High Rates of Depression, Anxiety, and Sleep Disturbances Found in NMOSD


Across 31 studies of patients with NMOSD, more than half of the patients included reported having sleep disturbances associated with their condition.

Data from a recently published meta-analysis comprised of more than 4000 individuals with neuromyelitis optica spectrum disorder (NMOSD) highlighted the high prevalence of depression, anxiety, and sleep disturbances in this patient population. Investigators concluded that the findings underscore the importance of monitoring psychological status in NMOSD as well as the need for preventive approaches, early diagnosis, and interventions to improve medical and psychosocial outcomes.

After searching PubMed, the Cochrane Central Register of Controlled Trials (CENTRAL), Embase, and Web of Science, the meta-analysis was comprised of 31 studies involving 4213 participants with NMOSD. Studies that specifically defined patients with NMOSD with known depression, anxiety, and sleep disturbances as their target population were excluded. The analysis did not limit studies based on country of origin, nor were there limitations on the age or gender of the included patients.

Led by Xianglin Liu, The First People’s Hospital of Changde City, Changde, China, 26 studies reported on depression, 8 on anxiety, and 6 on sleep disturbances. Overall, the pooed prevalence of depression was 40% (95% CI, 32-49), the pooled prevalence of anxiety was 45% (95% CI, 24-66), and the pooled prevalence of sleeping disturbances was 55% (95% CI, 46-64). Of note, there were significant between-study heterogeneity that was not resolved by the proposed subgroup analyses and sensitivity analyses, and thus, investigators concluded that overall estimates must be met with caution.

In addition to statistical analyses using I2 statistic and Chi-square test, a sensitivity analysis of the pooled prevalence was conducted by omitting 1 study in each turn, to estimate the impact of an individual study on the pooled results. In terms of depression, the sensitivity analysis showed that no study affected the pooled prevalence by over 2%, or the affected I2 value by over 1%, when excluded. As for anxiety, the pooled prevalence ranged from 37% to 51% by removing a single study 1 time. For sleep disturbances, the pooled prevalence ranged from 51% to 58% by removing a single study 1 time.

A series of subgroup analysis according to the screening tools, region, publication year, study design, and sample size were conducted to explore the potential source of heterogeneity, and the pooled prevalence between subgroups was compared using the Chi-square test. In this subgroup analysis, screening tools (test for subgroup difference [TSD]: Chi2 = 23.70; P <.01) and study design (TSD: Chi2 = 105.53; P <.01) were identified as the relevant heterogeneity moderators for depression.

READ MORE: Insurance and Cost-Related Barriers to Blame for Spotty Access to NMOSD Treatments

As for anxiety, subgroup findings showed that region (TSD: Chi2 = 16.67; P <.01), study design (TSD: Chi2 = 18.83; P <.01) and screening tools (TSD: Chi2 = 457.76; P <.01) were highlighted as the relevant heterogeneity moderators. Region (TSD: Chi2 = 5.79; P = .02) and sample size (TSD: Chi2 = 5.79; P = .002) were documented as the relevant heterogeneity moderators in the pooled prevalence of sleep disorders.

Regarding depression prevalence, the Beck Depression Inventory, Hamilton Depression Rating Scale, and Hospital Anxiety and Depression Scale yielded similar prevalence values between 40% and 48%. Notably, this prevalence estimate was significantly lower than the prevalence yielded by the Self-Reported Quick Inventory of Depressive Symptomatology, which estimated the prevalence at 67%.

"It is worth noting that although the structured diagnostic interview may have a better reliability and validity, the measure user-friendly and the instructions easy to follow for patients should be taken into account in clinical practice,” Liu et al wrote. “Scales can be seen as a cost-effective choice after a tradeoff between the psychometric robustness and the patient's acceptability, because it is not expensive for the professional time required for the screen, and provide clinically convenient information to increase the efficiency of medical evaluation to clinicians."

1. Liu J, Zhang X, Zhong Y, Liu X. The prevalence of depression, anxiety, and sleep disturbances in patients with neuromyelitis optica spectrum disorders (NMOSD): a systematic review and meta-analysis. Mult Scler & Relat Disor. 2023;79:105007. doi:10.1016/j.msard.2023.105007
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