The impact of drugs for multiple sclerosis on sleep

Abstract

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...

<p>The Effectiveness of Occupational Therapy-Based Sleep Interventions on Quality of Life and Fatigue in Patients with Multiple Sclerosis: A Pilot Randomized Clinical Trial Study</p>

“…Taken together, there is growing literature on the presence of sleep disorders in MS, although few intervention studies have been published and further research is warranted. 12,16 Evidence in the current literature supports the influence of sleep quality and severity of fatigue on the quality of life in patients with MS. 17 Fatigue is a common symptom present in MS 5 and has a bidirectional relationship with sleep quality. 1,5,18,19 Several studies have highlighted the potential for interventions of sleep disorders to improve fatigue and vice versa.…”

Circadian Activity Rhythm in Early Relapsing–Remitting Multiple Sclerosis

“…The use of interferon beta, glatiramer acetate [27], and dimethyl fumarate (personal observation) might have caused, even in the steady state phase, a subtle disruption of sleep, although there are no available data on the effects of these drugs on sleep in the drugs' technical sheets. A recent review on the subject [28] reported possible negative effects caused by glatiramer acetate and interferon beta, whereas data on first line oral drugs (dimethyl fumarate and teriflunomide) are not yet available.…”

Sleep quality, daytime sleepiness, fatigue, and quality of life in patients with multiple sclerosis treated with interferon beta-1b: results from a prospective observational cohort study

“…Restless legs syndrome (RLS) appears to play an important role since it has consistently been shown to be more common in patients with MS [2, 9, 12] and is associated with poor sleep [8, 13, 14]. The type of MS treatment may also impact sleep and fatigue.…”

“…The type of MS treatment may also impact sleep and fatigue. Disease-modifying drugs (DMD), such as interferon beta-1b, might affect sleep quality and fatigue, but results in this connection are ambiguous [8, 13, 14]. …”