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Aldughmi M.1, Siengsukon C.2
1University of Jordan, Department of Physiotherapy, Amman, Jordan, 2University of Kansas Medical Center, Department of Physical Therapy and Rehabilitation Science, Kansas City, United States
Background: Fatigue is experienced by up to 90% of people with multiple sclerosis (MS), and around 50% of people with MS report sleep disturbances. There is no consensus about an efficient clinical measure that assesses both fatigue and sleep in people with MS. The Neurological Fatigue Index (NFI-MS) is a self-report measure that has been validated to assess fatigue in people with MS and is the only fatigue scale that contains a sleep component that assess how sleep quality contributes to fatigue.
Purpose: To examine the relationship between the NFI-MS components and the gold standard self-reported measure of sleep, the Pittsburgh Sleep Quality Index (PSQI).
Methods: Fifty-two individuals with relapsing-remitting or secondary-progressive MS (46.8 ± 10.1 years of age) participated in this study. Participants completed the NFI-MS which consists of 23 questions to assess fatigue in the past two weeks and completed the PSQI that assess sleep quality in the past month. The NFI-MS has a physical, cognitive, and two sleep components (relief by diurnal sleep and abnormal nocturnal sleep). Spearmans correlations were utilized to examine the associations between the PSQI global score and the NFI-MS components.
Results: There was a significant positive association between the NFI-MS abnormal nocturnal sleep component and the PSQI global score (r= .571, p= .001), meaning higher fatigue affected by abnormal sleep is associated with poorer sleep quality. Also, there was a significant positive association between the NFI-MS physical component and PSQI global score (r= .431, p= .001), meaning higher physical fatigue is associated with poorer sleep quality. There were no significant associations between PSQI global score and the remaining NFI-MS components (relief by diurnal sleep and cognitive components).
Conclusion(s): The results of this study demonstrate that poor sleep quality measured using the PSQI increases both physical fatigue and fatigue caused by abnormal nocturnal sleep in people with MS. However, it appears that poor sleep quality is not associated with higher cognitive fatigue in these patients.
Implications: The NFI-MS is a quick, easy to administer scale that can be used in clinics to assess fatigue and the effect of abnormal sleep on fatigue in people with MS. The finding that physical fatigue is associated with poor sleep quality emphasize the need for therapists to consider the assessment of sleep quality during the rehabilitation process and possibly incorporate sleep education as part of the treatment plan.
Funding acknowledgements: The study was not funded.
Topic: Neurology
Ethics approval: The study was approved by the institutional review board of the University of Kansas Medical Center, Kansas, United States.
All authors, affiliations and abstracts have been published as submitted.
