Fatigue in multiple sclerosis is closely related to sleep disorders: a polysomnographic cross-sectional study

Veauthier, Christian; Radbruch, Helena; Gaede, Gunnar; Cf, Pfueller; Dörr, Jan; Bellmann‐Strobl, Judith; Kd, Wernecke; Zipp, Frauke; Paul, Friedemann; Jp, Sieb

doi:10.1177/1352458510393772

Cited by 178 publications

(159 citation statements)

References 30 publications

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“…29 Despite its importance, its prevalence in persons with MS remains unknown, with estimates ranging from 0% to 58% in published studies (see Table 4 for a summary of these studies). 15,[17][18][19] There are several potential reasons for the high variability among these findings and our estimates of OSA frequency. Primary outcome measures differed across studies, most of which were not designed to assess OSA prevalence.…”

Section: Discussionmentioning

confidence: 87%

Obstructive Sleep Apnea and Fatigue in Patients with Multiple Sclerosis

Braley

Segal

Chervin

2014

Journal of Clinical Sleep Medicine

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Study Objectives: The prevalence of obstructive sleep apnea (OSA) in persons with multiple sclerosis (MS) remains unknown, and little information exists regarding the relative contributions of OSA to symptoms of MS-related fatigue in the presence of other clinical and sleep-related confounders. The objectives of this study were to investigate the prevalence of diagnosed OSA and OSA risk among MS patients, and to assess relationships between fatigue severity, OSA, OSA risk, and sleep quality among persons with MS. Methods: N = 195 MS patients completed a questionnaire comprised of items regarding OSA diagnosis, sleep quality and quantity, daytime symptoms, and 4 validated scales: the Epworth Sleepiness Scale, Fatigue Severity Scale, Insomnia Severity Index, and STOP-Bang questionnaire. Medical records were also accessed to examine clinical characteristics that may predict fatigue or OSA risk. Results: N = 41 patients (21%) carried a formal diagnosis of OSA. N = 110 (56%) of all patients, and 38 (93%) of those with diagnosed OSA had STOP-Bang scores ≥ 3, indicating an elevated OSA risk. In regression models, the most signifi cant predictors of higher FSS scores were higher STOP-Bang scores (p = 0.01), higher number of nocturnal symptoms (p < 0.0001), and higher disability level (p < 0.0001). Conclusions: Sleep disturbances, and OSA in particular, may be highly prevalent yet underrecognized contributors to fatigue in persons with MS. S C I E N T I F I C I N V E S T I G A T I O N SM ultiple sclerosis (MS) is an autoimmune disease of the central nervous system that causes myelin destruction and axonal damage in the brain and spinal cord. Multiple sclerosis is the leading cause of non-traumatic neurological disability among young adults, and is associated with a variety of debilitating symptoms, including fatigue.Fatigue affects up to 90% of multiple sclerosis patients at some point during their disease course.1-4 This highly debilitating symptom imposes signifi cant socioeconomic consequences 5 and is a leading cause of diminished quality of life among individuals with MS.3 Although MS-related fatigue is often multifactorial, identifi cation of treatable causes that may contribute to its severity is an essential element of management of this symptom.Obstructive sleep apnea (OSA) may exacerbate fatigue severity in MS. This treatable disorder of sleep and breathing is a known cause of fatigue and related symptoms in general population studies, 6 and constitutes a signifi cant risk factor for cardiovascular disease, metabolic syndrome, motor vehicle accidents, reduced productivity, cognitive dysfunction, and poor quality of life.7-14 Yet, despite its impact in the general population, the extent to which OSA contributes to fatigue in persons with MS is poorly understood, and the prevalence of OSA in MS remains unclear. Whereas some contend that the prevalence of OSA is higher in MS patients than in the general population, heterogeneity in subjects studied, sample sizes, and outcome measures have led to highly variable e...

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Section: Discussionmentioning

confidence: 87%

Obstructive Sleep Apnea and Fatigue in Patients with Multiple Sclerosis

Braley

Segal

Chervin

2014

Journal of Clinical Sleep Medicine

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“…Patients with MS who have a diagnosis of OSA and those at elevated risk for OSA have increased fatigue compared with undiagnosed or low-risk patients [Veauthier et al 2011[Veauthier et al , 2012Kaminska et al 2012;Braley et al 2014b;Brass et al 2014]. OSA is also a predictor of diminished quality life in MS [Trojan et al 2012], and preliminary research suggests that apnea severity may correlate with impaired cognition in MS [Braley et al 2014a].…”

Section: Sleep-disordered Breathingmentioning

confidence: 99%

“…The Epworth Sleepiness Scale is an eight-item questionnaire that measures subjective sleepiness, or likelihood of dozing in various situations. While not specifically validated in patients with MS, it has been extensively utilized in a variety of outpatient settings and as a primary measure of sleepiness in MS research studies [Johns, 1991;Veauthier et al 2011;Kaminska et al 2012;Braley et al 2014b;Brass et al 2014].…”

Section: Fatigue and Other Consequences Of Sleep Disorders In Msmentioning

confidence: 99%

A practical approach to the diagnosis and management of sleep disorders in patients with multiple sclerosis

Braley

Chervin

2015

Ther Adv Neurol Disord

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Abstract:Patients with multiple sclerosis (MS) are at increased risk for comorbid sleep disturbances, which can profoundly contribute to poor functional status and fatigue. Insomnia, sleep-disordered breathing, and restless legs syndrome are among the most common sleep disorders experienced by patients with MS. Despite their impact, these underlying sleep disorders may escape routine clinical evaluations in persons with MS, thereby leading to missed opportunities to optimize functional status and quality of life in patients with MS. A practical, systematic approach to the evaluation and treatment of sleep disorders in MS, in the context of MS-specific variables that may influence risk for these conditions or response to therapy, is recommended to facilitate early diagnosis and successful treatment. This review summarizes the most common sleep disorders experienced by persons with MS, and offers a practical approach to diagnosis and management of these conditions.

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“…Unfortunately, many neurologists exhibit a therapeutic nihilism towards this debilitating symptom in regarding fatigue as some immanent and intractable feature of the condition with which the patient "has to learn to live". Only in recent years, a possible association of daytime fatigue with sleep disorders has become into focus; however, only very few studies have attempted to investigate the relationship between sleep disorders in general and MS-related fatigue by PSG or accelerometry and not only by questionnaires on sleep quality [14][15][16][17]. In sum, it is undoubtful that sleep disorders can contribute to daytime fatigue in MS.…”

mentioning

confidence: 99%

Fatigue and sleep disorders in multiple sclerosis: is obstructive sleep apnea a link?

Paul

Veauthier

2012

Sleep Breath

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Fatigue in multiple sclerosis is closely related to sleep disorders: a polysomnographic cross-sectional study

Abstract: Our results demonstrate a clear and significant relationship between fatigue and sleep disorders.

Cited by 178 publications

References 30 publications

Obstructive Sleep Apnea and Fatigue in Patients with Multiple Sclerosis

Obstructive Sleep Apnea and Fatigue in Patients with Multiple Sclerosis

A practical approach to the diagnosis and management of sleep disorders in patients with multiple sclerosis

Fatigue and sleep disorders in multiple sclerosis: is obstructive sleep apnea a link?

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