Sleep disturbances in patients with multiple sclerosis

Anna Pokryszko-Dragan, Małgorzata Bilińska, Ewa Gruszka, Łukasz Biel, Katarzyna Kamińska, Katarzyna Konieczna, Anna Pokryszko-Dragan, Małgorzata Bilińska, Ewa Gruszka, Łukasz Biel, Katarzyna Kamińska, Katarzyna Konieczna

Abstract

Sleep disturbances constitute one of the important yet underestimated aspects of functioning of patients with multiple sclerosis (MS). The objective of this study was to evaluate sleep disturbances in patients with MS, with regard to demographic factors, disease-related variables, co-existing conditions and fatigue. In 100 MS patients, Epworth Sleepiness Scale (ESS) and a questionnaire about sleep disturbances (SlD) were implemented. ESS and SlD results were analyzed with regard to age, gender, duration of MS, type of its course, degree of disability in Expanded Disability Status Scale (EDSS), MS therapies, coexisting diseases, results of Fatigue Severity Scale (FSS) and Modified Fatigue Impact Scale (MFIS). ESS score indicated increased daytime sleepiness in 19 patients. In SlD, 49 subjects reported sleep disturbances and 35 more than one of their kind (most commonly terminal and middle insomnia). No relationships were found between ESS and SlD scores and age, gender, MS duration, type of its course, EDSS or coexisting diseases. In 36 patients, somatic complaints interfered with sleep. The patients with depression had significantly lower ESS result and those currently treated with immunomodulation had significantly lower SlD score. SlD score correlated positively with FSS and MFIS. Sleep disturbances in MS patients may occur independently from demographic and disease-related variables, but they are often influenced by the symptoms of MS and therapies used. Sleep disturbances may contribute to fatigue in the course of MS.

References

    1. Bamer AM, Johnson KL, Amtmann D, Kraft GH. Prevalence of sleep problems in individuals with multiple sclerosis. Mult Scler. 2008;14:1127–1130. doi: 10.1177/1352458508092807.
    1. Caminero A, Bartolome M. Sleep disturbances in multiple sclerosis. J Neurol Sci. 2011;309:86–91. doi: 10.1016/j.jns.2011.07.015.
    1. Kaminska M, Kimoff RJ, Schwartzmann K, Trojan DA. Sleep disorders and fatigue in multiple sclerosis: evidence for association and interaction. J Neurol Sci. 2011;302:7–13. doi: 10.1016/j.jns.2010.12.008.
    1. Melamud L, Golan D, Luboshitzky R, Lavi I, Miller A. Melatonin dysregulation, sleep disturbances and fatigue in multiple sclerosis. J Neurol Sci. 2012;314:37–40. doi: 10.1016/j.jns.2011.11.003.
    1. Taphoorn MJB, Van Someren E, Snoek FJ, Strijers RLM, Swaab DF, Visscher F, De Waal LP, Polman CH (1993) Fatigue, sleep disturbances and circadian rhythm in multiple sclerosis. J Neurol 240:446–448
    1. Irwin MR, Wang M, Ribeiro D, Cho HJ, Olmstead R, Breen EC, Martinez-Maza O, Cole S. Sleep loss activates cellular inflammatory signaling. Biol Psychiatry. 2008;64:538–540. doi: 10.1016/j.biopsych.2008.05.004.
    1. Tachibana N, Howard RS, Hirsch NP, Miller DH, Moseley IF, Fish D. Sleep problems in multiple sclerosis. Eur Neurol. 1994;34:320–323. doi: 10.1159/000117070.
    1. Alarcia R, Ara JR, Martin J, López A, Bestué M, Bertol V, Vergara JM. Sleep disorders in multiple sclerosis. Neurologia. 2004;19:704–709.
    1. Merlino G, Fratticci L, Lenchig C, Valente M, Cargnelutti D, Picello M, Serafini A, Dolso P, Gigli GL. Prevalence of ‘poor sleep’ among patients with multiple sclerosis: an independent predictor of mental and physical status. Sleep Med. 2009;10:26–34. doi: 10.1016/j.sleep.2007.11.004.
    1. Bamer AM, Johnson KL, Amtmann D, Kraft GH. Beyond fatigue: assessing variables associated with sleep problems and use of sleep medications in multiple sclerosis. Clin Epidemiol. 2010;2:99–106.
    1. Attarian HP, Brown KM, Duntley SP, Carter JD, Cross AH. The relationship of sleep disturbances and fatigue in multiple sclerosis. Arch Neurol. 2004;61:525–528. doi: 10.1001/archneur.61.4.525.
    1. Kaynak H, Altintas A, Kaynak D, Uyanik O¨, Saip S, Agaoglu J, Onder G, Siva A. Fatigue and sleep disturbance in multiple sclerosis. Eur J Neurol. 2006;13:1333–1339. doi: 10.1111/j.1468-1331.2006.01499.x.
    1. Stanton BR, Barnes F, Silber E. Sleep and fatigue in multiple sclerosis. Mult Scler. 2006;12:481–486. doi: 10.1191/135248506ms1320oa.
    1. Merkelbach S, Schulz H, Kolmel KW, Gora G, Klingelhofer J, Dachsel R, Hoffmann F, Polzer U. Fatigue, sleepiness, and physical activity in patients with multiple sclerosis. J Neurol. 2011;258:74–79. doi: 10.1007/s00415-010-5684-3.
    1. Polman CH, Reingold SC, Banwell B, Clanet M, Cohen JA, Filippi M, Fujihara K, Havrdova E, Hutchinson M, Kappos L, Lublin FD, Montalban X, O’Connor P, Sandberg-Wollheim M, Thompson AJ, Waubant E, Weinshenker B, Wolinsky JS (2011) Diagnostic criteria for multiple sclerosis: 2010 revisions to the McDonald criteria. Ann Neurol 69:292–302
    1. Kurtzke JM. Rating neurological impairment in multiple sclerosis: an expanded disability status scale. Neurology. 1983;33:1444–1452. doi: 10.1212/WNL.33.11.1444.
    1. Johns MW. A new method for measuring daytime sleepiness: the Epworth sleepiness scale. Sleep. 1991;14:540–545.
    1. Cofta S, Urbański W, Kamieniarz G, Gożdzik J, Rzymkowska M. Skala senności Epworth (ESS)—zastosowanie diagnostyczne i prognostyczne w badaniach pacjentów z podejrzeniem obturacyjnego bezdechu śródsennego. Sen. 2005;5:1–7. doi: 10.3390/s5010001.
    1. Krupp LB, LaRocca NG, Muir-Nash J, Steinberg AD. The Fatigue Severity Scale. Application to patients with multiple sclerosis and systemic lupus erythematosus. Arch Neurol. 1989;46:1121–1123. doi: 10.1001/archneur.1989.00520460115022.
    1. Multiple Sclerosis Council for Clinical Practice Guidelines (1998) Fatigue and multiple sclerosis: evidence-based management strategies for fatigue in multiple sclerosis
    1. Dworzańska E, Mitosek-Szewczyk K, Stelmasiak Z. Zespół zmęczenia w stwardnieniu rozsianym. Neurol Neurochirurg Pol. 2009;43:71–76.
    1. Merkelbach S, Schulz H. What have fatigue and sleepiness in common? Letter to the Editor. J Sleep Res. 2006;15:105–106. doi: 10.1111/j.1365-2869.2006.00508.x.
    1. Attarian HP, Applebee G, Schuman C. Disturbances of sleep perception in a group of multiple sclerosis patients: a case report. Clin Exp Neuroimmunol. 2010;1:124–126. doi: 10.1111/j.1759-1961.2010.00012.x.
    1. Ferini-Strambi L, Filippi M, Martinelli V, Oldani A, Rovaris M, Zucconi M, Comi G, Smirne S. Nocturnal sleep study in multiple sclerosis: correlations with clinical and brain magnetic resonance imaging findings. J Neurol Sci. 1994;125:194–197. doi: 10.1016/0022-510X(94)90035-3.
    1. Hossain JL, Ahmad P, Reinish LW, Kayumov L, Hossain NK, Shapiro CM. Subjective fatigue and subjective sleepiness: two independent consequences of sleep disorders? J Sleep Res. 2005;14:245–253. doi: 10.1111/j.1365-2869.2005.00466.x.
    1. Lobentanz IS, Asenbaum S, Vass K, Sauter C, Klösch G, Kollegger H, Kristoferitsch W, Zeitlhofer J. Factors influencing quality of life in multiple sclerosis patients: disability, depressive mood, fatigue and sleep quality. Acta Neurol Scand. 2004;110:6–13. doi: 10.1111/j.1600-0404.2004.00257.x.
    1. Manconi M, Fabbrini M, Bonanni E, Filippi M, Rocca M, Murri L, Ferini-Strambi L. High prevalence of restless legs syndrome in multiple sclerosis. Eur J Neurol. 2007;14:534–539. doi: 10.1111/j.1468-1331.2007.01740.x.
    1. Wunderlin BW, Kesselring J, Ginzler H, Walser B, Kuhn M, Reinhart WH. Fatigue in multiple sclerosis is not due to sleep apnoea. Eur J Neurol. 1997;4:72–78. doi: 10.1111/j.1468-1331.1997.tb00302.x.
    1. Bohr KC, Haas J. Sleep related breathing disorders do not explain daytime fatigue in multiple sclerosis. Mult Scler. 1998;4:289a. doi: 10.1177/135245859800400410.
    1. Clark C, Fleming JA, Li D, Oger J, Klonoff H, Paty D. Sleep disturbance, depression, and lesion site in patients with multiple sclerosis. Arch Neurol. 1992;49:641–643. doi: 10.1001/archneur.1992.00530300077013.
    1. Mendozzi L, Tronci F, Garegnani M, Pugnetti L. Sleep disturbance and fatigue in mild relapsing remitting multiple sclerosis patients on chronic immunomodulant therapy: an actigraphic study. Mult Scler. 2010;16:238–247. doi: 10.1177/1352458509354551.
    1. Kos D, Kerckhofs E, Nagels G, D’hooghe MB, Ilsbroukx S. Origin of fatigue in multiple sclerosis: review of the literature. Neurorehabil Neural Repair. 2008;22:91–102.

Source: PubMed

Patrocinadores y Colaboradores

Condiciones médicas

Intervenciones de drogas

3
Suscribir