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Depression, anxiety, and sleep disturbances are highly prevalent in neuromyelitis optica spectrum disorder patients, according to a recent study.

Neuromyelitis optica spectrum disorder (NMOSD) is an autoimmune inflammatory disease primarily affecting the visual pathway, brain, and spinal cord. Global NMOSD incidence rates are 0.039–0.73/100,000 person-years in adults and 0.01–0.06/100,000 person-years in children. Psychiatric issues like depression, anxiety, and poor sleep decrease the health-related quality of life in these patients. 

A study in Multiple Sclerosis and Related Disorders estimated the pooled prevalence of depression, anxiety, and sleep disturbances in NMOSD patients.

Studies Included in the Review

A total of 31 studies comprising 4213 participants were included in this review. Among the 31 studies, 26 reported the prevalence of depression, 8 reported anxiety, and 6 reported poor sleep. Sample sizes in the studies ranged between 14 and 1349. All included studies were of moderate quality at least (quality assessment score of 3 or above).

A High Prevalence of Depression Observed in NMOSD

The pooled prevalence of depression from 26 studies (n=3780) was calculated at 40% (95% confidence interval (CI): 32–49%). A decreasing trend in depression prevalence was observed with increasing severity of depression. Depression prevalence was 21% with mild severity, 15% with moderate severity, and 9% with severe depression.

According to Cochran’s Q test and Higgins’ I-squared statistic (I2=98%, P<0.01), there was significant heterogeneity among studies, and a random-effects model was applied. In the sensitivity analysis, no study affected the pooled prevalence by over 2% or the I2 value by over 1% when excluded. Visual inspection of the funnel plot and Egger’s regression test revealed no evidence of publication bias (P=0.006). Screening tools and study design were identified as the relevant heterogeneity moderators.

A High Prevalence of Anxiety Observed in NMOSD

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The pooled prevalence of anxiety from eight studies (n=2344) was 45% (95% CI: 24–66%). According to Cochran’s Q test and Higgins’ I-squared statistic (I2=100%, P<0.01), significant heterogeneity existed among studies, and a random-effects model was applied. The pooled prevalence ranged from 37% to 51% by removing a single study one time in the sensitivity analysis. Possible publication bias was suggested by the asymmetric funnel plot and Egger’s regression test (P=0.344). Region, study design, and screening tools were identified as the relevant heterogeneity moderators.

Sleep Disturbances Are Highly Prevalent in NMOSD Patients

The pooled prevalence of sleep disturbances from six studies (n=762) was 55% (95% CI:46–64%). According to Cochran’s Q test and Higgins’ I-squared statistic (I2=79%, P<0.01), significant heterogeneity existed among studies, and a random-effects model was applied. The pooled prevalence ranged from 51% to 58% by removing a single study one time in the sensitivity analysis. Possible publication bias was suggested by the asymmetric funnel plot and Egger’s regression test (P=0.160). Region and sample size were identified as the relevant heterogeneity moderators.

Source:

Liu, J., Zhang, X., Zhong, Y., & Liu, X. (2023). The prevalence of depression, anxiety, and sleep disturbances in patients with neuromyelitis optica spectrum disorders (NMOSD): A systematic review and meta-analysis. Multiple Sclerosis and Related Disorders, 79, 105007. https://doi.org/10.1016/j.msard.2023.105007