Research Article| Volume 56, 103271, November 2021

A multidimensional approach to sleep health in multiple sclerosis

  • Daniel Whibley
    Epidemiology Group, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Scotland, United Kingdom

    Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI, United States
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  • Cathy Goldstein
    Division of Sleep Medicine, Department of Neurology, University of Michigan, Ann Arbor, MI, United States
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  • Anna L. Kratz
    Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI, United States
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  • Tiffany J. Braley
    Corresponding author at: Division of Multiple Sclerosis and Neuroimmunology, Department of Neurology, University of Michigan, C728 Med-Inn Building, 1500 E Medical Center Dr, Ann Arbor, MI 48109, United States.
    Division of Sleep Medicine, Department of Neurology, University of Michigan, Ann Arbor, MI, United States

    Division of Multiple Sclerosis and Neuroimmunology, Department of Neurology, University of Michigan, C728 Med-Inn Building, 1500 E Medical Center Dr, Ann Arbor, MI 48109, United States

    Department of Neurology, Ann Arbor VA, Ann Arbor, United States
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Published:September 20, 2021DOI:


      • A seven-domain framework was used to evaluate the sleep health of people with MS.
      • Objective sleep domains: duration, continuity, timing, regularity, rhythmicity.
      • Subjective sleep domains: daytime sleepiness and perception of sleep quality.
      • Seventy-six percent of the sample had extreme values for ≥2 sleep domains.



      Although sleep disturbances are common among people with Multiple Sclerosis (PwMS), understanding of their impact has been stymied by limitations in approaches to sleep measurement within this population. The aim of this study was to comprehensively phenotype sleep patterns in PwMS through application of an emerging seven-domain framework that includes sleep duration, continuity, timing, quality, rhythmicity, regularity, and sleepiness.


      Sleep domains were estimated from wrist-worn accelerometry, Epworth Sleepiness Scale and Pittsburgh Sleep Quality Index responses. Extreme sleep values within each domain were constructed using previously published guidelines. A composite score of extreme values was calculated for each participant. Associations between sleep domains and severity of MS symptoms were explored (pain, fatigue, depressive symptoms, and cognitive dysfunction).


      Among n = 49 participants, median total sleep time was 456.3 min. Median time spent awake after sleep onset was 37 min. Sleepiness, abnormal sleep timing, and poor sleep quality affected 33%, 35%, and 45% of participants, respectively. Seventy-six percent had ≥2 sleep domains in extreme ranges. PwMS had longer sleep duration and decreased sleep regularity compared to a non-MS historical cohort of older men. Greater daytime sleepiness, poorer sleep quality, and higher composite sleep health score were associated with more depressive symptoms, and lower sleep rhythmicity was associated with higher fatigue. Associations were observed between measures of cognitive function and sleep fragmentation, duration, quality, rhythmicity, and composite score.


      Application of a seven-domain sleep health framework that captures the dynamic and multifaceted aspects of sleep is feasible in PwMS, and offers potential for an improved understanding of the scope and impact of sleep disturbances in PwMS.


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