Fatigue and Sleep-Disordered Breathing in Multiple Sclerosis: A Clinically Relevant Association?

Kallweit, Ulf; Baumann, Christian; Harzheim, Michael; Hidalgo, Hildegard; Pöhlau, Dieter; Bassetti, Claudio; Linnebank, Michael; Valko, Philipp O.

doi:10.1155/2013/286581

Cited by 27 publications

(15 citation statements)

References 40 publications

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“…Kallweit et al [24] investigated 69 fatigued MS patients with overnight respirography, and they found SRBD in 41 %; subsequently started CPAP therapy improved fatigue as well.…”

Section: Sleep-related Breathing Disordersmentioning

confidence: 99%

Sleep Disorders in Multiple Sclerosis. Review

Veauthier

2015

Curr Neurol Neurosci Rep

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Sleep disorders are common in patients with multiple sclerosis (MS) and play a crucial role in health and quality of life; however, they are often overlooked. The most important sleep disorders in this context are as follows: insomnia, restless legs syndrome, periodic limb movement disorders, and sleep-related breathing disorders (SRBD). It is unclear if MS-related processes (lesions, brain atrophy) can cause symptomatic forms of sleep apnea. MS-related narcolepsy-like symptoms are described in the literature and, in some cases, have resolved with methylprednisolone pulse therapy. Similarly, REM sleep behavior disorder (RBD) is very rare in MS, but it can be an initial sign of MS where cortisone therapy may be helpful and can be taken into account in this specific context. Independent diagnosis and treatment is required for all of the abovementioned conditions. Treating physicians and neurologists should be aware of these comorbidities and initiate specific therapy. Highly fatigued or sleepy MS patients should have polysomnography in order not to overlook these diagnoses.

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“…Kallweit et al [24] investigated 69 fatigued MS patients with overnight respirography, and they found SRBD in 41 %; subsequently started CPAP therapy improved fatigue as well.…”

Section: Sleep-related Breathing Disordersmentioning

confidence: 99%

Sleep Disorders in Multiple Sclerosis. Review

Veauthier

2015

Curr Neurol Neurosci Rep

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“…However, with the exception of the Braley et al study ( 35 ), the mean BMI for all of the MS studies is under 30 kg/m 2 . Indeed, in the studies of Kallweit et al and Kaminska et al, the average BMI is 26 kg/m 2 , but the prevalence of SDB is 62 and 69%, respectively ( 17 , 30 ). This is clearly very high for a non-obese population.…”

Section: What Are Possible Risk Factors For Sdb In Ms?mentioning

confidence: 97%

“…Most of the studies were not designed to measure the prevalence of SDB per se . Some studies are retrospective ( 35 ), or included only fatigued patients ( 16 , 19 , 30 ). The study populations vary greatly in characteristics such as age, disability level, body mass index (BMI), and female to male ratio.…”

Section: How Common Is Sdb In Ms?mentioning

confidence: 99%

Sleep-Disordered Breathing in People with Multiple Sclerosis: Prevalence, Pathophysiological Mechanisms, and Disease Consequences

2018

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Sleep problems are common in people with multiple sclerosis (MS). Reported prevalence rates of sleep-disordered breathing (SDB) vary between 0 and 87%. Differences in recruitment procedures and study designs likely contribute to the wide variance in reported prevalence rates of SBD in MS. This can make attempts to compare SDB rates in people with MS to the general population challenging. Little is known about the pathophysiological mechanisms that contribute to SDB in people with MS or whether MS contributes to SDB disease progression. However, compared to the general obstructive sleep apnea (OSA) population, there are clear differences in the clinical phenotypes of SDB in the MS population. For instance they are typically not obese and rates of SDB are often comparable or higher to the general population, despite the high female predominance of MS. Thus, the risk factors and pathophysiological causes of SDB in people with MS are likely to be different compared to people with OSA who do not have MS. There may be important bidirectional relationships between SDB and MS. Demyelinating lesions of MS in the brain stem and spinal cord could influence breathing control and upper airway muscle activity to cause SDB. Intermittent hypoxia caused by apneas during the night can increase oxidative stress and may worsen neurodegeneration in people with MS. In addition, inflammation and changes in cytokine levels may play a key role in the relationship between SDB and MS and their shared consequences. Indeed, fatigue, neurocognitive dysfunction, and depression may worsen considerably if both disorders coexist. Recent studies indicate that treatment of SDB in people with MS with conventional first-line therapy, continuous positive airway pressure therapy, can reduce fatigue and cognitive impairment. However, if the causes of SDB differ in people with MS, so too may the optimal therapy. Thus, many questions remain concerning the relationship between these two disorders and the underlying mechanisms and shared consequences. Improved understanding of these factors has the potential to unlock new therapeutic targets.

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“…Es existieren keine Studien, die die Prävalenz von schlafbezogenen Atmungsstörungen bei MS im Vergleich zur Allgemeinbevölkerung untersuchen [28]. In Studien mit konsekutiven MS-Patienten wurden Prävalenzen des obstruktiven Schlafapnoesyndroms (OSA) von 0 % bis 58 % gefunden; allerdings wurden dabei verschiedene diagnostische Untersuchungen eingesetzt (Polygrafie oder Polysomnografie), verschiedene Grenzwerte und Klassifikationssysteme verwendet und die Gruppengröße variierte bei diesen Studien erheblich [11,28,[35][36][37]. Vor dem Hintergrund, dass Studien im Bereich der Schlaganfallforschung zeigten, dass es nach infratentoriellen Hirninfarkten vermehrt zu zentralen Schlafapnoen kommt, stellt sich die Frage, ob auch infratentorielle Läsionen im Rahmen einer MS zu einer zentralen Schlafapnoe führen können [29,[38][39][40][41][42].…”

Section: Schlafbezogene Atmungsstörungenunclassified

Schlafstörungen bei Multipler Sklerose

Veauthier¹

2019

Nervenheilkunde

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ZusammenfassungGegenstand und Ziel: Patienten mit Multipler Sklerose (MS) leiden häufig an einer die Lebensqualität deutlich beeinträchtigenden Schlafstörung. Es soll ein Überblick über den gegenwärtigen Stand der Literatur gegeben werden. Material und Methoden: Übersichtsarbeit. Ergebnisse: Mehrere Studien haben bei der MS im Vergleich zur Allgemeinbevölkerung eine erhöhte Prävalenz für ein Restless-legs-Syndrom (RLS) gezeigt, im Besonderen bei MS-Patienten mit einem erhöhten Grad der Behinderung. Rund ein Viertel der MS-Patienten leidet an einer chronischen Insomnie. Es existieren symptomatische Formen der Narkolepsie und der REM-Schlaf-Verhaltensstörung (RBD), am ehesten durch akute Läsionen hervorgerufen. Ob Läsionen auch schlafbezogene Atmungsstörungen verursachen können, kann noch nicht ausreichend beurteilt werden. Schlussfolgerung und klinische Relevanz: Beim Neuauftreten einer Narkolepsie oder eines RBD sollte zügig eine kraniale Kernspintomografie mit Kontrastmittel erfolgen. Bei der Behandlung schlafmedizinischer Erkrankungen kommen die von den Fachgesellschaften empfohlenen Behandlungsrichtlinien zur Anwendung (die Behandlung unterscheidet sich bei MS-Patienten nicht grundsätzlich von der Behandlung dieser Erkrankungen in der Allgemeinbevölkerung). MS-Fatigue-Patienten sollten niedrigschwellig eine Polygrafie oder Polysomnografie erhalten.

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Fatigue and Sleep-Disordered Breathing in Multiple Sclerosis: A Clinically Relevant Association?

Cited by 27 publications

References 40 publications

Sleep Disorders in Multiple Sclerosis. Review

Sleep Disorders in Multiple Sclerosis. Review

Sleep-Disordered Breathing in People with Multiple Sclerosis: Prevalence, Pathophysiological Mechanisms, and Disease Consequences

Schlafstörungen bei Multipler Sklerose

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