Association between frailty and sleep quality in people living with multiple sclerosis and obesity: An observational cross-sectional study

Mult Scler Relat Disord. 2024 Jan:81:105154. doi: 10.1016/j.msard.2023.105154. Epub 2023 Nov 24.


Background: A majority of the people with multiple sclerosis (pwMS) experience sleep disturbances. Frailty is also common in pwMS. The geriatric literature strongly suggests that frailty is associated with worse sleep outcomes in community-dwelling older adults, but this association has yet to be explored among pwMS. This study focused on examining the association between frailty and sleep quality in pwMS.

Methods: Seventy-six people with both MS and obesity (mean age: 47.6 ± 10.9 years, 81.6 % female, mean body mass index (BMI): 37.10 ± 5.5 kg/m2, mean Patient Determined Disease Steps (PDDS): 0.82 ± 1.20) were included in this cross-sectional secondary analysis. A comprehensive frailty index (FI) based on 41 health deficits from various health domains was calculated based on standardized procedures. Sleep quality was determined by the Pittsburgh Sleep Quality Index questionnaire (PSQI).

Results: Overall, 67.1 % of the participants were identified as non-frail (FI ≤ 0.25), and 32.9 % were identified as frail (FI > 0.25). A significant correlation was observed between FI scores and global PSQI scores (ρ = 0.43, p < 0.05). Cross-tabulation analyses revealed that frail participants had worse subjective sleep quality, sleep latency, habitual sleep efficiency, sleep disturbances, daytime dysfunction, and higher use of sleep medications compared to non-frail participants (p < 0.05).

Conclusions: The current study identified a significant association between frailty and sleep quality in people with both MS and obesity with minimal disability. These findings underscore the importance of untangling the relationship between frailty and sleep quality in pwMS. These results could lead to a more targeted approach for rehabilitation interventions aiming to improve frailty in MS.

Keywords: Frailty; Multiple sclerosis; Rehabilitation; Sleep; Sleep quality.

Publication types

  • Observational Study

MeSH terms

  • Adult
  • Aged
  • Cross-Sectional Studies
  • Female
  • Frail Elderly
  • Frailty* / epidemiology
  • Humans
  • Male
  • Middle Aged
  • Multiple Sclerosis* / complications
  • Multiple Sclerosis* / epidemiology
  • Obesity / complications
  • Obesity / epidemiology
  • Sleep Quality