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Undiagnosed sleep disorders appear common in patients with MS, fatigue, analysis reveals

Thursday, December 13 2007 | Comments
Evidence Grade 0 What's This?
Undiagnosed sleep disorders may be common in patients with multiple sclerosis and may contribute to the fatigue commonly reported by these patients, findings from a recent analysis demonstrate.

Dr. Mark Gudesblatt, who is a neurologist with South Shore Neurologic Associates in Bay Shore, NY, and his colleagues identified 46 patients with MS and complaints of fatigue. All patients underwent polysomnography (PSG) at 1 of 10 accredited sleep centers. A total of 47 PSG studies were conducted from 2004 to 2007 (1 patient underwent 2 PSG studies 3 years apart, with the second conducted after a 10-point reduction in body mass index).

All patients exhibited abnormalities on PSG. The mean sleep efficiency (SE) among the patients was 75% (range, 33%-97%), mean sleep-onset latency (SOL) was 44 minutes (range, 6.5 minutes-159.5 minutes), and mean latency to REM sleep was 190 minutes (range, 37 minutes-427 minutes); 5 patients never achieved REM sleep. The mean apnea-hypopnea index (AHI) was 29.5 (range, 0-81), and the mean number of arousals per hour was 19 (range, 1-62.8).

PSG data supported a diagnosis of obstructive sleep apnea (OSA) in 39 of 47 patients (mild, n=12; moderate, n=16; severe, n=11), upper airway resistance syndrome in 8 of 47 patients, severe sleep fragmentation associated with alpha intrusion in non-REM sleep in 1 patient, and primary snoring without sleep-disordered breathing events in 1 patient.

The study authors noted that sleep disturbances were common even among the 20 patients with a BMI of <28. In these patients, the mean SE was 74%, mean SOL was 43 minutes, mean latency to REM sleep was 180 minutes (calculated for 18 patients; 2 patients never achieved REM sleep), mean AHI was 23, and the mean arousal index was 20 events/hour.

In an interview with VerusMed, Dr. Gudesblatt explained that fatigue is common in MS and is often attributed to multiple factors, including depression, treatments for MS, or the disease itself, but is infrequently attributed to sleep disorders. As a result, patients may receive treatment for fatigue, such as a stimulant, that does nothing to treat the underlying sleep disorder.

In light of these findings, Dr. Gudesblatt urged neurologists to ask their patients with MS and fatigue about their sleep and recommended that patients with fatigue undergo PSG sleep evaluations to identify possible sleep disorders. (Poster P04.083.)

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