Sleep disturbance and fatigue in multiple sclerosis: A systematic review and meta-analysis.

Sleep disturbance is common in people with multiple sclerosis and may worsen fatigue; however, the assessment of sleep-fatigue relationships varies across studies. To better understand sleep-fatigue relationships in this population, we conducted a systematic review and random effects meta-analyses for the associations between fatigue and 10 sleep variables: Sleep-disordered breathing, daytime sleepiness, sleep quality, insomnia, restless legs, number of awakenings, sleep efficiency, sleep latency, sleep duration, and wake after sleep onset. Of the 1062 studies screened, 46 met inclusion criteria and provided sufficient data for calculating Hedges' g. Study quality was assessed using the Newcastle-Ottawa Scale. Sample characteristics did not differ between the 10 analyses. Results indicated that sleep quality and insomnia (assessed via self-report or diagnostic criteria) were strongly associated with fatigue (all gs ≥ 0.80 and all ps < .001). In contrast, the number of awakenings and sleep duration (assessed objectively) were not significantly associated with fatigue. Remaining sleep variables yielded moderate, significant effects. Most effects did not vary based on study quality or sample demographics. Results highlight that insomnia and perceptions of poor sleep have a stronger link than objective sleep duration to fatigue in multiple sclerosis and may represent a more effective target for intervention.

Reliability and validity of the multiple sclerosis resiliency scale (MSRS).

OBJECTIVE: The objective of this study was to determine the internal reliability and construct validity of the Multiple Sclerosis Resiliency Scale (MSRS) in comparison with a common measure of global resilience. METHODS: Participants were 216 community-dwelling adults with MS (mean age: 48.8 ± 12.5 years; 77% female; median disease duration: 8 years) recruited through a university-affiliated MS Center. Participants completed the MSRS, 10-item Connor Davidson Resilience Scale (CDRS), Perceived Stress Scale (PSS), and depressive and anxious symptom items from the SymptoMScreen. RESULTS: The MSRS exhibited fair to excellent internal consistency (αs 0.74 to 0.91) and divergent validity with disability severity (r = -0.19), MS duration (r = 0.07), and MS subtype (r = -0.01). The MSRS total and Emotional and Cognitive Strategies subscale scores were moderately correlated with the CDRS (rs = 0.50 and 0.62), PSS (rs = -0.56 and - 0.62), depressive symptoms (rs = -0.49 and - 0.54), and anxious symptoms (rs = -0.38 and - 0.047). The MSRS total and Emotional and Cognitive Strategies subscale scores exhibited fair to good accuracy (AUCs = 0.73 to 0.83) for identifying participants in the highest and lowest CDRS quartiles; however, cutoff scores yielded only fair sensitivity and specificity, and the measures differed significantly in classification of participants into highest and lowest quartiles. CONCLUSION: Although the MSRS may be useful in assessing resilience to MS-specific challenges, use of a global resilience measure may still be indicated depending on the clinical and research context.

Cognitive Assessment of Individuals with Multiple Sclerosis in the Arab World: a Systematic Review.

The prevalence of multiple sclerosis (MS) is on the rise globally, and recent epidemiological studies have observed increased rates in the Arab world (i.e., countries of North Africa and the Middle East where Arabic is the primary language). However, assessment of cognitive impairment and its relevant covariates (e.g., fatigue and depressive symptomatology) in the Arab world has not been rigorously reviewed. Thus, the objective of the present study was to systematically review the current use of cognitive assessment measures in observational and interventional studies of individuals with MS in the Arab world. A systematic review of studies that assessed cognitive function in adults with MS in the Arab world was conducted using PubMed, PsycINFO, CINAHL, The Cochrane Library, Embase, WHO Global Index Medicus, and Ovid Global Health. Studies that featured at least one objective cognitive measure were included. Eligible studies were reviewed for bias and study quality using the QUADAS-2 and NIH QAT. Study characteristics and finding were extracted by two independent reviewers, with results confirmed by a third reviewer. A total of 13 (N = 846) studies met inclusion criteria. Risk of bias and included measures varied across studies. Results demonstrated inconsistent availability and use of MS cognitive assessment tools across the Arab world. An Arabic version of the BICAMS was the only cognitive battery that was evaluated with regard to psychometric properties. The most common individual test include in reviewed studies was the SDMT. However, validation studies are still needed for this and a number of other measures. Other measures are still in the early stages of translation and cultural-linguistic norming. This review of cognitive assessment of individuals with MS in the Arab world was limited by variable study quality and measure selection. The present review provides a summary of the tests most commonly used in this region and recommendations for future investigation.