Sleep and Breathing

, Volume 16, Issue 4, pp 1255–1265 | Cite as

Sleepiness, fatigue, and risk of obstructive sleep apnea using the STOP-BANG questionnaire in multiple sclerosis: a pilot study

  • Robert A. Dias
  • Kimberly A. Hardin
  • Heather Rose
  • Mark A. Agius
  • Michelle L. Apperson
  • Steven D. Brass
Original Article
First Online:
Received:
Revised:
Accepted:

Abstract

Purpose

This study aims: (1) to identify patients with multiple sclerosis (MS) who are at high risk for obstructive sleep apnea (OSA) by utilizing the STOP-BANG questionnaire and (2) to evaluate the relationship between OSA risk as determined by the STOP-BANG questionnaire and self-reported sleepiness and fatigue using the Epworth Sleepiness Scale (ESS) and the Fatigue Severity Scale (FSS), respectively.

Methods

A total of 120 consecutive patients presenting to the UC Davis Neurology MS Clinic were invited to participate in an anonymous survey. The exclusion criteria were: age <18 years, indefinite MS diagnosis, or incomplete survey.

Results

There were 103 subjects included in our study: 42% of subjects (n = 43) met the criteria for high-risk OSA, 69% of subjects (n = 71) screened high for fatigue (FSS ≥ 4), but only 24 subjects (23%) screened high for excessive daytime sleepiness (ESS > 10). In males, 44% of the variation in ESS scores and 63% in FSS scores were explained by the STOP-BANG components. However, only 17% of the variation in ESS scores and 15% of the variation in FSS scores was explained by the STOP-BANG components in females.

Conclusions

Over 40% of MS patients were identified as high risk for OSA based on the STOP-BANG questionnaire. The STOP-BANG questionnaire offers clinicians an efficient and objective tool for improving detection of OSA risk in MS patients.

Keywords

Obstructive sleep apnea Multiple sclerosis Sleepiness Fatigue 

Abbreviations

AHI

Apnea–hypopnea index

BMI

Body mass index

EEG

Electroencephalography

ESS

Epworth Sleepiness Scale

FSS

Fatigue Severity Scale

OSA

Obstructive sleep apnea

MS

Multiple sclerosis

PSG

Polysomnography

UC

University of California

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Notes

Acknowledgements

The authors would like to thank Steffany Lim, clinical research coordinator in UC Davis Department of Neurology, for her assistance in overseeing the administration of the survey and data collection.

Conflicts of interest

The authors declare that they have no conflicts of interest.

References

  1. 1.
    Hauser SL, Goodin DS (2011) Multiple sclerosis and other demyelinating diseases. In: Longo DL, Fauci AS, Kasper DL, et al (eds) Harrison’s principles of internal medicine, 18th edn. McGraw Hill, New York, in pressGoogle Scholar
  2. 2.
    Ferini-Strambi L (2011) Sleep disorders in multiple sclerosis. Handb Clin Neurol 99:1139–1146PubMedCrossRefGoogle Scholar
  3. 3.
    Krupp L (2006) Fatigue is intrinsic to multiple sclerosis (MS) and is the most commonly reported symptom of the disease. Mult Scler 12:367–368PubMedCrossRefGoogle Scholar
  4. 4.
    Stanton BR, Barnes F, Silber E (2006) Sleep and fatigue in multiple sclerosis. Mult Scler 12:481–486PubMedCrossRefGoogle Scholar
  5. 5.
    Braley TJ, Chervin RD (2010) Fatigue in multiple sclerosis: mechanisms, evaluation, and treatment. Sleep 33:1061–1067PubMedGoogle Scholar
  6. 6.
    Janardhan V, Bakshi R (2002) Quality of life in patients with multiple sclerosis: the impact of fatigue and depression. J Neurol Sci 205:51–58PubMedCrossRefGoogle Scholar
  7. 7.
    Lerdal A, Celius EG, Krupp L, Dahl AA (2007) A prospective study of patterns of fatigue in multiple sclerosis. Eur J Neurol 14:1338–1343PubMedCrossRefGoogle Scholar
  8. 8.
    Brass SD, Duquette P, Proulx-Therrien J, Auerbach S (2010) Sleep disorders in patients with multiple sclerosis. Sleep Med Rev 14:121–129PubMedCrossRefGoogle Scholar
  9. 9.
    Young T, Palta M, Dempsey J, Skatrud J, Weber S, Badr S (1993) The occurrence of sleep-disordered breathing among middle-aged adults. N Engl J Med 328:1230–1235PubMedCrossRefGoogle Scholar
  10. 10.
    Young T, Finn L, Peppard PE, Szklo-Coxe M, Austin D, Nieto FJ, Stubbs R, Hla KM (2008) Sleep disordered breathing and mortality: eighteen-year follow-up of the Wisconsin sleep cohort. Sleep 31:1071–1078PubMedGoogle Scholar
  11. 11.
    Young T, Peppard PE, Gottlieb DJ (2002) Epidemiology of obstructive sleep apnea: a population health perspective. Am J Respir Crit Care Med 165:1217–1239PubMedCrossRefGoogle Scholar
  12. 12.
    Kaminska M, Kimoff RJ, Schwartzman K, Trojan DA (2011) Sleep disorders and fatigue in multiple sclerosis: evidence for association and interaction. J Neurol Sci 302:7–13PubMedCrossRefGoogle Scholar
  13. 13.
    Tachibana N, Howard RS, Hirsch NP, Miller DH, Moseley IF, Fish D (1994) Sleep problems in multiple sclerosis. Eur Neurol 34:320–323PubMedCrossRefGoogle Scholar
  14. 14.
    Wunderlin BW, Kesselring J, Ginzler H, Walser B, Kuhn M, Reinhart WH (1997) Fatigue in multiple sclerosis is not due to sleep apnea. Eur J Neurol 4:72–78CrossRefGoogle Scholar
  15. 15.
    Ferini-Strambi L, Filippi M, Martinelli V, Oldani A, Rovaris M, Zucconi M, Comi G, Smirne S (1994) Nocturnal sleep study in multiple sclerosis: correlations with clinical and brain magnetic resonance imaging findings. J Neurol Sci 125:194–197PubMedCrossRefGoogle Scholar
  16. 16.
    Kaynak H, Altintas A, Kaynak D, Uyanik O, Saip S, Ağaoğlu J, Onder G, Siva A (2006) Fatigue and sleep disturbances in multiple sclerosis. Eur J Neurol 13:1333–1339PubMedCrossRefGoogle Scholar
  17. 17.
    Veauthier C, Radbruch H, Gaede G, Pfueller CF, Dörr J, Bellmann-Strobl J, Wernecke KD, Zipp F, Paul F, Sieb JP (2011) Fatigue in multiple sclerosis is closely related to sleep disorders: a polysomnographic cross-sectional study. Mult Scler 17:613–622PubMedCrossRefGoogle Scholar
  18. 18.
    Kos D, Kerckhofs E, Nagels G, D’hooghe MB, Ilsbroukx S (2008) Origin of fatigue in multiple sclerosis: review of the literature. Neurorehabil Neural Repair 22:91–100PubMedGoogle Scholar
  19. 19.
    Leocani L, Colombo B, Comi G (2008) Physiopathology of fatigue in multiple sclerosis. Neurol Sci 29:S241–S243PubMedCrossRefGoogle Scholar
  20. 20.
    Pittion-Vouyovitch S, Debouverie M, Guillemin F, Vandenberghe N, Anxionnat R, Vespignani H (2006) Fatigue in multiple sclerosis is related to disability, depression and quality of life. J Neurol Sci 243:39–45PubMedCrossRefGoogle Scholar
  21. 21.
    Gold SM, Irwin MR (2006) Depression and immunity: inflammation and depressive symptoms in multiple sclerosis. Neurol Clin 24:507–519PubMedCrossRefGoogle Scholar
  22. 22.
    Bakshi R (2003) Fatigue associated with multiple sclerosis: diagnosis, impact and management. Mult Scler 9:219–227PubMedCrossRefGoogle Scholar
  23. 23.
    Mills PJ, Kim JH, Bardwell W, Hong S, Dimsdale JE (2008) Predictors of fatigue in obstructive sleep apnea. Sleep Breath 12:397–399PubMedCrossRefGoogle Scholar
  24. 24.
    Chung F, Yegneswaran B, Liao P, Chung SA, Vairavanathan S, Islam S, Khajehdehi A, Shapiro CM (2008) STOP questionnaire: a tool to screen patients for obstructive sleep apnea. Anesthesiology 108:812–882PubMedCrossRefGoogle Scholar
  25. 25.
    Abrishami A, Khajehdehi A, Chung F (2010) A systematic review of screening questionnaires for obstructive sleep apnea. Can J Anaesth 57:423–438PubMedCrossRefGoogle Scholar
  26. 26.
    Vasu TS, Doghramji K, Cavallazzi R, Grewal R, Hirani A, Leiby B, Markov D, Reiter D, Kraft WK, Witkowski T (2010) Obstructive sleep apnea syndrome and postoperative complications: clinical use of the STOP-BANG questionnaire. Arch Otolaryngol Head Neck Surg 136:1020–1024PubMedCrossRefGoogle Scholar
  27. 27.
    Kumar S, McElligott D, Goyal A, Baugh M, Ionita R (2010) Risk of obstructive sleep apnea in hospitalized patients. Chest 138:779ACrossRefGoogle Scholar
  28. 28.
    Ong TH, Raudha S, Fook-Chong S, Lew N, Hsu AA (2010) Simplifying STOP-BANG: use of a simple questionnaire to screen for OSA in an Asian population. Sleep Breath 14:371–376PubMedCrossRefGoogle Scholar
  29. 29.
    Johns MW (1991) A new method for measuring daytime sleepiness: the Epworth Sleepiness Scale. Sleep 14:540–545PubMedGoogle Scholar
  30. 30.
    Johns MW (1992) Reliability and factor analysis of the Epworth Sleepiness Scale. Sleep 15:376–381PubMedGoogle Scholar
  31. 31.
    Krupp LB, LaRocca NG, Muir-Nash J, Steinberg AD (1989) The fatigue severity scale. Application to patients with multiple sclerosis and systemic lupus erythematosus. Arch Neurol 46:1121–1123PubMedCrossRefGoogle Scholar
  32. 32.
    Flachenecker P, Kumpfel T, Kallmann B, Gottschalk M, Grauer O, Rieckmann P, Trenkwalder C, Toyka KV (2002) Fatigue in multiple sclerosis: a comparison of different rating scales and correlation to clinical parameters. Mult Scler 8:523–526PubMedCrossRefGoogle Scholar
  33. 33.
    Senthilvel E, Auckley D, Dasarathy J (2011) Evaluation of sleep disorders in the primary care setting: history taking compared to questionnaires. J Clin Sleep Med 7:41–48PubMedGoogle Scholar
  34. 34.
    Netzer NC, Stoohs RA, Netzer CM, Clark K, Strohl KP (1999) Using the Berlin Questionnaire to identify patients at risk for the sleep apnea syndrome. Ann Intern Med 131:485–491PubMedGoogle Scholar
  35. 35.
    Chung F, Yegneswaran B, Liao P, Chung SA, Vairavanathan S, Islam S, Khajehdehi A, Shapiro CM (2008) Validation of the Berlin Questionnaire and American Society of Anesthesiologists checklist as screening tools for obstructive sleep apnea in surgical patients. Anesthesiology 108:822–830PubMedCrossRefGoogle Scholar
  36. 36.
    Hiestand DM, Britz P, Goldman M, Phillips B (2006) Prevalence of symptoms and risk of sleep apnea in the US population: results from the national sleep foundation sleep in America 2005 poll. Chest 130:780–786PubMedCrossRefGoogle Scholar
  37. 37.
    West SD, Nicoll DJ, Stradling JR (2006) Prevalence of obstructive sleep apnoea in men with type 2 diabetes. Thorax 61:945–950PubMedCrossRefGoogle Scholar
  38. 38.
    Sharma S, Parker AT (2011) Prevalence of obstructive sleep apnea in patient population undergoing cardiac rehabilitation. J Cardiopulm Rehabil Prev 31(3):188–192Google Scholar
  39. 39.
    Srijithesh PR, Shukla G, Srivastav A, Goyal V, Singh S, Behari M (2011) Validity of the Berlin Questionnaire in identifying obstructive sleep apnea syndrome when administered to the informants of stroke patients. J Clin Neurosci 18:340–343PubMedCrossRefGoogle Scholar
  40. 40.
    Patt BT, Jarjoura D, Lambert L, Roy S, Gordillo G, Schlanger R, Sen CK, Khayat RN (2010) Prevalence of obstructive sleep apnea in patients with chronic wounds. J Clin Sleep Med 6:541–544PubMedGoogle Scholar
  41. 41.
    Merkelbach S, Schulz H, Kolmel HW, Gora G, Klingelhöfer J, Dachsel R, Hoffmann F, Polzer U (2011) Fatigue, sleepiness, and physical activity in patients with multiple sclerosis. J Neurol 258:74–79PubMedCrossRefGoogle Scholar
  42. 42.
    Mills RJ, Young CA (2010) The relationship between fatigue and other clinical features of multiple sclerosis. Mult Scler 17:604–612PubMedCrossRefGoogle Scholar
  43. 43.
    Nguyen AT, Baltzan MA, Small D, Wolkove N, Guillon S, Palayew M (2006) Clinical reproducibility of the Epworth Sleepiness Scale. J Clin Sleep Med 2:170–174PubMedGoogle Scholar
  44. 44.
    Rosenthal LD, Dolan DC (2008) The Epworth sleepiness scale in the identification of obstructive sleep apnea. J Nerv Ment Dis 196:429–431PubMedCrossRefGoogle Scholar
  45. 45.
    Bardwell WA, Moore P, Ancoli-Israel S, Dimsdale JE (2003) Fatigue in obstructive sleep apnea: driven by depressive symptoms instead of apnea severity? Am J Psychiatry 160:350–355PubMedCrossRefGoogle Scholar
  46. 46.
    Vgontzas AN, Bixler EO, Chrousos GP (2006) Obesity-related sleepiness and fatigue: the role of the stress system and cytokines. Ann N Y Acad Sci 1083:329–344PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2012

Authors and Affiliations

  • Robert A. Dias
    • 1
    • 2
  • Kimberly A. Hardin
    • 1
  • Heather Rose
    • 3
  • Mark A. Agius
    • 2
  • Michelle L. Apperson
    • 2
  • Steven D. Brass
    • 2
  1. 1.Department of Pulmonary, Critical Care and Sleep MedicineSacramentoUSA
  2. 2.Department of NeurologyUC Davis Medical CenterSacramentoUSA
  3. 3.School of EducationUC DavisDavisUSA

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