Sleep abnormalities are very common among patients with multiple sclerosis (MS) affecting approximately 60% of them but still remain under-recognized and inadequately addressed. Some common types of sleep disorders include insomnia, sleep-related movement disorders, sleep-related breathing disorders, and circadian rhythm disorders affecting MS populations.
In 25-35% of MS patients sleep interruptions are present, with sleep fragmentation, both in the macro and microstructure, and this condition may explain, in part, the presentation of fatigue.
Correlate sleep-related disorders with the presence of fatigue and its severity in patients with relapsing-remitting MS (RRMS).
24 patients with RRMS were evaluated between March 1, 2018 and February 28, 2020.
Each patient underwent: Modified Fatigue Impact Scale, Insomnia Severity Index, STOP-BANG, Pittsburgh Sleep Quality Index and nocturnal polysomnography with oxygen saturation.
The data was analyzed using the Minitab® 15.1.20.0 package.
24 patients were included; 75% female (3:1); mean age 36.3 years, (± 9); with mean 1.96 (± 0.8) years since diagnosis. 58% presented some alteration in sleep patterns, predominating awakenings and micro-awakenings fragmentation.
Regarding the presence of fatigue in patients with sleep disorders, it was observed that the ones with altered structure (micro-awakenings / awakenings or intervened wakefulness) have presented a considerably higher score on the fatigue scale. Patients with adequate structure presented a mean of 18.3 (± 15), while those who presented a fragmented structure due to awakenings and micro-awakenings presented a mean of 34.58 (± 23.74).
In relation to the sleep quality, a higher score was detected in patients considered as poor sleepers (mean 32.21 ± 21.95), compared to patients with adequate rest (mean 16.2 ± 13.77). The same occurs concerning insomnia, where a higher score on fatigue scale is detected in patients with moderate severity clinical insomnia (mean 49.5 ± 9.32) in relation to those without clinically significant insomnia (mean 20.42 ± 23.12).
The results suggest that sleep alterations are involved in fatigue clinical expression in RRMS patients, supporting the importance of exploring their presence in initial evaluation. In this way, we could improve not only sleep structure and quality, but also fatigue in our patients, improving their quality of life and quality years.