Læknablaðið - sep. 2019, Síða 24
384 LÆKNAblaðið 2019/105
R A N N S Ó K N
Background: Sleep disturbances are common, underdiagnos-
ed and have negative consequences for people with multiple
sclerosis.
Objective: Gather information about the prevalence of poor
sleep quality and sleep disturbances in Icelanders with multiple
sclerosis.
Method: A cross-sectional self-report survey. Population:
Icelanders with multiple sclerosis. Sample: People with multiple
sclerosis, who were on the online mailing list or had access to
Facebook groups of the Multiple-Sclerosis-Society in Iceland. An
electronic link with background questions and 4 questionnaires
was available to participants. Questionnaires: The Pittsburgh-
Sleep-Quality-Index (PSQI), the Insomnia-Severity-Index, the
STOP-Bang-questionnaire and 5 diagnostic criteria for restless
legs syndrome. Questionnaires were used to screen for poor
sleep quality, and 7 different factors that can cause disturbed
sleep. Data was analyzed with SPSS version 25.
Results: Almost 40% of Icelanders with multiple sclerosis
participated or 234 persons. Mean age was 47 years (range
20-92) and 77% were female. The prevalence of poor sleep quality
(PSQI>5), was 68%. The factors that most often caused dis-
turbed sleep were; bathroom breaks (39%), pain (37%), insomnia
symptoms (30%) and sleep apnea symptoms (24%). Majority of
participants or 79% had at least one sleep disturbance and on
average they had close to two. Insomnia symptoms were strongly
related to poor sleep quality.
Conclusion: High prevalence of poor sleep quality and sleep
disturbances in people with multiple sclerosis needs to be
addressed. PSQI can be used to screen for poor sleep quality and
to assess whether further sleep evaluation is needed. Screening,
diagnosis and treatment of insomnia should be implemented.
Prevalence of Poor Sleep Quality and Sleep Disturbances
in Icelanders with Multiple Sclerosis
ENGLISH SUMMARY
1Reykjalundur rehabilitation center, Mosfellsbaer, Iceland, 2Department of Health Sciences, University of Akureyri, Akureyri, Iceland, 3Akureyri Hospital, Akureyri,
Iceland, 4Department of Physiology, Faculty of Medicine, University of Iceland.
Key words: Multiple sclerosis, sleep quality, sleep disturbances, obstructive sleep apnea, restless legs syndrome, insomnia.
Correspondence: Aðalbjörg Albertsdóttir, adalbjorg.alberts@reykjalundur.is
1. National Clinical Guideline Centre. Multilple Sclerosis.
Management of Multiple Sclerosis in Primary and
Secondary Care. NICE Clincal Guidelines. London 2014.
2. Lunde HMB, Bjorvatn B, Myhr K-, Bø L. Clinical
assessment and management of sleep disorders in
multiple sclerosis: a literature review. Acta Neurol Scand
2013; 127: 24-30.
3. Ma S, Rui X, Qi P, Liu G, Yang J. Sleep disorders in patients
with multiple sclerosis in China. Sleep Breath 2017; 21:
149-54.
4. Braley TJ, Segal BM, Chervin RD. Obstructive sleep apnea
and fatigue in patients with multiple sclerosis. J Clin Sleep
Med 2014; 10: 155-62.
5. Brass SD, Li C, Auerbach S. The underdiagnosis of sleep
disorders in patients with multiple sclerosis. J Clin Sleep
Med 2014; 10: 1025-31.
6. Strober LB. Fatigue in multiple sclerosis: A look at the role
of poor sleep. Front Neurol 2015; 6: 21.
7. Minden SL, Frankel D, Hadden L, Perloff J, Srinath KP,
Hoaglin DC. The Sonya Slifka longitudinal multiple scler-
osis study: methods and sample characteristics. Mult Scler
2006; 12: 24-38.
8. Fisk JD, Pontefract A, Ritvo PG, Archibald CJ, Murray TJ.
The impact of fatigue on patients with multiple sclerosis.
Can J Neurol Sci 1994; 21: 9-14.
9. Braley TJ, Boudreau EA. Sleep disorders in multiple scler-
osis. Curr Neurol Neurosci Rep 2016; 16: 50.
10. Côté I, Trojan D, Kaminska M, Cardoso M, Benedetti
A, Weiss D, et al. Impact of sleep disorder treatment on
fatigue in multiple sclerosis. Mult Scler 2013; 19: 480-9.
11 Darien IL (ritsj). International classification of sleep
disorders–third edition. American Academy of Sleep
Medicine, USA 2014.
12. Buysse DJ, Reynolds CF, Monk TH, Berman SR, Kupfer
DJ. The Pittsburgh sleep quality index: A new instrument
for psychiatric practice and research. Psychiatry Res 1989;
28: 193-213.
13. Mollayeva T, Thurairajah P, Burton K, Mollayeva S,
Shapiro CM, Colantonio A. The Pittsburgh sleep quality
index as a screening tool for sleep dysfunction in clinical
and non-clinical samples: a systematic review and meta-
analysis. Sleep Med Rev 2016; 25: 52-73.
14. Elíasdóttir Ó, Kjartansson Ó, Olafsson E. Prevalence of
multiple sclerosis in Iceland. Neuroepidemiology 2018; 51:
50-6.
15. hagstofa.is – hagstofa.is/utgafur/frettasafn/mannfjoldi/
mannfjoldinn-a-3-arsfjordungi-2018/ - janúar 2019.
16. Albertsdóttir A, Sigurðardóttir AK, Þorleifsdottir B.
Rannsókn á svefngæðum fólks með MS á Íslandi.
MS-blaðið 2018; 35: 22-3. msfelag.is/static/files/Greinar/
LyfogMedferdir/msbladid_201802_adalbjorgalberts_
svefngaedi.pdf - janúar 2019.
17. msfelag.is - msfelag.is/is/felagid/frodleikur/frettir/
konnun-a-svefngaedum-folks-med-ms-a-islandi – janúar
2019.
18. Hinz A, Glaesmer H, Brähler E, Löffler M, Engel
C, Enzenbach C, et al. Sleep quality in the general
population: psychometric properties of the Pittsburgh
sleep quality index, derived from a German community
sample of 9284 people. Sleep Med 2017; 30: 57-63.
19. Þórðardóttir EB. Long-term health consequences of
avalanches in Iceland in 1995: A 16 year follow-up. Thesis
for the degree of Philosophiae Doctor. University of
Iceland, Reykjavík 2016. hdl.handle.net/1946/24937 – jan-
úar 2019.
20. Bastien CH, Vallières A, Morin CM. Validation of the
Insomnia severity index as an outcome measure for
insomnia research. Sleep Med 2001; 2: 297-307.
21. Morin CM, Belleville G, Bélanger L, Ivers H. The Insomnia
severity index: psychometric indicators to detect insomnia
cases and evaluate treatment response. Sleep 2011; 34: 601-
8.
22. Nagappa M, Liao P, Wong J, Auckley D, Ramachandran
SK, Memtsoudis S, et al. Validation of the STOP-Bang
questionnaire as a screening tool for obstructive sleep
apnea among different populations: a systematic review
and meta-analysis. PLoS ONE 2015; 10: e0143697.
23. irlssg.org/diagnostic-criteria – janúar 2019.
24. Hulsen T, Vlieg Jd, Alkema W. BioVenn – a web app-
lication for the comparison and visualization of biological
lists using area-proportional Venn diagrams. BMC
Genomics 2008; 9: 488.
25. Manconi M, Ferini-Strambi L, Filippi M, Bonanni E,
Ludice A, Murri L, et al. Multicenter case-control study
on restless legs syndrome in multiple sclerosis: The REMS
Study. Sleep 2008; 31: 944-52.
26. Bauters F, Rietzschel ER, Hertegonne KBC, Chirinos
JA. The link between obstructive sleep apnea and
cardiovascular disease. Curr Atheroscler Rep 2016; 18: 1.
27. Walker M. Why We Sleep. Scribner, New York 2017.
28. Sateia MJ. International Classification of Sleep Disorders-
Third Edition. CHEST 2014; 146: 1387-94.
Heimildir
Greinin barst til blaðsins 2. apríl 2019, samþykkt til birtingar 7. ágúst 2019.
Aðalbjörg Albertsdóttir1
Árún K. Sigurðardóttir2,3
Björg Þorleifsdóttir4