BackgroundInsomnia is a common problem that affects approximately 50% of patients with multiple sclerosis (MS), who suffer from sleep disturbances. In general, persons with insomnia are at a higher risk of developing depression. This study was conducted to assess insomnia among non-depressed MS patients in Saudi Arabia.MethodsBased on the Patient Health Questionnaire-9 (PHQ-9), those who scored 4 or less for depression out of 598 MS patients were selected (n = 112). A cross-sectional study was conducted to interview 112 non-depressed MS patients in order to assess insomnia among them. A data collection sheet has been designed by the researchers. It comprised socio-demographic variables (e.g., gender, age, area of residence, and marital status) and clinical variables (disease duration, age at disease onset, previous diagnosis of depression, and used antidepressant drugs). Insomnia was assessed by the Insomnia Severity Index (ISI), while severity of illness was assessed using the Patient Determined Disease Steps (PDDS).ResultsA total of 72 patients (64.3%) were females, and 62 (55.4%) were married. Their mean age was 32.6 years (SD = 8.9), ranging from 15 to 56 years. As for educational level, 64 (57.1%) had a Bachelor degree. The mean age at disease onset was 26 years (SD = 8.9). The mean duration of illness was 1.9 years. Symptoms of insomnia were present among 14 patients (12.5%). No statistical significance was found between the mean PDSS of insomnia and non-insomnia patients. Significant differences were present between insomnia and non-insomnia patients as regards their education level (P = 0.005) and use of antidepressant drugs (P = 0.008).ConclusionsPrevalence of insomnia among non-depressed MS patients is low. Insomnia is associated with educational and use of antidepressants. Further research is needed to assess severity of different types of insomnia among depressed and non-depressed MS patients.

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Background: Despite the apparent benefits of disease-modifying drug (DMD) use among multiple sclerosis (MS) patients, their rates of adherence are often variable and in some cases are quite low. Aim of the study: To assess medication adherence and its relationship with treatment satisfaction of MS patients in Saudi Arabia Patients and methods: Following a cross-sectional design, 598 adult MS patients were recruited from all tertiary care hospitals in all regions of Saudi Arabia. Patients' medication adherence was assessed using the Arabic version of the eight-item Morisky Medication Adherence Scale (MMAS-8). Treatment satisfaction was assessed using the Treatment Satisfaction Questionnaire for Medication. Disease severity was assessed using the Patient-Determined Disease Steps (PDDS). Results: The most used drug was interferon beta-1b (24.1%), while 18.7% were using interferon beta-1a and 17.4% were using fingolimod. Patients' mean PDDS was 2.8 ± 1.9. Only 9.7% were "adherent" to medication. Patients' adherence differed according to their educational level (p < 0.001), their currently received medications (p = 0.032), with those on Fingolimod having the highest adherence (17.3%). Treatment satisfaction was significantly higher among adherent patients (p < 0.023). The main reasons for changing prescribed drugs were the presence of attacks, i.e., response to treatment was substandard (41.8%) and the experienced side effects of used drugs (39.9%). PDDS differed significantly according to patients' treatment adherence only among those receiving interferon beta-1b, with higher mean severity score among those who were adherent (p = 0.002). Conclusions: Medication adherence among MS patients in Saudi Arabia is low. Higher adherence is associated with patients' higher education. The main underlying reasons for changing prescribed drugs are the presence of attacks, substandard response to treatment, or suffering the DMDs' side effects. Medication adherence is associated with higher treatment satisfaction.