Sleep Disorders Common in Multiple Sclerosis

From Medscape Medical News - By: Jim Kling

July 8, 2010 (San Antonio, Texas) — Sleep disorders are highly prevalent in patients with multiple sclerosis (MS) and may exacerbate fatigue associated with the condition, according to a study presented here at the Consortium of Multiple Sclerosis Centers 24th Annual Conference and the Third Joint Meeting of Americas Committee for Treatment and Research in Multiple Sclerosis.

To determine the prevalence and nature of sleep disorders in MS patients, researchers at Baylor College of Medicine in Houston, Texas, conducted a prospective study of 100 patients (81 women; mean age, 40 years), recording demographic information, type of MS, date of diagnosis, use of tobacco and alcohol, sleeping habits, caffeine consumption, and medical history, including current and previous treatments and other medical conditions. Patients with congestive heart failure, primary respiratory disorders, obstructive respiratory disorders, or another neurodegenerative condition were excluded.

Half of patients were receiving interferon treatment, 17% glatiramer acetate, 22% natalizumab, and 11% other treatment regimens. Nine percent of patients had a family history of sleep disorders.

Participants were given a sleep disorder questionnaire and were scored on the Epworth Sleepiness Scale.

Pilar Prieto, MD, an MS fellow at the Baylor College of Medicine, reported the study findings. She said that 40% of patients reported current sleep disturbances with a score of 9 or greater on the Epworth Sleepiness Scale, and 87.5% of these patients experienced significant fatigue. The most commonly reported sleep disturbances was difficulty falling asleep. The second most common concern was frequent awakenings.

"If we can modify these factors and give them a good night's rest, we can make a big change in their life," Dr. Prieto told Medscape Medical News. "As physicians we need to look further if the patient has fatigue. We can't only blame MS. It could be something else. "[Sleep disorders] could be one of the causes of fatigue," she noted.

The prevalence of sleep disorders is likely related to the severity of the MS, according to Randall Schapiro, MD, clinical professor of neurology at the University of Minnesota, who attended the session.

"A prevalence of sleep disorders of 40% would surprise me if the patients had an EDSS [Expanded Disability Status Scale] of 2. If they had an EDSS of 6 or 7, it wouldn't surprise me," Dr. Schapiro told Medscape Medical News.

Dr. Schapiro agreed that sleep disorders are an important factor in MS patients: "Fatigue is a common problem in MS, and we need to look for treatable causes of it. Sleep disorders are one of those causes. What this shows you is that probably we should be doing more sleep studies in MS patients."

The study did not receive commercial support. Dr. Prieto and Dr. Schapiro have disclosed no relevant financial relationships.

Consortium of Multiple Sclerosis Centers 24th Annual Conference and the Third Joint Meeting of Americas Committee for Treatment and Research in Multiple Sclerosis (CMSC): Abstract S07. Presented June 4, 2010.

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