Author Of 1 Presentation
P0755 - Study of Sleep Abnormalities in patients with Neuromyelitis Optica Spectrum Disorder – AQP-4, Seronegative NMOSD and MOG associated disorders (ID 1662)
Abstract
Background
Neuromyelitis optica spectrum disorder (NMOSD) typical lesions occur in aquaporin- 4 (AQP-4) enriched circumventricular organs and the diencephalon involved in neurobiology of sleep. Missense mutation in myelin oligodendrocyte glycoprotein associated disorder (MOGAD) has been identified as a cause of familial narcolepsy with cataplexy. Recognizing sleep abnormalities in NMOSD and MOGAD is particularly significant for understanding the pathology and improving the quality of life.
Objectives
To assess the clinical parameters that affect the quality of sleep in AQP-4 positive NMOSD (AQP-4+NMOSD), seronegative NMOSD (SN-NMOSD), MOGAD and to determine the differences in sleep abnormalities among the three subgroups
Methods
This was a prospective cross-sectional study conducted at NIMHANS, India. Adults with NMOSD and MOGAD underwent neurological evaluation and disability assessment using including Expanded Disability Status Scale (EDSS). Patients’ sleep was assessed using Epworth sleepiness scale (ESS), Pittsburgh Sleep Quality Index (PSQI), REM Behavior disorder (RBD) sleep questionnaire, Restless Legs Syndrome (RLS) Questionnaire and Berlin Questionnaire for obstructive sleep apnea (OSA). Anxiety and depression was analyzed using Hamilton’s Anxiety Rating scale (HAM-A), Hamilton’s Depression Rating scale (HAM-D)
Results
20 AQP-4+NMOSD (38.7 ± 10.1 years, 100% females), 9 MOGAD (40.33 ± 10.1 years, 66.7% females), 16 SN-NMOSD (41.3 ± 9.0 years, 75% females) patients were included. Mean disease duration was 2.7 years in AQP-4+NMOSD and MOGAD and 5.5 years in SN-NMOSD. Mean PSQI score was 7.1 ± 3.4 in AQP-4+NMOSD, 5.1± 2.1 in MOGAD, 7.2 ± 4.5 in SN-NMOSD. Mean ESS score was 6.7± 3.1 in AQP-4+NMOSD, 7.9 ± 2.3 in MOGAD, and 8.6 ± 3.8 in SN-NMOSD. Median EDSS score was 3.5 in AQP-4+NMOSD, 2 in MOGAD and 3.75 in SN-NMOSD. 30% of AQP-4+NMOSD, 11.1% of MOGAD, and 37.5% of SN-NMOSD met the criteria for RLS. 10% of AQP-4+NMOSD met the criteria for RBD. 10% of AQP-4+NMOSD, 11.1% of MOGAD and 25% of SN-NMOSD had high risk for OSA. 45% of AQP-4+NMOSD, 33.3% of MOGAD, and 100% of SN-NMOSD had anxiety. 90% of AQP-4+NMOSD, 100% of MOGAD, and 68.8% of SN-NMOSD had depression. There was a positive correlation between EDSS and PSQI in MOGAD group (ρ = .786, p = 0.03). There was statistically significant difference in PSQI between SN-NMOSD and MOGAD, and in HAM-D between AQP-4+NMOSD and MOGAD (p < 0.05)
Conclusions
EDSS score was highest in SN-NMOSD and most of the sleep indices were affected in them including anxiety. All the sleep scales showed highest severity in SN-NMOSD followed by AQP4+NMOSD, while depression was profound in MOGAD followed by AQP-4+NMOSD. These results raise the importance of sleep patterns and should be included when delineating a comprehensive care plan for these patients. Larger prospective studies are required along with molecular studies and imaging correlation to understand the patterns of sleep abnormalities in NMOSD and MOGAD.