Sleep Problems in Multiple Sclerosis

Abstract

Twenty-eight consecutive patients with multiple sclerosis (MS) were clinically evaluated to determine the presence of sleep-related disorders. There were 12 males and 16 females aged between 22 and 67 with disability ranging between 1.5 and 8.5 on Kurtzke extended disability status score (EDSS). Fifteen patients (54%) reported sleep-related problems. These included difficulties initiating sleep and/or frequent awakenings due to spasms or discomfort in the legs (8 patients), difficulty in initiating or maintaining sleep (3), habitual snoring (4) and nocturia (1). All-night oximetry was performed and the tracings analysed for the number of dips in oxygen saturation (SaO₂) or more than 4%. Three patients showed significant sleep-related oxygen desaturation (>5 dips of >4% SaO₂/h). Subsequent polysomnography performed in 2 of the 3 patients with significant oxygen desaturation confirmed the presence of sleep apnoea. MRI analysis of brain stem regions showed abnormalities in 20/22 cases. The 3 patients showing nocturnal oxygen desaturation had MRI brain stem lesions, but their locations were variable and their general appearance not different from that seen in the 17 without sleep apnoea. Sleep disturbance in MS is common but poorly recognised. It is usually due to leg spasms, pain, immobility, nocturia or medication. It is much less commonly associated with nocturnal respiratory insufficiency.

Daytime sleepiness versus fatigue in patients with multiple sclerosis: A systematic review on the Epworth sleepiness scale as an assessment tool

“…It has been reported that at least 50 % of patients with MS complain about sleep disturbances or poor sleep [5,84] The largest study included in our review comprised 2,375 MS patients and focused on the frequency of sleep disorders and their association with fatigue and sleepiness [31]. As assessed by the ESS, the prevalence of daytime sleepiness was reported to be 30%, while that for abnormal fatigue measures was 60%.…”

Autonomic dysfunction in multiple sclerosis

“…In a large study of more than thousand individuals with MS, prevalence of moderate or severe sleep problems was more than 50% [62]. The most common symptoms are difficulty initiating and maintaining sleep, frequent awakenings because of leg cramps and discomfort, snoring and nocturia [63]. Lack of sleep leads to increased fatigue, daytime somnolence and respiratory dysfunction episodes [64].…”

Monitoring My Multiple Sclerosis

“…Stability of the MMMS scale over a period of 2 weeks to 3 months was measured by the intraclass cor- of difficulty falling asleep, frequent awakenings, snoring, and nocturia. 39 The factored subscale Cognitive/Mental explained 8.3% of the variance in the MMMS. Cognitive dysfunction has a prevalence of up to 65% of individuals with MS. 40 Cognitive areas most often affected are memory, attention, information processing, abstract/conceptual reasoning, and visuospatial skills.…”

“…Conditions associated with fatigue among those with MS include mood and sleep disorders. Sleep disturbance, with a prevalence of 51.5%, 38 may be due to leg spasms, pain, immobility, nocturia, or medication 39 and can consist definitions of RRMS and SPMS, RRMS generally indicates disease relapses with full recovery or with sequelae and residual deficit upon recovery, while SPMS indicates progression with or without occasional relapses, minor remissions, and plateaus. 2 Some of the study participants may have been undergoing a transition in disease classification from RRMS to SPMS.…”