Pain-Related Autonomic Dysregulation During Sleep in Multiple Sclerosis: Insights from Wearable Sensor Data

Pain is a common and disabling symptom in people with Multiple Sclerosis (MS), manifesting as either nociceptive or neuropathic, and is known to affect the autonomic nervous system (ANS) and sleep. Wearable sensors can help in gaining insights in this regard, offering an ecological solution to monitor physiological signals in the real-world. In this study, we used a medical wrist-worn device to assess sleep-related ANS activity in MS patients experiencing different types of pain. Features were extracted from photoplethysmographic (PPG) signal, electrodermal activity (EDA), skin temperature (SKT), and accelerometer (ACC) data, and then analyzed by implementing Linear Mixed Effects Models. While we found a lower number of wakes after sleep onset and a higher sleep efficiency in the neuropathic pain category, we also observed significant autonomic dysregulation in patients experiencing either nociceptive (EDA mean slope p<0.01, EDA SympatheticN p<0.05) or neuropathic pain (EDA SympatheticN and EDA autocorrelation p<0.05). These findings suggest a significant association between pain and autonomic patterns during sleep, which can be further corroborated in future studies with a larger sample size to have a better understanding of the underlying mechanisms.Clinical Relevance- Wearable devices are a promising tool for monitoring pain-related autonomic dysregulation, enabling continuous recordings in the real-world. This approach may facilitate personalized pain management strategies by offering objective physiological insights.