Sleep Disorders In Multiple Sclerosis Research Articles

Impact of Dimethylfumarate on Sleep in Multiple Sclerosis Patients: An Actigraphic Study.

Sleep disorders in multiple sclerosis (MS) patients are common. Dimethylfumarate is an oral disease-modifying drug (DMT), whose impact on sleep is unknown. The aim of this study was to characterize actigraphic patterns in MS patients treated with dimethylfumarate. Twenty relapsing-remitting MS patients with low to a mild disability, aged 20-50y, treated with dimethylfumarate for more than 6 months, were enrolled. All subjects had no history of sleep disorders. Actigraphy was used to study sleep patterns during a seven-day period. Sleep quality was assessed by the Pittsburgh Sleep Quality Index (PSQI). Twenty healthy subjects served as controls. Our results showed statistically significant differences between some actigraphic patterns in MS patients treated with dimethylfumarate and healthy subjects, but the values for patients were still within normal limits. PSQI score was higher in MS patients compared to controls. Our findings suggest that dimethylfumarate, an oral DMT with a favourable benefit-risk profile, does not strongly alter sleep patterns in MS patients with low to mild disability and with no history of sleep disorders. Actigraphy is a simple diagnostic tool, able to support an objective measure of sleep parameters. The simplicity of application may allow considering its use for a screening of sleep disorders in MS patients.

Relationship between cognitive disturbances and sleep disorders in multiple sclerosis is modulated by psychiatric symptoms

BackgroundMultiple sclerosis (MS) patients with cognitive impairment (CI) frequently suffer from sleep disturbances and emotional symptoms. The aim of this study was to investigate the relationship between CI and sleep disturbances and the role of anxiety and depression on this relationship in MS patients. MethodsProspective cross-sectional study including 80 MS patients that underwent neurologic, cognitive, psychiatric assessment, and polysomnographic registration. Partial correlations analysis adjusted by demographic and clinical variables were used to investigate associations between cognitive and sleep measures. Moderator role effect of psychiatric symptoms was also explored with linear models. ResultsThirty-six MS patients had CI. In all patients, worse performances at global, memory and attention cognitive domains were correlated with reduced sleep efficacy and longer periods of nocturnal wake (NW), while poor attention performances were associated with reduced REM-sleep (r = 0.26, p = 0.022). Memory performances were also negatively correlated with anxiety (r = −0.27, p = 0.015). The relationship between NW and memory performances was moderated by trait anxiety (p < 0.001). ConclusionsOur findings suggest that low sleep efficiency, NW, and reduced REM-sleep might affect cognitive abilities in MS. Higher trait anxiety appeared to impact on the relationship between increased NW and poor memory performances.Treatment of sleep and psychiatric disturbances may contribute to mitigating cognitive disorders in MS.

Restless legs syndrome and related factors in people with multiple sclerosis in Turkey

ABSTRACT Objective Restless legs syndrome is one of the most reported sleep disorders in multiple sclerosis (MS). The study aims to investigate the possible factors related to the occurrence and severity of restless legs syndrome in persons with MS (pwMS) comparing with healthy controls. Methods This is a case-control study that included 447 pwMS and 57 healthy controls. Demographic and clinical data such as gender, age, duration of education, body mass index, marital status, disease duration, and MS type were recorded. Neurological disability was assessed by the Expanded Disability Status Scale. The Restless Legs Syndrome Rating Scale was used to assess the severity of restless legs syndrome. Results The prevalence of restless legs syndrome in pwMS was 133 (29.8%) and 3 (4.9%) in healthy controls (p < 0.001). There was no significant difference between the groups in terms of gender, body mass index, and MS type (p > 0.05). Patients with restless legs syndrome have more advanced age, longer disease duration, and higher Expanded Disability Status Scale scores than patients without restless legs syndrome (p < 0.05). The correlation between restless legs syndrome severity and age, Expanded Disability Status Scale score, disease duration was not statistically significant (p > 0.05). Conclusions This study has shown that the presence of restless legs syndrome is high in persons with MS compared to healthy controls. Advanced age, disease duration, and higher disability level could be related to the increased rate of restless legs syndrome in persons with MS, especially those with high-frequency symptoms.

Discrepancies between self-reported and device-measured sleep parameters in adults with multiple sclerosis.

Sleep problems are a common consequence of multiple sclerosis; however, there is limited evidence regarding the agreement between device-measured and self-reported sleep parameters in adults with multiple sclerosis. The present study examined the agreement between self-reported and device-measured parameters of sleep quality in a sample of adults with multiple sclerosis. Participants (n = 49) completed a 7-day sleep diary and wore a wrist-worn ActiGraph GT3×+ (ActiGraph Corp., Pensecola, FL) for seven consecutive nights to quantify self-reported and device-measured sleep parameters, respectively. There was a significant discrepancy between self-reported and device-measured parameters of total time in bed (mean difference = 19.8 [51.3] min), sleep onset latency (mean difference = 22.2 [19.5] min), and frequency of awakenings during the night (mean difference = 12.8 [6.8]). Intraclass correlation estimates indicated poor agreement between methods on most parameters, except for total time in bed (intraclass correlation = 0.80). Bland-Altman plots suggested that total time in bed and total sleep time had acceptable levels of agreement and linear regression analyses indicated that sleep onset latency (F = 113.91, B = -1.34, P < .001), number of awakenings (F = 543.34, B = 1.85, P < .001), and sleep efficiency (F = 18.39, B = -0.77, P < .001) had significant proportional bias. Our results draw attention to the discrepancies between sleep parameter measurements and highlight the importance of including both self-report and device-measured outcomes for a complete and accurate representation of sleep in adults with multiple sclerosis. Cederberg KLJ, Mathison BG, Schuetz ML, Motl RW. Discrepancies between self-reported and device-measured sleep parameters in adults with multiple sclerosis. J Clin Sleep Med. 2022;18(2):415-421.

Sleep disorders in multiple sclerosis

Sleep disorders in multiple sclerosis

Sleep in multiple sclerosis patients treated with interferon beta: an actigraphic study

ABSTRACT Objective Sleep disorders in multiple sclerosis (MS) patients are common and complex. Some evidences suggest that interferon beta (IFN-β), a first line disease modifying therapy can be involved in the induction of sleep architecture changes. The aim of this study was to evaluate and characterize actigraphic patterns in MS patients treated with IFN-β. Methods Ten relapsing remitting MS patients with low to mild disability (Expanded Disability Status Scale<2.5), aged 20–50y treated with IFN-β for more than 6 months were enrolled. Actigraphy was used to study sleep pattern. Sleep quality was assessed by the Pittsburgh Sleep Quality Index (PSQI). Ten sex-and age-matched healthy subjects served as controls. In patients, a comparison between drug free nights and nights following drug administration was made. Results Patients had significantly higher PSQI (p = 0.006), sleep onset latency (p = 0.029), sleep efficiency percentage (p = 0.001) and number of wake episodes (p = 0,0001) values, when compared with controls. When comparing the actigraphic results acquired in the nights after treatment with those acquired in the free-drug nights, the only significant difference (p = 0.038) was detected for time in bed that was higher after IFN-β administration. Conclusions Our results, besides confirming the presence of alterations in sleep patterns in MS patients, suggest that IFN-β may contribute to promote alteration in sleep architecture. Actigraphy is a simple diagnostic tool, able to support an objective measure of sleep parameters. The relative simplicity of application and low costs may allow considering its use for an adequate screening of sleep disorders in MS patients.

Antidepressant Effects of a Persian Medicine Remedy On Multiple Sclerosis Patients: A Double-Blinded Randomized Clinical Trial

Background: Multiple sclerosis (MS), an inflammatory neurodegenerative disease of the central nervous system, is accompanied by some psychiatric disorders, one prominent example of which is depression. The aim of this study was to investigate the effects of a Persian herbal medicine treatment that contains Crocus sativus, Hypericum perforatum, Cinnamon verum, and Vitis vinifera on fatigue and sleep disorders in MS patients.Materials and Methods: A Persian medicine remedy containing C.sativus, H.perforatum, C.verum, and V.vinifera was tested for its ability to improve the symptoms of depression in MS patients. This randomized double-blind clinical study was performed among 52 patients with MS who were allocated to their respective research groups through blocked randomization. The patients were treated for 4 weeks with either the drug or the placebo. To quantify the symptoms of depression, Beck depression inventory (BDI) was used.Result: Forty-six patients completed the study. In the course of the study, as the primary outcome, BDI decreased in the drug group (p=0.000) and the placebo group (p=0.001) significantly, but the rate of change in the drug group was significantly higher than in the placebo group (-13.9 ± 8.6 vs. -3.9 ± 4.3, p=0.000). While analyzing time and treatment effect for BDI, significant decreases in BDI were observed for the drug group, but not in the placebo group (p= 0.001).Conclusion: The present study suggests that Persian medicine remedy treatment in combination with chemical drugs may improve depression symptoms in MS patients. More investigations are needed to discover the exact mechanisms and processes involved. [GMJ.2019;ipress:e1212]

Short Report: Impact of Sleep Disorders on Depression and Patient-Perceived Health-Related Quality of Life in Multiple Sclerosis.

Sleep disorders in multiple sclerosis (MS) are associated with reduced health-related quality of life (HRQOL) and depression. However, research investigating and comparing how the two most common sleep disorders-insomnia and obstructive sleep apnea (OSA)-affect depression and HRQOL in MS is limited. The goal of this study is to examine the impact of diagnosed sleep disorders on patient-reported 1) HRQOL and 2) depressive symptoms in patients with MS. We performed a retrospective medical record review of 531 adult patients with MS: 287 (54%) with a comorbid sleep disorder (insomnia or OSA) and 244 (46%) without a diagnosed sleep disorder. Neither 1) average ratings of depression or HRQOL nor 2) the proportion of moderate depression or moderately impaired HRQOL differed between individuals with MS and insomnia and those with MS and OSA. Neither sleep disorder predicted increased depression or poorer HRQOL. However, individuals with MS and a comorbid sleep disorder (insomnia or OSA) had poorer HRQOL compared with those without a diagnosed sleep disorder (MS only). Presence of a diagnosed sleep disorder may negatively affect HRQOL in MS. Providers should continue to screen for sleep disorders given their negative impact on patients with MS and the availability of effective treatments for insomnia and OSA.

Sleep disorders in multiple sclerosis: present-day knowledge and future perspectives

Sleep disorders in multiple sclerosis: present-day knowledge and future perspectives

Sleep Disorders in Multiple Sclerosis.

Recent studies suggest that individuals with multiple sclerosis (MS) are at increased risk for sleep disturbances and that sleep disturbances contribute to fatigue and other chronic symptoms in MS. Although fatigue occurs commonly in people with MS, this symptom is often attributed to MS-specific pathology. Consequently, sleep disorders are often unrecognized and untreated in this population. Timely diagnosis and treatment of sleep problems in MS offer a new opportunity to ameliorate some of the daytime fatigue experienced by patients with MS. To increase this opportunity, the practitioner should be comfortable performing basic screening for common sleep complaints among patients with MS. The objectives of this review are to summarize the latest relevant data on sleep disorders in MS and offer a helpful approach to the identification and workup of the most common sleep problems in this population. Unexplored research avenues and opportunities to address important questions at the interface of sleep and MS are also discussed.

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

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.

Sleep disorders in multiple sclerosis in China: clinical, polysomnography study, and review of the literature.

Sleep disorders are common in multiple sclerosis (MS). The aim of this study was to assess the subjective and objective sleep disturbances in patients with MS and to investigate their relationships with fatigue and excessive daytime sleepiness. All participants completed standardized questionnaires and underwent nocturnal polysomnography. English literature regarding MS and sleep disorders was systematically reviewed through PubMed searches. Eleven patients with MS with fatigue, 10 patients with MS without fatigue, and 11 controls were included in the study. According to the Pittsburg sleep quality index, 61.9% of the patients with MS were poor sleepers and based on the Epworth sleepiness scale, 38.1% of the patients with MS met the criteria of excessive daytime sleepiness. Additionally, patients with MS had more disturbed sleep with higher total arousal index (P < 0.01) and periodic limb movement arousal index (P < 0.001) than controls. None of the patients or controls had an apnea/hypopnea index greater than five. One patient had restless legs syndrome and four had rapid eye movement sleep behavior disorder. Our study shows that sleep disorders and excessive daytime sleepiness are frequent in MS.

Pathophysiological background and clinical characteristics of sleep disorders in multiple sclerosis

Sleep disorders in multiple sclerosis (MS) are more common than in general population and are considered to be one of the important etiological factors in development of fatigue, most common and debilitating symptom of MS. Although almost all of the major subgroups of sleep disorders such as insomnia, sleep disordered breathing, REM sleep behavior disorder, narcolepsy and restless legs syndrome have been described in the MS patients their higher prevalence in MS population than in healthy controls in some of the sleep disorders is not fully elucidated. Immunological background in disease development in both multiple sclerosis and sleep disorders have been proposed as possible common pathophysiological mechanism and recent findings of disrupted melatonin pathways in MS patients suggest multi-level causative mechanism of the development of sleep disorders in MS.

Unusual Symptoms and Syndromes in Multiple Sclerosis

In multiple sclerosis (MS), symptoms vary widely from patient to patient. Certain events in MS are well recognized (eg, optic neuritis, brainstem and spinal cord relapses) and do not lead to much clinical confusion. However, other events that occur in MS may be less expected and may be underrecognized by some clinicians and may lead to an extensive and potentially unnecessary investigation for what is a known problem in MS. This article reviews Lhermitte sign, Pulfrich phenomenon, Uhthoff phenomenon, and the useless hand of Oppenheim, along with the underrecognized phenomena of transient neurologic events (including tonic spasms). Disorders of temperature regulation in MS (likely based on hypothalamic involvement) which can present with bizarre behavioral change and evade diagnosis, are also discussed. The article concludes with a review of epilepsy and sleep disorders in MS, both of which appear to occur at an increased frequency in the MS population and may have implications for therapy. This article is meant to help clinicians recognize and treat this fascinating set of underrecognized phenomena in MS and perhaps save patients trips to the emergency department, extraneous testing, and ineffective intervention.

Restless Legs Syndrome in Multiple Sclerosis

There is a growing interest in sleep disorders in multiple sclerosis (MS) due to their high frequency and possible relationship to fatigue, a hallmark symptom in MS. Among them, insomnia and restless legs syndrome (RLS) are the most common ones. RLS is a sleep-related motor disorder characterized by a strong urge to move associated with uncomfortable sensations in the limbs. It is frequently under diagnosed in patients with MS although its course is often particularly severe. Several arguments support a symptomatic origin of RLS in MS patients. Independently of any causal relationship, the high prevalence of RLS in MS patients has clinical implications. The purpose of the present review is (i) to summarize the epidemiological data and clinical characteristics of RLS in MS patients in order to increase sensitivity to this disorder; (ii) to document the substantial body of evidence in support of a symptomatic origin of RLS in MS and from this (iii) to delineate the proposition that MS may represent a clinical model to study RLS-associated pathological changes.

Clinical assessment and management of sleep disorders in multiple sclerosis: a literature review

The major sleep disorders are common in multiple sclerosis (MS) and are associated with significant morbidity. Despite this, the rate of recognition and management of these conditions are low. All types of sleep disorders are seen in patients with MS: insomnia, circadian rhythm sleep disorders, sleep-related movement disorders, sleep-related breathing disorders, hypersomnia (narcolepsy), and parasomnia (REM sleep behavior disorder; RBD). This literature review covers the prevalence, clinical features, and treatment of sleep disorders in MS. Based on clinical experience, the spectrum of symptoms associated with MS, and the current knowledge of MS pathophysiology, we have also enclosed proposed strategies for clinical assessment and investigation of sleep disorders in MS patients.

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

In this small pilot study, published in the current issue of Sleep and Breathing, Dias and colleagues [1] try to identify multiple sclerosis (MS) patients who are at risk for obstructive sleep apnea (OSA) by applying the STOP-BANG questionnaire which has been validated as a screening tool for OSA in various populations, but not yet in MS patients [2]. Interestingly, almost half of the cohort exhibited STOPBANG scores indicative of a high OSA risk, which was approximately threefold higher in men than in women. In men, a significant correlation between STOP-BANG scores and measures of daytime sleepiness (Epworth Sleepiness Scale) and fatigue (Fatigue Severity Scale) was reported. Although the study has some obvious methodological limitations discussed by the authors, such as a lack of a subsequent polysomnography (PSG) to confirm the presence of OSA in patients at high risk according to the STOP-BANG questionnaire, the attempt to shed light on the elusive influence of nocturnal sleep abnormalities on daytime sleepiness and fatigue in MS is laudable. Fatigue is defined as “a subjective lack of physical and/or mental energy that is perceived by the individual or caregiver to interfere with usual and desired activities” [3]. Fatigue is the most frequent MS symptom, reported by up to 97% of patients [4–6], two thirds of whom consider it as their most disabling symptom [7]. Fatigue does not only exert a substantial negative impact on quality of life, but is also a major cause of unemployment in MS [8]. Fatigue has been related to neuroimaging findings [9], neuroendocrine dysregulation [10], XMRV virus infections [11], depression and cognitive dysfunction [12, 13]. However, despite its high prevalence, our knowledge on pathophysiology and treatment of MS-related fatigue is insufficient. 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 [14–17]. In sum, it is undoubtful that sleep disorders can contribute to daytime fatigue in MS. In a recently published study [18], the authors proposed a screening instrument for sleep disorders because owing to limited resources not every MS patient complaining of fatigue can be admitted to a sleep laboratory. Beyond that, it makes sense to develop a screening instrument especially for OSA in the context of MS-related fatigue to identify patients at high risk. Further polysomnographic investigations have to validate this specific STOP-BANG questionnaire in the context ofMS-related fatigue. Secondly, prospective studies have to evaluate whether a consequent treatment of the respective sleep disorder will beneficially influence fatigue in MS. If this can be demonstrated, a new therapeutic horizon F. Paul (*) NeuroCure Clinical Research Center and Experimental and Clinical Research Center, Charite University Medicine Berlin, Chariteplatz 1, 10117 Berlin, Germany e-mail: friedemann.paul@charite.de

Beyond fatigue: Assessing variables associated with sleep problems and use of sleep medications in multiple sclerosis

BACKGROUND: Recent research indicates that sleep disturbances are common in persons with multiple sclerosis (MS), though research to date has primarily focused on the relationship between fatigue and sleep. In order to improve treatment of sleep disorders in MS, a better understanding of other factors that contribute to MS sleep disturbance and use of sleep medications in this population is needed. METHODS: Individuals with MS (N = 473) involved in an ongoing self-report survey study were asked to report on use of over-the-counter and prescription sleep medications. Participants completed the Medical Outcomes Study Sleep (MOSS) scale and other common self-report symptom measures. Multiple regression was used to evaluate factors associated with sleep problems and descriptive statistics were generated to examine use of sleep medications. RESULTS: The mean score on the MOSS scale was 35.9 (standard deviation, 20.2) and 46.8% of the sample had moderate or severe sleep problems. The majority of participants did not use over-the-counter (78%) or prescription (70%) sleep medications. In a regression model variables statistically significantly associated with sleep problems included depression, nighttime leg cramps, younger age, pain, female sex, fatigue, shorter duration of MS, and nocturia. The model explained 45% of the variance in sleep problems. Of the variance explained, depression accounted for the majority of variance in sleep problems (33%), with other variables explaining significantly less variance. CONCLUSIONS: Regression results indicate that fatigue may play a minor role in sleep disturbance in MS and that clinicians should consider the interrelationship between depression and sleep problems when treating either symptom in this population. More research is needed to explore the possibility of under-treatment of sleep disorders in MS and examine the potential effectiveness of nonpharmaceutical treatment options.

Sleep Disorders in Multiple Sclerosis

Sleep disorders are pervasive in patients with multiple sclerosis (MS) although clinically underrecognized by most physicians. The most common sleep disorders seen in patients with MS include insomnia, nocturnal movement disorders, sleep-disordered breathing, narcolepsy, and rapid eye movement sleep behavior disorder. Factors that influence the quality of sleep in this patient population include pain, nocturia, depression, medication effect, location of lesions, and disease severity. Disrupted sleep has the potential to cause daytime somnolence, increased fatigue, and nonrefreshing sleep, and it may be associated with dangerous respiratory events. Awareness and treatment of these conditions is vital to improving health and quality of life in patients with MS.