and Scoring Criteria
4.5. Statistical Analyses
5. Conclusions
Acknowledgments
Author Contributions
Conflicts of Interest
References
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Veauthier, C.; Gaede, G.; Radbruch, H.; Wernecke, K.-D.; Paul, F. Sleep Disorders Reduce Health-Related Quality of Life in Multiple Sclerosis (Nottingham Health Profile Data in Patients with Multiple Sclerosis). Int. J. Mol. Sci. 2015, 16, 16514-16528. https://doi.org/10.3390/ijms160716514
Veauthier C, Gaede G, Radbruch H, Wernecke K-D, Paul F. Sleep Disorders Reduce Health-Related Quality of Life in Multiple Sclerosis (Nottingham Health Profile Data in Patients with Multiple Sclerosis). International Journal of Molecular Sciences. 2015; 16(7):16514-16528. https://doi.org/10.3390/ijms160716514
Chicago/Turabian StyleVeauthier, Christian, Gunnar Gaede, Helena Radbruch, Klaus-Dieter Wernecke, and Friedemann Paul. 2015. "Sleep Disorders Reduce Health-Related Quality of Life in Multiple Sclerosis (Nottingham Health Profile Data in Patients with Multiple Sclerosis)" International Journal of Molecular Sciences 16, no. 7: 16514-16528. https://doi.org/10.3390/ijms160716514