Sleep disorders and fatigue in multiple sclerosis: Evidence for association and interaction

Kamińska, Marta; Kimoff, R. John; Schwartzman, Kevin; Trojan, DA

doi:10.1016/j.jns.2010.12.008

Cited by 88 publications

(71 citation statements)

References 99 publications

(133 reference statements)

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“…10,31 There are few studies reporting on the impact of fatigue and sleep in patients with MS. 8 In the present study, fatigue and poor sleep quality were strongly related. Several mechanisms may contribute to the relationship between fatigue and poor sleep in MS. 43 Increased levels of inflammatory cytokines or lesions in the brain may disrupt pathways involved with sleep. Sleep apnea, which is common in people with MS, may also result in fatigue and sleep disruption.…”

Section: Discussionmentioning

confidence: 99%

Fatigue, Sleep Quality, and Disability in Relation to Quality of Life in Multiple Sclerosis

Tabrizi¹,

Radfar²

2015

International Journal of MS Care

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Section: Discussionmentioning

confidence: 99%

Fatigue, Sleep Quality, and Disability in Relation to Quality of Life in Multiple Sclerosis

Tabrizi¹,

Radfar²

2015

International Journal of MS Care

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“…Proposed mechanisms whereby IFN-β may improve sleep quality include modulation of cytokines levels or restoration of the circadian secretion of melatonin and its suppressed metabolism. 39,40 Finally, in a study in patients with MS comparing subjective measures of daytime alertness with nocturnal polysomnography, neither periodic limb movement index nor subjective sleepiness scales were found to be associated with the use of IFN-β. 17 The data reviewed here also provide insights as to why some of the above-mentioned studies conflict.…”

Section: Ifn-βmentioning

confidence: 99%

The impact of drugs for multiple sclerosis on sleep

et al. 2016

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Abstract:Although there is a growing literature on the presence of sleep disorders in multiple sclerosis (MS), few studies have specifically addressed the impact of drugs on sleep of these patients. Moreover, even when sleep is considered, quantitative assessment by standardized questionnaires or polysomnography is lacking. The studies that have been done highlight that interferon-beta and some symptomatic medications may affect sleep, thus contributing to fatigue, depression, and poor quality of life; conversely, natalizumab and cannabinoids may improve sleep. Common limitations of the literature reviewed here are small sample size, selection bias, and often a lack of objective outcome measures. Clinicians need to remember to ask about sleep in all MS patients and intervene when appropriate. A systematic approach that takes sleep into account is recommended to enhance recognition and appropriate management of sleep disruption, including disorders related to medication. Consideration of the impact on sleep should also be part of the design of trials of new therapies. Tables 1 and 2, both disease-modifying drugs and common symptomatic medications for MS may interfere with sleep. 33 Keywords MethylprednisoloneAs known, insomnia and other sleep changes, such as decreased REM sleep, are common side effects of steroid treatment, even after only a few days of administration. 34 A randomized, placebo-controlled trial of oral methylprednisolone given in pulses every 4 weeks as an add-on therapy to IFN-β-1a for the treatment of relapsing-remitting MS was carried out. 6 The authors found that steroid intake led to a significant reduction in relapse rate; however, insomnia was one of the most frequent adverse event recorded (~25% of patients). 6 As in the general population, the clinician must consider this co-morbid cause of insomnia and encourage lifestyle changes (such as proper sleep hygiene), cognitive behavioral therapy (CBT), and pharmacological intervention if needed. 35 A very recent prospective multicenter observational study evaluated through self-report questionnaires the frequency, severity, and impact on activities of daily living of adverse effects of high-dose intravenous methylprednisolone in relapsing-remitting MS patients with a relapse. The authors observed that sleep disturbance (not better specified) was among the most common adverse events experienced by the patients (44% of 59), especially in those with high disease impact or high disability. 8Nevertheless, although most clinicians warn patients about the steroid-related effects on sleep, an actigraphy study evaluating the short-term tolerance of 5-day regimen of intravenous methylprednisolone demonstrated high sleep efficiency, which is discrepant with the complaints reported by the patients. The authors conclude that sleep efficiency was not disturbed by methylprednisolone in patients, whether used for a clinically isolated syndrome (CIS), MS relapse, or sub-acute disease progression. 7 IFN-βSince its introduction as an established therapy for re...

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“…Primary factors may include inflammation, demyelination, and destruction of axons in the central nervous system, the presence of immune markers, and neuroendocrine system disturbances. Secondary factors may include sleep problems, depression or other psychological variables, medications, and lack of exercise [12].…”

Section: Introductionmentioning

confidence: 99%

The Analysis of Relationship Between Lesion of Functional Systems of Nervous System and Severity of Fatigue in Patients With Multiple Sclerosis

Mialovytska

Khyzhniak

2017

EUREKA: Health Sciences

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Despite numerous investigations, fatigue remains one of the least studied manifestations of MS. However, significant prevalence of this symptom proves importance of its study. The aim of the study was to define a prognostic assessment of fatigue development accompanying lesions of certain functional systems and degree of disability. Material and methods. 96 patients, aged 15 to 58 years with a diagnosis of MS have been examined. MS patients were examined with the same protocol, using formalized scales. To detect fatigue and determine the degree of its severity was used Fatigue Severity Scale (FSS). The degree of disability in patients was assessed by Kurtzke EDSS (Expanded Disability Status Scale). Statistical methods for the data analysis were also used, including methods of descriptive statistics, probability assessment and prognostic significance of obtained data using odds ratio (OR). Results. Fatigue was detected in 49.1% of patients with a degree of disability lower than 4 EDSS scores and in 90.4% of patients with disability higher than 4 EDSS scores (p=0.0027). The assessment of functional systems at the time of observation has statistically significant prognostic values according to the following parameters: pyramidal system lesion (OR=7.43 (2.43–22.76)), coordination disorders (OR=4.60 (1.05–20.25)), cranial nerve lesion (OR=4.33 (1.40–13.39)), (p<0.05). Lesion of the pyramidal and coordination systems at the onset of the disease may increase risk for detection of fatigue higher than 4 scores in the follow-up observation (lesion of pyramidal system – OR=1.62 (0.5–5.25), coordination disorders OR=1.41 (0.58–5.16)). Conclusion. The results of our investigation showed that symptom of fatigue is observed in almost 90 % of MS patients. The study showed that fatigue in MS patients depends on the degree of disability and lesions of certain functional systems.

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Sleep disorders and fatigue in multiple sclerosis: Evidence for association and interaction

Cited by 88 publications

References 99 publications

Fatigue, Sleep Quality, and Disability in Relation to Quality of Life in Multiple Sclerosis

Fatigue, Sleep Quality, and Disability in Relation to Quality of Life in Multiple Sclerosis

The impact of drugs for multiple sclerosis on sleep

The Analysis of Relationship Between Lesion of Functional Systems of Nervous System and Severity of Fatigue in Patients With Multiple Sclerosis

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