Relationship Between Sleep, Fatigue and Depression in Pediatric Multiple Sclerosis

Background: Decreased quality of sleep is known to be associated with fatigue and depression in both adults with multiple sclerosis (MS) and otherwise healthy children. The prevalence of sleep problems in pediatric MS and their relationship with fatigue and depression is not well studied.

Objectives: (1) To determine the prevalence of sleep problems in pediatric MS. (2) To examine the relationship between sleep quality, fatigue and depression.

Methods: Youth with MS or monophasic demyelinating conditions (mono-ADS) were recruited consecutively from the Neuroinflammatory Clinic at the Hospital for Sick Children (HSC) in Toronto, ON. Participants completed four questionnaires: Child Sleep Habits Questionnaire (CSHQ), Child Behaviour Checklist Sleep Composite (CBCL), Pediatric Multidimensional Fatigue Scale (PedsQL) and Center for Epidemiological Studies Depression Scale (CES-DC). For the CSHQ, a cut-off score of 41 was used to identify participants who had a potential sleep disorder. Differences between total scores in the two groups were analyzed using independent samples t-test or Mann-Whitney U test, as appropriate. The relationship between sleep, fatigue and depression scores was examined using Spearman’s correlations. Ethics approval was obtained from the HSC REB.

Results: 43 participants (aged 5-17) were included (MS=14, mono-ADS=29). In those with MS, 57% reported at least one sleep problem, such as parasomnias, sleep anxiety or daytime sleepiness, and 33% met the threshold for a possible sleep disorder. There were no differences in self-reported sleep problems between the MS and mono-ADS cohorts.  We found a significant positive correlation between sleep problems and fatigue (r=0.74, p=0.02) and sleep problems and depression (r=0.79, p=0.01) in the mono-ADS, but not the MS cohort. 

Conclusions: Higher levels of sleep problems were associated with increased fatigue and depression in mono-ADS, but not MS. Reasons for this are unclear, but reinforce the important role that ongoing disease activity may play in fatigue in youth with MS.  Objective measures of sleep, such as actigraphy, may be more sensitive to the identification of sleep problems and may provide further insight into the nature of the relationship between sleep, fatigue and depression in youth with MS.