Abstract
Purpose
The purpose of the present study is to investigate sleep-disordered breathing and symptoms of sleepiness in a consecutive clinical cohort of multiple sclerosis (MS) patients.
Methods
Twenty-one (16 females) community-dwelling adults aged 18–75 years with MS and an Expanded Disability Status Scale score between 2 and 6 were recruited consecutively from an academic teaching hospital MS clinic. Participants performed a home sleep study (ResMed ApneaLink Plus) to objectively quantify sleep-disordered breathing. Subjective sleepiness and its impact were assessed using the Epworth Sleepiness Scale, Pittsburgh Sleep Quality Index, and Functional Outcomes of Sleep Questionnaire.
Results
Three (one female) of the 19 participants who completed home overnight testing had central sleep apnea (median apnea-hypopnea index = 15 [range = 8–36] events/h sleep, median nadir SaO2 = 88 % [range = 81–88]). There were no cases of obstructive sleep apnea. Thirty-three percent of participants reported excessive daytime sleepiness, and 71% reported poor sleep quality.
Conclusions
Home sleep testing was well tolerated, and a high proportion of central rather than obstructive sleep apnea was observed in a clinical MS sample. Possible reasons include brainstem or spinal cord lesions from MS affecting the control of breathing. Poor sleep quality and daytime sleepiness were common in this group.
References
Veauthier C, Radbruch H, Gaede G et al (2011) Fatigue in multiple sclerosis is closely related to sleep disorders: a polysomnographic cross-sectional study. Mult Scler 17:613–622
Kaminska M, Kimoff RJ, Benedetti A, Robinson A, Bar-Or A, Lapierre Y, Schwartzman K, Trojan DA (2012) Obstructive sleep apnea is associated with fatigue in multiple sclerosis. Mult Scler 18:1159–1169
Kaynak H, Altintas A, Kaynak D, Uyanik O, Saip S, Agaoglu J, Onder G, Siva A (2006) Fatigue and sleep disturbance in multiple sclerosis. Eur J Neurol 13:1333–1339
Braley TJ, Chervin RD, Segal BM (2012) Fatigue, tiredness, lack of energy, and sleepiness in multiple sclerosis patients referred for clinical polysomnography. Multiple Sclerosis Int 2012:7
Braley TJ, Segal BM, Chervin RD (2014) Obstructive sleep apnea and fatigue in patients with multiple sclerosis. J Clin Sleep Med 10:155–162
Braley TJ, Boudreau EA (2016) Sleep disorders in multiple sclerosis. Curr Neurol Neurosci Rep 16:1–8
Braley TJ, Kratz AL, Kaplish N, Chervin RD (2016) Sleep and cognitive function in multiple sclerosis. Sleep 39:1525–1533
Veauthier C, Gaede G, Radbruch H, Gottschalk S, Wernecke KD, Paul F (2013) Treatment of sleep disorders may improve fatigue in multiple sclerosis. Clin Neurol Neurosurg 115:1826–1830
Cote I, Trojan DA, Kaminska M et al (2013) Impact of sleep disorder treatment on fatigue in multiple sclerosis. Mult Scler 19:480–489
Kallweit U, Baumann CR, Harzheim M, Hidalgo H, Hlau D, Bassetti CL, Linnebank M, Valko PO (2013) Fatigue and sleep-disordered breathing in multiple sclerosis: a clinically relevant association? Multiple Sclerosis Int 2013:7
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 125:194–197
Tachibana N, Howard RS, Hirsch NP, Miller DH, Moseley IF, Fish D (1994) Sleep problems in multiple sclerosis. Eur Neurol 34:320–323
Neau JP, Paquereau J, Auche V, Mathis S, Godeneche G, Ciron J, Moinot N, Bouche G (2012) Sleep disorders and multiple sclerosis: a clinical and polysomnography study. Eur Neurol 68:8–15
Chen JH, Liu XQ, Sun HY, Huang Y (2014) Sleep disorders in multiple sclerosis in China: clinical, polysomnography study, and review of the literature. J Clin Neurophysiol 31:375–381
Bixler EO, Vgontzas AN, Ten Have T, Tyson K, Kales A (1998) Effects of age on sleep apnea in men: I. Prevalence and severity. Am J Respir Crit Care Med 157:144–148
Kurtzke JF (1983) Rating neurologic impairment in multiple sclerosis an expanded disability status scale (EDSS). Neurology 33:1444–1444
Ward KL, McArdle N, James A et al (2015) A comprehensive evaluation of a two-channel portable monitor to “rule in” obstructive sleep apnea. J Clin Sleep Med 11:433–444
Nigro CA, Dibur E, Malnis S, Grandval S, Nogueira F (2013) Validation of ApneaLink Ox for the diagnosis of obstructive sleep apnea. Sleep Breath 17:259–266
Ng SS, Chan TO, To KW, Ngai J, Tung A, Ko FW, Hui DS (2009) Validation of a portable recording device (ApneaLink) for identifying patients with suspected obstructive sleep apnoea syndrome. Intern Med J 39:757–762
Ragette R, Wang Y, Weinreich G, Teschler H (2010) Diagnostic performance of single airflow channel recording (ApneaLink) in home diagnosis of sleep apnea. Sleep Breath 14:109–114
Nigro CA, Serrano F, Aimaretti S, Gonzalez S, Codinardo C, Rhodius E (2010) Utility of ApneaLink for the diagnosis of sleep apnea-hypopnea syndrome. Medicina 70:53–59
ResMed (2009) ApneaLinkTM plus white paper 1–11
Berry RB, Budhiraja R, Gottlieb DJ et al (2012) Rules for scoring respiratory events in sleep: update of the 2007 AASM manual for the scoring of sleep and associated events. Deliberations of the Sleep Apnea Definitions Task Force of the American Academy of Sleep Medicine. J Clin Sleep Med 8:597–619
Buysse DJ, Reynolds CF, Monk TH, Berman SR, Kupfer DJ (1989) The Pittsburgh Sleep Quality Index—a new instrument for psychiatric practice and research. Psychiatry Res 28:193–213
Johns MW (1991) A new method for measuring daytime sleepiness—the Epworth Sleepiness Scale. Sleep 14:540–545
Weaver TE, Laizner AM, Evans LK et al (1997) An instrument to measure functional status outcomes for disorders of excessive sleepiness. Sleep 20:835–843
Eckert DJ, Jordan AS, Merchia P, Malhotra A (2007) Central sleep apnea: pathophysiology and treatment. Chest 131:595–607
Martins RT, Eckert DJ (2014) Central sleep apnea due to other medical disorders. Sleep Med Clin 9:57–67
Braley TJ, Segal BM, Chervin RD (2012) Sleep-disordered breathing in multiple sclerosis. Neurology 79:929–936
Pokryszko-Dragan A, Bilinska M, Gruszka E, Biel L, Kaminska K, Konieczna K (2013) Sleep disturbances in patients with multiple sclerosis. Neurol Sci 34:1291–1296
Brass SD, Li CS, Auerbach S (2014) The underdiagnosis of sleep disorders in patients with multiple sclerosis. J Clin Sleep Med 10:1025–1031
Dias RA, Hardin KA, Rose H, Agius MA, Apperson ML, Brass SD (2012) Sleepiness, fatigue, and risk of obstructive sleep apnea using the STOP-BANG questionnaire in multiple sclerosis: a pilot study. Sleep Breath Schlaf Atmung 16:1255–1265
Boe Lunde HM, Aae TF, Indrevag W, Aarseth J, Bjorvatn B, Myhr KM, Bo L (2012) Poor sleep in patients with multiple sclerosis. PLoS One 7:e49996
Stanton BR, Barnes F, Silber E (2006) Sleep and fatigue in multiple sclerosis. Mult Scler 12:481–486
Wunderlin BW, Kesselring J, Ginzler H, Walser B, Kuhn M, Reinhart WH (1997) Fatigue in multiple sclerosis is not due to sleep apnoea. Eur J Neurol 4:72–78
Merlino G, Fratticci L, Lenchig C, Valente M, Cargnelutti D, Picello M, Serafini A, Dolso P, Gigli GL (2009) Prevalence of ‘poor sleep’ among patients with multiple sclerosis: an independent predictor of mental and physical status. Sleep Med 10:26–34
Strober LB (2015) Fatigue in multiple sclerosis: a look at the role of poor sleep. Front Neurol 6:21
Shen J, Barbera J, Shapiro CM (2006) Distinguishing sleepiness and fatigue: focus on definition and measurement. Sleep Med Rev 10:63–76
Veauthier C, Paul F (2014) Sleep disorders in multiple sclerosis and their relationship to fatigue. Sleep Med 15:5–14
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Funding
A National Health and Medical Research Council of Australia (NHMRC) Program Grant on Motor Impairment (1055084) provided financial support for this study. The ApneaLink devices used for the home sleep studies were provided by ResMed. AVK was supported by a Career Development Fellowship from the National Health and Medical Research Council of Australia (1065663). DJE is supported by a NHMRC RD Wright Fellowship (1049814) and NeuroSleep, a NHMRC Centre for Research Excellence (1060992). The funding body had no role in the design or conduct of this research.
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The authors declare that they have no conflicts of interest.
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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.
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Informed consent was obtained from all individual participants included in the study.
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Lin, M., Krishnan, A.V. & Eckert, D.J. Central sleep apnea in multiple sclerosis: a pilot study. Sleep Breath 21, 691–696 (2017). https://doi.org/10.1007/s11325-016-1442-9
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DOI: https://doi.org/10.1007/s11325-016-1442-9