Pathways Between Multiple Sclerosis, Sleep Disorders, and Cognitive Function: Longitudinal Findings from The Nurses' Health Study

Overview

Journal Mult Scler

Publisher Sage Publications

Specialty Neurology

Date 2023 Jan 12

PMID 36633265

Authors

Tiffany J Braley

Monica M Shieu

Afsara B Zaheed

Galit Levi Dunietz

Affiliations

Soon will be listed here.

Abstract

Background: The potential mediating and moderating effects of sleep disorders on cognitive outcomes in multiple sclerosis (MS) have been insufficiently studied.

Objectives: To determine direct and indirect longitudinal associations between sleep disorders and perceived cognitive dysfunction in women with MS.

Methods: The 2013 and 2017 waves of the Nurses' Health Study ( = 63,866) were utilized. All diagnoses and symptoms including MS ( = 524) were self-reported. Subjective cognitive function was measured using a composite score of four memory items and three binary outcomes that assessed difficulty following instructions, conversations/plots, and street navigation. Moderating and mediating effects of diagnosed/suspected obstructive sleep apnea (OSA), sleepiness, and insomnia between MS and cognition were estimated using the four-way decomposition method.

Results: Prevalence of diagnosed/suspected OSA, sleepiness, and insomnia in 2013 were higher for nurses with MS (NwMS). NwMS were more likely to report cognitive difficulties in 2017. Insomnia mediated 5.4%-15.1% of the total effect between MS and following instructions, conversations/plots, and memory impairment, while sleepiness mediated 8.6%-12.3% of the total effect for these outcomes. In interaction analyses, OSA significantly accounted for 34% of the total effect between MS and following instructions.

Conclusion: Prevalent OSA, insomnia, and sleepiness could differentially moderate or mediate the effect of MS on cognition in women with MS.

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