Multiple Sclerosis: Sleep Disorders Both Common and Underdiagnosed

Steven D. Brass, M.D., M.P.H., M.B.A. PI and Lead Author on the study Director of Neurology Sleep Clinical Program Co-Medical Director of Sleep Medicine Laboratory Associate Clinical Professor in the Department of Neurology UC Davis Health System 4860 Y Street — Suite 3700 Sacramento, CA 95817 MedicalResearch.com Interview with:
Steven D. Brass, M.D., M.P.H., M.B.A.
PI and Lead Author on the study
Director of Neurology Sleep Clinical Program
Co-Medical Director of Sleep Medicine Laboratory
Associate Clinical Professor in the Department of Neurology
UC Davis Health System 4860 Y Street — Suite 3700
Sacramento, CA 95817

Medical Research: What was the primary finding of your study?

Dr. Brass : Among the 11,400 surveys mailed out to all members of the Northern California Chapter of the National Multiple Sclerosis Society, 2,810 (24.6%) were returned. Of these, 2,375 (84.5%) met the inclusion criteria. Among the completed surveys, 898 (37.8%) screened positive for obstructive sleep apnea, 746 (31.6%) for moderate to severe insomnia, and 866 (36.8%) for restless legs syndrome.  In contrast, only 4%, 11%, and 12% of the cohort reported being diagnosed by a health care provider with obstructive sleep apnea, insomnia, and restless legs syndrome, respectively. Excessive daytime sleepiness was noted in 30% of respondents based on the Epworth Sleepiness Scale. More than 60% of the respondents reported an abnormal level of fatigue based on the Fatigue Severity Scale.  There was also an increased risk between complaints of Fatigue based on screening positive for the Fatigue Severity Scale  and screening positive for Obstructive Sleep Apnea  (1.850, with a 95% p-value < 0.001).


Medical Research: What was most surprising about the results?

Dr. Brass : This survey demonstrates there is a significant burden of sleep disorders that are likely undiagnosed and unrecognized in the MS population.  The number that was the most shocking was the  large discrepenancy in the survey between being screened positive for OSA  (37.8%) and being diagnosed with OSA by a provider (4%).

Medical Research: Why are these results important?

Dr. Brass : The vast majority of these sleep disorders were undiagnosed in this MS population and the presence of a sleep disorders may be contributing to the most disabling multiple sclerosis symptom fatigue. This may support that further attention on the diagnosis and management of sleep disorders in this MS population is needed.  Greater attention to the sleep of MS patients is needed by providers who care for these MS patients especially those complaining of fatigue with a special focus on obstructive sleep apnea.  Not only does undiagnosed obstructive sleep apnea lead to fatigue but it can put the subjects at higher risk for cognitive problems, emotional problems, hypertension, diabetes, stroke and car accidents from falling asleep at the wheel.

Citation:

The Underdiagnosis of Sleep Disorders in Patients with Multiple Sclerosis
Brass SD, Li CS, Auerbach S.

J Clin Sleep Med. 2014 Sep 15;10(9):1025-31. doi: 10.5664/jcsm.4044.

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