Background

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.

Objectives

Correlate sleep-related disorders with the presence of fatigue and its severity in patients with relapsing-remitting MS (RRMS).

Methods

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.

Results

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).

Conclusions

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.

Background

Patients with multiple sclerosis (MS) often have unrecognized sleep abnormalities, more frequently than the general population. Mainly respiratory disorders, insomnia, REM sleep disorders, narcolepsy and restless legs syndrome are reported. Sleep-related disorders can affect the quality of life (QOL) in patients diagnosed with MS.

Objectives

Analyze sleep-related disorders in patients with relapsing-remitting multiple sclerosis (RRMS) and their possible impact on QOL.

Methods

24 patients with RRMS were evaluated between March 1, 2018 and February 28, 2020.

Each patient underwent: Multiple Sclerosis Quality of Life 54 (MSQOL-54), 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.

Results

24 patients were included; 75% female; mean age 36.3 years, (± 9); with a mean of 1.96 (± 0.8) years after diagnosis.

58% presented some alteration in sleep patterns, predominating awakenings and micro-awakenings fragmentation.

Analyzing patients QOL according to sleep disorders, those who presented some structure alteration obtained a lower QOL scale score (mean 77.2 [± 12.76] in patients with normal structure and mean 66.75 [± 15.34] in those with awakenings and micro-awakenings structure fragmented).

Patients with clinical insomnia had a lower QOL scale score, highlighting an inverse relationship between the QOL and the severity of the insomnia. Patients without clinically significant insomnia presented a QOL scale mean 76.93 (± 14.08), while in patients with clinical insomnia of moderate severity the mean was 57.75 (± 16.38).

Regarding the quality of sleep, categorizing this variable into normal and poor sleepers, 79% were in the second group. Analyzing the QOL according to this variable, those who presented an adequate quality of sleep, showed better QOL.

Conclusions

Sleep-related disorders are a common problem among people with MS. These disorders can be serious enough to interfere with physical, social, emotional and mental functioning for those who suffer from them, generating a significant impact on people's QOL.

Our results demonstrate the sleep abnormalities in RRMS patients, supporting the need and importance of exploring their presence in initial evaluation.

The development of preventive strategies and interventions that reduce sleep alterations could improve QOL in patient with RRMS.