Polysomnographic measures of disturbed sleep are associated with reduced quality of life in multiple sclerosis

Trojan, Daria A.; Kamińska, Marta; Bar‐Or, Amit; Benedetti, Andrea; Lapierre, Yves; Costa, Deborah Da; Robinson, Ann; Cardoso, Mauro José Lahm; Schwartzman, Kevin; Kimoff, R. John

doi:10.1016/j.jns.2011.12.013

Cited by 36 publications

(29 citation statements)

References 41 publications

(49 reference statements)

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“…Insomnia is known to be associated with lower self-reported QoL in the general population 1 . Also, previous studies have found comparable results for the impact of poor sleep on QoL in MS patients (Trojan et al, 2012).…”

Section: Discussionsupporting

confidence: 56%

InMS: Chronic insomnia disorder in multiple sclerosis – a Portuguese multicentre study on prevalence, subtypes, associated factors and impact on quality of life

Viana

Rodrigues

Fernandes

et al. 2015

Multiple Sclerosis and Related Disorders

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Section: Discussionsupporting

confidence: 56%

InMS: Chronic insomnia disorder in multiple sclerosis – a Portuguese multicentre study on prevalence, subtypes, associated factors and impact on quality of life

Viana

Rodrigues

Fernandes

et al. 2015

Multiple Sclerosis and Related Disorders

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“…2 Even at the polysomnographic level, measures of disturbed sleep are associated with reduced quality of life in this population. 4 A better understanding of the factors that contribute to sleep disturbances in MS is needed to improve treatment. Up to now, research has primarily focused on the prevalence of sleep disorders in MS, and the relationship between sleep and MS-associated fatigue.…”

Section: Introductionmentioning

confidence: 99%

The impact of drugs for multiple sclerosis on sleep

et al. 2016

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Abstract:Although there is a growing literature on the presence of sleep disorders in multiple sclerosis (MS), few studies have specifically addressed the impact of drugs on sleep of these patients. Moreover, even when sleep is considered, quantitative assessment by standardized questionnaires or polysomnography is lacking. The studies that have been done highlight that interferon-beta and some symptomatic medications may affect sleep, thus contributing to fatigue, depression, and poor quality of life; conversely, natalizumab and cannabinoids may improve sleep. Common limitations of the literature reviewed here are small sample size, selection bias, and often a lack of objective outcome measures. Clinicians need to remember to ask about sleep in all MS patients and intervene when appropriate. A systematic approach that takes sleep into account is recommended to enhance recognition and appropriate management of sleep disruption, including disorders related to medication. Consideration of the impact on sleep should also be part of the design of trials of new therapies. Tables 1 and 2, both disease-modifying drugs and common symptomatic medications for MS may interfere with sleep. 33 Keywords MethylprednisoloneAs known, insomnia and other sleep changes, such as decreased REM sleep, are common side effects of steroid treatment, even after only a few days of administration. 34 A randomized, placebo-controlled trial of oral methylprednisolone given in pulses every 4 weeks as an add-on therapy to IFN-β-1a for the treatment of relapsing-remitting MS was carried out. 6 The authors found that steroid intake led to a significant reduction in relapse rate; however, insomnia was one of the most frequent adverse event recorded (~25% of patients). 6 As in the general population, the clinician must consider this co-morbid cause of insomnia and encourage lifestyle changes (such as proper sleep hygiene), cognitive behavioral therapy (CBT), and pharmacological intervention if needed. 35 A very recent prospective multicenter observational study evaluated through self-report questionnaires the frequency, severity, and impact on activities of daily living of adverse effects of high-dose intravenous methylprednisolone in relapsing-remitting MS patients with a relapse. The authors observed that sleep disturbance (not better specified) was among the most common adverse events experienced by the patients (44% of 59), especially in those with high disease impact or high disability. 8Nevertheless, although most clinicians warn patients about the steroid-related effects on sleep, an actigraphy study evaluating the short-term tolerance of 5-day regimen of intravenous methylprednisolone demonstrated high sleep efficiency, which is discrepant with the complaints reported by the patients. The authors conclude that sleep efficiency was not disturbed by methylprednisolone in patients, whether used for a clinically isolated syndrome (CIS), MS relapse, or sub-acute disease progression. 7 IFN-βSince its introduction as an established therapy for re...

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“…8,21,22,34 We have previously reported a high prevalence of OSAH among MS patients, and its strong association with fatigue. 22 Others have reported insomnia, narcolepsy and REM sleep behaviour disorder.…”

Section: Discussionmentioning

confidence: 97%

“…All subjects underwent a comprehensive baseline clinical evaluation, including screening blood tests (with serum ferritin and vitamin B12 levels), and sleep and symptom questionnaires, and a full overnight laboratory PSG. 21,22 Based on questionnaire and PSG results, subjects were referred to a board-certified Sleep physician for clinical evaluation and management.…”

Section: Methodsmentioning

confidence: 99%

“…21 23 Expanded Disability Status Scale (EDSS; assesses MS disability on a 0 to 10 scale, a higher score indicating greater disability) score of 0 to 7.0; 24 relapse-free for at least 30 days prior to screening and during the study; and no chronic steroid treatment (for more than 30 days) for the last 6 months prior to study. Exclusion criteria included: active treatment for RLS-PLM and any significant medical condition or cognitive disorder that could preclude compliance with the study.…”

Section: Patient Selectionmentioning

confidence: 99%

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High false-positive rate of questionnaire-based restless legs syndrome diagnosis in multiple sclerosis

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Polysomnographic measures of disturbed sleep are associated with reduced quality of life in multiple sclerosis

Cited by 36 publications

References 41 publications

InMS: Chronic insomnia disorder in multiple sclerosis – a Portuguese multicentre study on prevalence, subtypes, associated factors and impact on quality of life

InMS: Chronic insomnia disorder in multiple sclerosis – a Portuguese multicentre study on prevalence, subtypes, associated factors and impact on quality of life

The impact of drugs for multiple sclerosis on sleep

High false-positive rate of questionnaire-based restless legs syndrome diagnosis in multiple sclerosis

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