Fatigue, sleepiness and depression in multiple sclerosis: defining the overlaps for a better phenotyping

Sparasci, Davide; Gobbi, Claudio; Castelnovo, Anna; Riccitelli, Gianna Carla; Disanto, Giulio; Zecca, Chiara; Manconi, Mauro

doi:10.1007/s00415-022-11143-6

Cited by 16 publications

(11 citation statements)

References 50 publications

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“…Fatigue, as one of the most prevalent "hidden symptoms" of multiple sclerosis, has a high impact on the quality of life, employment status, capacity to work, and sick leave [4]. Recent studies demonstrated not only a strong overlap of fatigue and depression but also a mutually reinforcing relationship between fatigue and depression contributing to a diminished quality of life [6,51]. Therefore, an objective diagnostic approach is crucial to identify fatigue and to enable patient monitoring and response to interventions.…”

Section: Discussionmentioning

confidence: 99%

“…Fatigue in MS is not merely a feeling of tiredness; it is often described as overwhelming exhaustion that significantly impacts daily functioning and the quality of life [3,4]. Despite its prevalence and impact, measuring fatigue objectively has remained a challenge in the field of MS research [5], especially since there is a strong overlap between depression and sleepiness as well as associations with other psychiatric disorders [6,7]. Notably, fatigue in MS often involves both abnormal cognitive and motor fatigability, which can be assessed using the established Fatigue Scale for Motor and Cognitive Functions (FSMC) [8].…”

Section: Introductionmentioning

confidence: 99%

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The Cortical Silent Period and Its Association with Fatigue in Multiple Sclerosis: The Need for Standardized Data Collection

Strauss,

Herr,

Nafz

et al. 2023

Brain Sciences

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The cortical silent period (CSP), assessed with transcranial magnetic stimulation (TMS), provides insights into motor cortex excitability. Alterations in the CSP have been observed in multiple sclerosis (MS), although a comparison of the sometimes contradictory results is difficult due to methodological differences. The aim of this study is to provide a more profound neurophysiological understanding of fatigue’s pathophysiology and its relationship to the CSP. Twenty-three patients with MS, along with a matched control group, underwent comprehensive CSP measurements at four intensities (125, 150, 175, and 200% resting motor threshold), while their fatigue levels were assessed using the Fatigue Scale for Motor and Cognitive Functions (FSMC) and its motor and cognitive subscore. MS patients exhibited a significantly increased CSP duration compared to controls (p = 0.02), but CSP duration was not associated with the total FSMC, or the motor or cognitive subscore. Our data suggest a systematic difference in MS patients compared to healthy controls in the CSP but no association with fatigue when measured with the FSMC. Based on these results, and considering the heterogeneous literature in the field, our study highlights the need for a more standardized approach to neurophysiological data collection and validation. This standardization is crucial for exploring the link between TMS and clinical impairments in diseases like MS.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

The Cortical Silent Period and Its Association with Fatigue in Multiple Sclerosis: The Need for Standardized Data Collection

Strauss,

Herr,

Nafz

et al. 2023

Brain Sciences

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“…Depressive mood and sleep inertia are closely connected as well [ 24 ]. Fatigue, depression, and sleepiness overlap not only in sleep disorders but also in other medical illnesses [ 29 ].…”

Section: Discussionmentioning

confidence: 99%

Central Disorders of Hypersomnolence: Association with Fatigue, Depression and Sleep Inertia Prevailing in Women

et al. 2022

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Fatigue, depression, and sleep inertia are frequently underdiagnosed manifestations in narcolepsy and idiopathic hypersomnia. Our cross-sectional study design included diagnostic interview accompanied by assessment instruments and aimed to explore how these factors influence disease severity as well as to elucidate any sex predisposition. One hundred and forty-eight subjects (female 63%) were divided into narcolepsy type 1 (NT1; n = 87, female = 61%), narcolepsy type 2 (NT2; n = 22, female = 59%), and idiopathic hypersomnia (IH; n = 39, female = 69%). All subjects completed a set of questionnaires: Epworth Sleepiness Scale (ESS), Hospital Anxiety and Depression Scales (HADS), Fatigue Severity Scale (FSS), and Sleep Inertia Questionnaire (SIQ). In narcoleptic subjects, questionnaire data were correlated with the Narcolepsy Severity Scale (NSS), and in subjects with idiopathic hypersomnia, with the Idiopathic Hypersomnia Severity Scale (IHSS). The highest correlation in narcoleptic subjects was found between NSS and ESS (r = 0.658; p < 0.0001), as well as FSS (r = 0.506; p < 0.0001), while in subjects with idiopathic hypersomnia, the most prominent positive correlations were found between IHSS and SIQ (r = 0.894; p < 0.0001), FSS (r = 0.812; p < 0.0001), HADS depression scale (r = 0.649; p = 0.0005), and HADS anxiety scale (r = 0.528; p < 0.0001). ESS showed an analogic correlation with disease severity (r = 0.606; p < 0.0001). HADS anxiety and depression scores were higher in females (p < 0.05 and p < 0.01), with similar results for FSS and SIQ scales (p < 0.05 for both), and a trend toward higher ESS values in females (p = 0.057). Our study illustrates that more attention should be focused on pathophysiological mechanisms and associations of fatigue, depression, as well as sleep inertia in these diseases; they influence the course of both illnesses, particularly in women.

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“…Common psychological issues linked to fatigue in MS patients include depression, anxiety [ 49 ], and stress [ 50 ]. Depression particularly influences mental fatigue [ 51 ], with research revealing a 3.6-fold increase in fatigue among depressed patients [ 52 ]. The use of stimulants and antidepressants has demonstrated a significant reduction in fatigue symptoms, emphasizing this strong connection [ 52 , 53 ].…”

Section: Introductionmentioning

confidence: 99%

“…Depression particularly influences mental fatigue [ 51 ], with research revealing a 3.6-fold increase in fatigue among depressed patients [ 52 ]. The use of stimulants and antidepressants has demonstrated a significant reduction in fatigue symptoms, emphasizing this strong connection [ 52 , 53 ]. Fatigue can also be triggered by previously perceived stress [ 54 , 55 ], and chronic stress is likely to predict increased fatigue [ 50 ].…”

Section: Introductionmentioning

confidence: 99%

Sleep Disorders and Fatigue among Patients with MS: The Role of Depression, Stress, and Anxiety

Zekibakhsh Mohammadi,

Kianimoghadam,

Mikaeili

et al. 2024

Neurology Research International

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Sleep disorders and fatigue represent prominent symptoms frequently experienced by individuals with multiple sclerosis (MS). Some psychological factors such as depression, stress, and anxiety seem to have a relationship with such problems. This study aimed to examine the role of depression, stress, and anxiety in predicting sleep disorders and fatigue among patients with MS. Employing a cross-sectional descriptive-correlational design, the study involved a sample size of 252 participants selected through purposive sampling based on inclusion and exclusion criteria. We utilized a demographic information questionnaire along with the Mini-Sleep Questionnaire (MSQ), Fatigue Severity Scale (FSS), and Depression, Anxiety, and Stress Scale (DASS-21) to collect data and analyzed them applying SPSS22, incorporating statistical measures including Pearson correlation and regression. The results of the Pearson correlation coefficient showed that sleep disorders had a positive and significant relationship with depression (r = 0.56; P<0.001), stress (r = 0.40; P<0.001), and anxiety (r = 0.52; P<0.001). There was no significant relationship between age and the development of sleep disorders in total score (r = −0.001; P<0.985), but age had a relationship with insomnia (r = −0.146; P<0.021) and oversleeping (r = 0.153; P<0.015). Age and fatigue did not have a significant relationship as well (r = −0.044; P<0.941). In addition, fatigue had a positive and significant relationship with depression (r = 0.52; P<0.001), stress (r = 0.48; P<0.001), and anxiety (r = 0.54; P<0.001). The results of the regression analysis also showed that depression, stress, and anxiety predict 0.37% of the total variance of sleep disorders (F = 48.34; P<0.001) and 0.35% of the total variance of fatigue (F = 44.64; P<0.001). Our findings suggest that depression, stress, and anxiety play a significant role in predicting sleep disorders and fatigue among patients with MS. This study has been reported in accordance with the TREND checklist for nonrandomized trials.

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Fatigue, sleepiness and depression in multiple sclerosis: defining the overlaps for a better phenotyping

Cited by 16 publications

References 50 publications

The Cortical Silent Period and Its Association with Fatigue in Multiple Sclerosis: The Need for Standardized Data Collection

The Cortical Silent Period and Its Association with Fatigue in Multiple Sclerosis: The Need for Standardized Data Collection

Central Disorders of Hypersomnolence: Association with Fatigue, Depression and Sleep Inertia Prevailing in Women

Sleep Disorders and Fatigue among Patients with MS: The Role of Depression, Stress, and Anxiety

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