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Sleep in multiple sclerosis and neuromyelitis optica spectrum disorder—the SEMN study

  • Neurology • Original Article
  • Published:
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Abstract

Purpose

This study aimed to (1) evaluate in patients with multiple sclerosis (MS) and neuromyelitis optica spectrum disorder (NMOSD) the presence of sleep disorders such as hypersomnia, fatigue, risk of apnea, and the presence of restless legs syndrome/Willis-Ekbom disease (RLS/WED); (2) evaluate quality of sleep in patients with MS and NMOSD; and (3) correlate them with clinical and imaging data.

Methods

The study was cross-sectional and was carried out in the sector of demyelinating diseases of the neurology service of HUGV-UFAM, Manaus, Brazil, from January 2017 to December 2020.

Results

Our sample consisted of 60 patients, 41 with MS and 19 with NMOSD. We found that patients with MS and NMOSD have poor sleep quality (65%) and hypersomnia (53% in MS; 47% in NMOSD), but low risk of apnea by STOP-BANG. The frequency of RLS/WE found was 14% in MS, and 5% in NMOSD. No correlation existed between sleep quality, number of relapses, and sleep quality for the Expanded Disability Status Scale (EDSS), i.e., fatigue/illness duration.

Conclusion

Patients with MS and NMOSD have poor sleep quality, excessive sleepiness, and are at low risk for OSA, yet the frequency of RLS/WED is like that of the general population. There does not seem to be a significant difference between these sleep disorders in these demyelinating diseases of the CNS.

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Abbreviations

CNS:

Central nervous system

EDSS:

Expanded Disability Status Scale

OSA:

Obstructive sleep apnea

MS:

Multiple sclerosis

NMOSD:

Neuromyelitis optica spectrum disorder

RLS/WED:

Restless legs syndrome/Willis-Ekbom disease

PSG:

Polysomnography

UFAM:

Universidade Federal do Amazonas

UEA:

Universidade Estadual do Amazonas

References

  1. Belbasis L, Bellou V, Evangelou E, Ioannidis JP, Tzoulaki I (2015) Environmental risk factors and multiple sclerosis: an umbrella review of systematic reviews and meta-analyses. Lancet Neurol 14(3):263–273. https://doi.org/10.1016/S1474-4422(14)70267-4

    Article  PubMed  Google Scholar 

  2. Olsson T, Barcellos LF, Alfredsson L (2017) Interactions between genetic, lifestyle and environmental risk factors for multiple sclerosis. Nat Rev Neurol 13(1):25–36. https://doi.org/10.1038/nrneurol.2016.187

    Article  CAS  PubMed  Google Scholar 

  3. Browne P, Chandraratna D, Angood C, Tremlett H, Baker C, Taylor BV et al (2014) Atlas of multiple sclerosis 2013: a growing global problem with widespread inequity. Neurology 83(11):1022–1024. https://doi.org/10.1212/WNL.0000000000000768

    Article  PubMed  PubMed Central  Google Scholar 

  4. Gilmour H, Ramage-Morin PL, Wong SL (2018) Multiple sclerosis: prevalence and impact. Health Rep 29(1):3–8

    PubMed  Google Scholar 

  5. Kaynak H, Altintas A, Kaynak D, Uyanik O, Saip S, Agaoglu J et al (2006) Fatigue and sleep disturbance in multiple sclerosis. Eur J Neurol 13(12):1333–1339. https://doi.org/10.1111/j.1468-1331.2006.01499.x

    Article  CAS  PubMed  Google Scholar 

  6. Vitkova M, Gdovinova Z, Rosenberger J, Szilasiova J, Nagyova I, Mikula P et al (2014) Factors associated with poor sleep quality in patients with multiple sclerosis differ by disease duration. Disabil Health J 7(4):466–471. https://doi.org/10.1016/j.dhjo.2014.05.004

    Article  PubMed  Google Scholar 

  7. Besedovsky L, Lange T, Born J (2012) Sleep and immune function. Pflugers Arch 463(1):121–137. https://doi.org/10.1007/s00424-011-1044-0

    Article  CAS  PubMed  Google Scholar 

  8. Almeida CM, Malheiro A (2016) Sleep, immunity and shift workers: a review. Sleep Sci 9(3):164–168. https://doi.org/10.1016/j.slsci.2016.10.007

    Article  PubMed  PubMed Central  Google Scholar 

  9. Wilder-Smith A, Mustafa FB, Earnest A, Gen L, Macary PA (2013) Impact of partial sleep deprivation on immune markers. Sleep Med 14:1031–1034

    Article  CAS  PubMed  Google Scholar 

  10. Fondell E, Axelsson J, Franck K et al (2011) Short natural sleep is associated with higher T cell and lower NK cell activities. Brain Behav Immun 25(7):1367–1375

    Article  CAS  PubMed  Google Scholar 

  11. de Almeida CM, de Lima TA, Castro DB et al (2011) Immunological/virological peripheral blood biomarkers and distinct patterns of sleeping quality in chronic hepatitis C patients. Scand J Immunol 73(5):486–495

    Article  PubMed  Google Scholar 

  12. Yamout B, Sahraian M, Bohlega S et al (2019) Consensus recommendations for the diagnosis and treatment of multiple sclerosis: 2019 revisions to The MENACTRIMS Guidelines. Mult Scler Relat Disord 37:1–13. https://doi.org/10.1016/j.msard.2019.101459

    Article  Google Scholar 

  13. Wingerchuk DM, Banwell B, Bennett JL et al (2015) International consensus diagnostic criteria for neuromyelitis optica spectrum disorders. Neurology 85:177–189. https://doi.org/10.1212/WNL.0000000000001729

    Article  PubMed  PubMed Central  Google Scholar 

  14. Bertolazi AN, Fagondes SC, Hoff LS et al (2011) Validation of the Brazilian Portuguese version of the Pittsburgh Sleep Quality Index. Sleep Med 12(1):70–75. https://doi.org/10.1016/j.sleep.2010.04.020

    Article  PubMed  Google Scholar 

  15. Bertolazi AN, Fagondes SC, Hoff LS et al (2009) Portuguese-language version of the Epworth sleepiness scale: validation for use in Brazil. J Bras Pneumol 35(9):877–883

    Article  PubMed  Google Scholar 

  16. Mendes MF, Pavan K, Marangoni BE et al (2008) Cross-cultural of the fatigue severity scale to portuguese language. Med reabil 27(3):69–71

    Google Scholar 

  17. Fröhlich AC, Eckeli AL, Bacelar A et al (2015) Brazilian consensus on guidelines for diagnosis and treatment for restless legs syndrome. Arq Neuropsiquiatria 73(3):260–280. https://doi.org/10.1590/0004-282X20140239

    Article  Google Scholar 

  18. Duarte RLM, Fonseca LBM, Magalhães-da-Silveira FJ et al (2017) Validação do questionário STOP-Bang para a identificação de apneia obstrutiva do sono em adultos no Brasil. J Bras Pneumol 43(6):456–463. https://doi.org/10.1590/S1806-37562017000000139

    Article  PubMed  PubMed Central  Google Scholar 

  19. Andrechuk CRS, Netzer N, Zancanella E et al (2019) Cultural adaptation and evaluation of the measurement properties of the Berlin Questionnaire for Brazil. Sleep Med 60:182–187. https://doi.org/10.1016/j.sleep.2019.03.022

    Article  PubMed  Google Scholar 

  20. Allen RP, Picchietti DL, Garcia-Borreguero D et al (2014) Restless legs syndrome/Willis–Ekbom disease diagnostic criteria: updated International Restless Legs Syndrome Study Group (IRLSSG) consensus criteria – history, rationale, description, and significance. Sleep Med 15:860–873

    Article  PubMed  Google Scholar 

  21. Cohen J (1988) Statistical power analysis for the behavioral sciences, 2nd edn. Lawrence Erlbaum Associates, Hillside

    Google Scholar 

  22. Thompson B (2007) Effect sizes, confidence intervals, and confidence intervals for effect sizes. Psychol Sch 44:423–432. https://doi.org/10.1002/pits.20234

    Article  Google Scholar 

  23. Shaygannejad V, SadeghiBahmani D, Soleimani P et al (2020) Comparison of prevalence rates of restless legs syndrome, self-assessed risks of obstructive sleep apnea, and daytime sleepiness among patients with multiple sclerosis (MS), clinically isolated syndrome (CIS) and neuromyelitis optica spectrum disorder (NMOSD). Sleep Med 70:97–105

    Article  PubMed  Google Scholar 

  24. Gomez-Choco MJ, Iranzo A, Blanco Y et al (2007) Prevalence of restless legs syndrome and REM sleep behavior disorder in multiple sclerosis. Mult Scler 13(6):805–808

    Article  CAS  PubMed  Google Scholar 

  25. Vitkova M, Gdovinova Z, Rosenberger J et al (2014) Factors associated with poor sleep quality in patients with multiple sclerosis differ by disease duration. Disabil Health J 7(4):466–471

    Article  PubMed  Google Scholar 

  26. Rabi SHM, Shahmirzaei S, Sahraian MA et al (2021) Clin Neurol Neurosurg 204:106606. https://doi.org/10.1016/j.clineuro.2021.106606

    Article  Google Scholar 

  27. Allen RP, Earley CJ (2001) Restless legs syndrome: a review of clinical and pathophysiologic features. J Clin Neurophysiol 18:128–147

    Article  CAS  PubMed  Google Scholar 

  28. Kaminska M, Kimoff RJ, Benedetti A et al (2012) Obstructive sleep apnea is associated with fatigue in multiple sclerosis. Mult Scler 18(8):1159–1169

    Article  CAS  PubMed  Google Scholar 

  29. Dias RA, Hardin KA, Rose H et al (2012) Sleepiness, fatigue, and risk of obstructive sleep apnea using the STOP-BANG questionnaire in multiple sclerosis: a pilot study. Sleep Breath 16(4):1255–1265. https://doi.org/10.1007/s11325-011-0642-6

    Article  PubMed  Google Scholar 

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Author information

Authors and Affiliations

  1. Faculty of Medicine at the Getulio Vargas Hospital, Federal University of Amazonas, Tomas de Villa Nova, N. 4, Praca 14, Manaus, AM, ZIP 69020-170, Brazil

    Nise Alessandra Carvalho Sousa, Satiko Andrezza Ferreira Takano, Siane Prado Lima Souza & Ronaldo Marques Pontes Rabelo

  2. School of Health Sciences, University of Amazonas, Carvalho Leal Street, N. 1777, Manaus, AM, ZIP 69065-001, Brazil

    Carlos Mauricio Oliveira de Almeida

Authors
  1. Nise Alessandra Carvalho Sousa
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  2. Carlos Mauricio Oliveira de Almeida
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  3. Satiko Andrezza Ferreira Takano
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  4. Siane Prado Lima Souza
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  5. Ronaldo Marques Pontes Rabelo
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Contributions

All authors contributed to the study: conceptualization and design (Sousa, NAC); methodology (Sousa, NAC; De Almeida, CMO); execution (Sousa, NAC; Takano SAF; Souza, SPL; Rabelo, RMP); formal analysis and investigation (Sousa, NAC; Takano SAF; Souza, SPL; Rabelo, RMP); writing (Sousa, NAC; De Almeida, CMO; Takano SAF); writing—review and edition (De Almeida, CMO).

Corresponding author

Correspondence to Carlos Mauricio Oliveira de Almeida.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee (name of institute/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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The authors declare no competing interest.

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Sousa, N.A.C., de Almeida, C.M.O., Takano, S.A.F. et al. Sleep in multiple sclerosis and neuromyelitis optica spectrum disorder—the SEMN study. Sleep Breath 27, 2453–2458 (2023). https://doi.org/10.1007/s11325-023-02824-1

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  • DOI: https://doi.org/10.1007/s11325-023-02824-1

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