The Relationship of Sleep Disturbances and Fatigue in Multiple Sclerosis

Attarian, Hrayr; Brown, Kelly M.; Duntley, Stephen P.; Carter, Jewell D.; Cross, Anne H.

doi:10.1001/archneur.61.4.525

Cited by 185 publications

(135 citation statements)

References 24 publications

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“…1 Third, abnormalities of circadian rhythm, including, in particular, increased daytime somnolence, have recently been described in other fatigue-associated conditions and implicated heavily in the pathogenesis of fatigue. 9,10 The data presented here confirm the presence of significant sleep abnormality in PBC, highlight a particular increase in daytime somnolence, and suggest that the degree of such daytime somnolence correlates significantly with severity of perceived fatigue.…”

Section: Discussionsupporting

confidence: 75%

“…Comparisons were made between groups using Student t test (for normally distributed data sets) and Mann-Whitney non-parametric testing for nonnormally distributed data sets. [5][6][7][8][9], P Ͻ .05). Global sleep quality as assessed by the PSQI was significantly lower in the patient group than in the normal controls (Table 2).…”

Section: Methodsmentioning

confidence: 99%

“…This has led to the suggestion that factors causing disruption in sleep rhythms may play an important role in the pathogenesis of fatigue. 9,10 Sleep abnormality has previously been documented in cases of PBC, with patients who self-reported fatigue showing the greatest levels of abnormality. 3 The tools used to measure sleep in this study were not, how-ever, optimal for the specific study of daytime somnolence, the aspect of sleep abnormality seemingly most strongly associated with fatigue.…”

mentioning

confidence: 95%

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Fatigue in primary biliary cirrhosis is associated with excessive daytime somnolence

et al. 2006

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A significant proportion of patients with primary biliary cirrhosis (PBC) suffer from severe fatigue. The aim of this study was to characterize patterns of daytime sleep in patients with PBC (using both objective and subjective assessment approaches) and to study the association between sleep abnormality and fatigue severity. Fatigue severity was assessed in 48 female subjects with PBC (using a disease-specific quality of life instrument (the PBC-40) and a generic fatigue measure (Fatigue Impact Scale [FIS]) as well as 48 case-matched normal controls. All participants also completed the Pittsburgh Sleep Quality Index (PSQI) and the Epworth Sleepiness Scale (ESS, which assesses daytime hypersomnolence). Objective sleep assessment was performed using accelerometry over 7 days. Global sleep quality assessed by the PSQI was significantly lower in the PBC group compared to controls (P < .0001). ESS scores were significantly higher in patients with PBC than controls (P ‫؍‬ .0001), suggesting significantly greater daytime somnolence in the patients with PBC. Objective sleep assessment confirmed that subjects with PBC were sleeping on average almost twice as long as controls during the daytime. Both degree of daytime somnolence (ESS) and actual daytime sleep activity (accelerometry) correlated strongly with fatigue severity in the patient group (r 2 ‫؍‬ 0.5, P < .0001 and r 2 ‫؍‬ 0.2, P < .01, respectively).

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Section: Discussionsupporting

confidence: 75%

Section: Methodsmentioning

confidence: 99%

mentioning

confidence: 95%

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Fatigue in primary biliary cirrhosis is associated with excessive daytime somnolence

et al. 2006

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“…5 Sleepiness and fatigue, although often occurring in the same patient, can exist independently, and either can negatively impact quality of life in MS. 3 The etiology of these symptoms has not been completely elucidated, although studies have shown that sleep disturbances are associated with a higher incidence of fatigue and daytime sleepiness. [6][7][8] Obstructive sleep apnea, often associated with sleepiness or fatigue, is prevalent in MS. 9,10 Other non-therapy-related diagnoses that may affect the efficiency of sleep could include sleep fragmentation, restless leg syndrome/periodic limb movements of sleep, menopause, frequent urination, muscle spasms, depression, and pain.…”

mentioning

confidence: 99%

Naps-MS

Sater¹,

Gudesblatt²,

Kresa-Reahl³

et al. 2016

International Journal of MS Care

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Background: Patients with multiple sclerosis (MS) have higher rates of fatigue, mood disturbance, and cognitive impairments than healthy populations. Disease-modifying agents may affect sleep. Although patients taking natalizumab often show improvement in fatigue during the first year of therapy, the mechanism behind this effect is unknown. The aim of the NAPS-MS study was to investigate whether natalizumab affected objective measures of sleep as determined by polysomnography (PSG) and multiple sleep latency testing (MSLT) in patients with MS with fatigue or sleepiness initiating therapy. Additional goals were to evaluate changes in measures of fatigue, mood, and cognition and to correlate these measures with objective sleep measures. Methods: Patients underwent PSG and MSLT before their first natalizumab infusion and after their seventh. Patients completed the Modified Fatigue Impact Scale, Fatigue Severity Scale (FSS), Epworth Sleepiness Scale (ESS), and visual analogue scale for fatigue (VAS-F) at their first, fourth, and seventh natalizumab infusions. NeuroTrax cognitive tests and the Hospital Anxiety and Depression Scale (HADS) were performed at the first and seventh natalizumab infusions. Results: Changes in sleep efficiency, wakefulness after sleep onset, and multiple sleep latency from baseline to 6 months of therapy did not reach significance. The FSS, VAS-F, ESS, and HADS scores were significantly improved after 6 months of therapy; cognitive scores were not significantly improved. Conclusions: Although treatment with natalizumab was associated with improvements in fatigue, sleepiness, and mood, changes in objective measures of sleep were not significant.

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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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The Relationship of Sleep Disturbances and Fatigue in Multiple Sclerosis

Abstract: There is a significant correlation between fatigue in MS patients and disrupted sleep or abnormal sleep cycles.

Cited by 185 publications

References 24 publications

Fatigue in primary biliary cirrhosis is associated with excessive daytime somnolence

Fatigue in primary biliary cirrhosis is associated with excessive daytime somnolence

Naps-MS

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

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