1016 Sleep Disturbance and Fatigue in Persons with Multiple Sclerosis (PwMS): A Meta-analysis

Abstract

Introduction: Fatigue is among the most common and disabling symptoms in persons with multiple sclerosis (PwMS). Sleep disturbance is thought to contribute to fatigue in MS; however, the magnitude of this relationship varies considerably across studies. Part of this variance may be due to the wide range of sleep parameters investigated in prior studies. The objective of the present study was to systematically and quantitatively investigate the association between sleep disturbance and fatigue in PwMS, with a focus on how this association differs between sleep parameters. Methods: A comprehensive literature search was conducted in five electronic databases: CINAHL, Cochrane, EMBASE, PsycINFO, and PubMed. Of the 1,576 articles screened, 37 studies (n = 6,129) were included based on the following criteria: (1) included at least one measure of fatigue and at least one measure of sleep; and (2) provided sufficient data to obtain bivariate correlations, odds ratios, and/or standardized mean differences for the relationship between sleep and fatigue. Effect sizes were transformed into a common metric (Fischer's z). Separate analyses were conducted based on the sleep parameters assessed and whether the measures were subjective (patient-reported) or objective (PSG, actigraphy). Results: Mean effect sizes (r) for associations between sleep parameters and fatigue were: moderate for objective REMSOL (0.42∗), subjective insomnia (0.36∗), objective sleep-related movement (0.34∗), and objective sleep-disordered breathing (0.28); and weak for subjective sleep-disordered breathing (0.22∗), objective nocturnal arousals (0.22∗), sleep efficiency (0.17∗), sleep onset latency (0.15∗), and sleep duration (0.13). ∗p