Sleep and fatigue in multiple sclerosis

Fatigue is common in multiple sclerosis (MS) and is an important cause of disability. However, the cause of fatigue is poorly understood. This study aimed to describe the frequency and pattern of sleep disturbance in a group of outpatients with MS, and to investigate the relationship between sleep disturbance and fatigue. Sixty outpatients with MS completed the Fatigue Severity Scale (FSS) and the Epworth Sleepiness Scale and kept a sleep diary for seven days. Fatigue and excessive daytime sleepiness were common in this group of patients (64 and 32%). Sleep problems on at least two nights per week occurred frequently, including initial insomnia in 42%, middle insomnia in 53% and terminal insomnia in 58%. The reasons cited for different types of insomnia varied, with anxiety and pain/discomfort being the commonest causes of initial insomnia and nocturia the commonest cause of middle insomnia. Middle insomnia was significantly correlated with daytime fatigue, a relationship that remained after controlling for disability. Sleep disturbance is common in MS and is associated with treatable symptoms, including pain and nocturia. Sleep disturbance may be an important factor contributing to fatigue in patients with MS.

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Restless Leg Syndrome in Patients with Multiple Sclerosis and its Effect on Frequency of Daytime Sleepiness and Fatigue of the Patients

Galen Medical Journal ◽

10.31661/gmj.v5i1.422 ◽

2016 ◽

Vol 5 (1) ◽

pp. 7-12

Author(s):

Nahid Ashjazadeh ◽

Zahra Shamszadeh

Keyword(s):

Multiple Sclerosis ◽

Daytime Sleepiness ◽

Study Group ◽

Expanded Disability Status Scale ◽

Restless Leg Syndrome ◽

Severity Scale ◽

Medical Sciences ◽

Disability Status ◽

Fatigue Severity ◽

Study Participants

Background: Restless leg syndrome (RLS), fatigue and daytime sleepiness are three known co-morbidities in patients with multiple sclerosis (MS). The aim of this study was to evaluate the frequency of RLS in patients with MS and its effect on the frequency of fatigue and daytime sleepiness in these patients. Material and Methods: One hundred twenty patients who referred to the Inpatients Neurology Ward of Chamran hospital, affiliated with the Shiraz University of Medical Sciences, from June 2014 to March 2015, were selected as the study participants. The patients with clinically definite MS, according to the 2010 Revised Mc-Donald criteria, and expanded disability status scale (EDSS) ≤5.5 were included. RLS, fatigue and daytime sleepiness were assessed by the criteria of the International RLS study group (IRLSSG), fatigue severity scale (FSS) and Epworth sleepiness scale (ESS) respectively and the related statistical analyzes were conducted. Results: Seventy eight patients (65%) met all the four IRLSSG criteria, 77 patients (64.1%) suffered from fatigue and only 36 patients (30%) had excessive daytime sleepiness. RLS was not significantly linked to mean age, sex, MS duration, and daytime sleepiness of the studied MS patients, but fatigue was more frequent in MS patients with RLS, which was statistically significant (P=0.018). Conclusion: The main result of this study is that RLS is a common comorbidity in MS and the patients with MS, who also suffer from RLS. They have frequently experienced higher fatigue symptoms than those without RLS. Therefore, the appropriate diagnosis and management of RLS may improve both RLS and fatigue in these patients. [GMJ. 2016;5(1):7-12]

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Diagnosis of sleepiness, fatigue and depression in patients with myasthenia gravis

Neuromuscular Diseases ◽

10.17650/2222-8721-2020-10-4-27-37 ◽

2020 ◽

Vol 10 (4) ◽

pp. 27-37

Author(s):

O. A. Kreis ◽

T. M. Alekseeva ◽

Yu. V. Gavrilov ◽

P. O. Valko ◽

Yu. Valko

Keyword(s):

Myasthenia Gravis ◽

Excessive Daytime Sleepiness ◽

Daytime Sleepiness ◽

Fatigue Severity Scale ◽

Severity Scale ◽

Impact Scale ◽

Fatigue Severity ◽

Autoimmune Comorbidity ◽

Fatigue Impact Scale ◽

The Impact

Introduction. Examination of excessive daytime sleepiness, fatigue and depression in patients with myasthenia gravis is important for differential diagnosis of other disorders, and adds to a comprehensive clinical assessment.Objective. The aim is a comprehensive assessment of sleepiness, fatigue and depression and evaluation of the impact of autoimmune comorbidity on these symptoms in myasthenia gravis patients, using newly validated Russian versions of international questionnaires. The present article aims at familiarizing a wider Russian-speaking audience of specialists in the field of neuromuscular disease and sleep medicine with the main findings of our previously published work.Materials and methods. The study included 73 patients with MG and 230 control subjects. For sleepiness, fatigue and depression evaluation were used: Fatigue Severity Scale (FSS), Fatigue Impact Scale (FIS) (cognitive / physical / psychosocial subscales), Epworth Sleepiness Scale (ESS), Beck Depression Inventory (BDI) (cognitive-affective and somatic domains), Spielberger–Khanin State Trait Anxiety Inventory (STAI).Results. The Fatigue Severity Scale and Fatigue Impact Scale showed good psychometric properties and can be used to identify distinct aspects of fatigue in patients with myasthenia gravis. The studied patient cohort revealed clinically significant fatigue (69.9 %), excessive daytime sleepiness (15.1 %), moderate to severe depression (20.5 %), a high level of personal (64.4 %) and situational anxiety (27.4 %). Among 13 patients with myasthenia gravis and additional autoimmune comorbidity, there were no significant differences in the severity of sleepiness, fatigue and depression compared with the main group.Conclusion. The use of self-reported scale of sleepiness, fatigue and depression combined with careful clinical-neurological characterization adds to a more comprehensive view of the patient. The identification of sleepiness, fatigue and depression can guide therapeutic decisions and contributes to a better patient care. The presence of concomitant autoimmune pathology in patients with myasthenia gravis does not seem to increase the severity of sleepiness, fatigue and depression.

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The relationship between problemsolving ability and fatigue severity in people with multiple sclerosis

Iranian Journal of Neurology ◽

10.18502/ijnl.v19i1.3289 ◽

2020 ◽

Author(s):

Seyed Alireza Derakhshanrad ◽

Emily Piven

Keyword(s):

Multiple Sclerosis ◽

Problem Solving ◽

Correlation Coefficient ◽

Descriptive Study ◽

Severity Scale ◽

Ongoing Debate ◽

Cross Sectional ◽

Fatigue Severity ◽

The Relationship ◽

The City

Background: The literature speculates that there may be a relationship between cognitive capacities and levels of fatigue in people with multiple sclerosis (MS), which has been under reported. This study has investigated one aspect of cognition by evaluating the association between problem-solving ability and the severity of fatigue. Methods: A cross-sectional, descriptive study was used to investigate the association between levels of problem-solving ability and degrees of fatigue severity. Eighty-five participants living in the city of Shiraz, Iran, completed Cassidy Problem-Solving Inventory (PSI) and the Fatigue Severity Scale (FSS). Pearson’s Product Moment Correlation Coefficient was used to analyze the data. Results: Problem-solving was inversely associated with fatigue (r = -0.381, P = 0.009), whereby higher levels of problem-solving ability were associated with lower degrees of fatigue. Conclusion: The results of this study contributed to the ongoing debate about the linkage between cognition and fatigue in people with MS, suggesting an association between problem-solving ability and fatigue severity. A possible implication would be the importance of problem-solving training for people with MS.

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Poor Sleep in Multiple Sclerosis Correlates with Beck Depression Inventory Values, but Not with Polysomnographic Data

Sleep Disorders ◽

10.1155/2016/8378423 ◽

2016 ◽

Vol 2016 ◽

pp. 1-5 ◽

Cited By ~ 6

Author(s):

Christian Veauthier ◽

Gunnar Gaede ◽

Helena Radbruch ◽

Klaus-Dieter Wernecke ◽

Friedemann Paul

Keyword(s):

Multiple Sclerosis ◽

Beck Depression Inventory ◽

Pittsburgh Sleep Quality Index ◽

Poor Sleep ◽

Severity Scale ◽

Analog Scale ◽

Impact Scale ◽

Fatigue Severity ◽

Fatigue Impact Scale ◽

The Relationship

Objectives. Pittsburgh Sleep Quality Index (PSQI) values correlate with depression, but studies investigating the relationship between PSQI values and polysomnographic (PSG) data showed inconsistent findings.Methods. Sixty-five consecutive patients with multiple sclerosis (MS) were retrospectively classified as “good sleepers” (GS) (PSQI ≤ 5) and “poor sleepers” (PS) (PSQI > 5). The PSG data and the values of the Visual Analog Scale (VAS) of fatigue, Modified Fatigue Impact Scale (MFIS), Fatigue Severity Scale (FSS), Epworth Sleepiness Scale (ESS), and the Beck Depression Inventory (BDI) were compared.Results. No significant differences were found either for PSG data or for ESS, MFIS, and FSS values; but PS showed significantly increased BDI and VAS values.Conclusions. Poor sleep is associated with increased depression and fatigue scale values.

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Excessive daytime sleepiness in the elderly: association with cardiovascular risk, obesity and depression

Revista Brasileira de Epidemiologia ◽

10.1590/s1415-790x2013000400007 ◽

2013 ◽

Vol 16 (4) ◽

pp. 872-879 ◽

Cited By ~ 14

Author(s):

Johnnatas Mikael Lopes ◽

Fábio Galvão Dantas ◽

Jovany Luis Alves de Medeiros

Keyword(s):

Excessive Daytime Sleepiness ◽

Daytime Sleepiness ◽

Geriatric Depression Scale ◽

Depression Scale ◽

The Elderly ◽

Cardiovascular Dysfunction ◽

Chi Square ◽

Chi Square Test ◽

The Relationship ◽

Health Districts

OBJECTIVE: To observe the relationship between Excessive Daytime Sleepiness (EDS) and the presence of risk factors for cardiovascular dysfunction, depression and obesity in the elderly. METHODS: We interviewed 168 elderly from the community of Campina Grande, Paraíba. They were selected according to health districts in the period of 2010. We used the Epworth Sleepiness Scale to diagnose excessive daytime sleepiness (> 10 points); waist circumference for the risk of cardiovascular dysfunction (> 94 or > 80 cm); Geriatric Depression Scale for depression (>10 points) and body mass index for obesity (> 25 kg/m2). Association analysis was performed by the Chi-square test adjusted for sex and age group, adopting α < 0.05. RESULTS: One hundred and sixty eight elderly individuals with mean age of 72.34 ± 7.8 years old participated in this study, being 122 (72.6%) women. EDS was identified in 53 (31.5%) of them; depression, in 72 (42.9%); overweight/obesity, in 95 (64.46%); and risk of cardiovascular dysfunction, in 129 (79.6%). Depressed men (78.6%, p = 0.0005) and risk of cardiovascular dysfunction (57.1%, p = 0.02) were more prone to EDS. In women, only obesity was related to sleepiness (42.1%, p = 0.01). Only those aged between 70 - 79 years old showed association between sleepiness and obesity. CONCLUSION: It was found that obesity for women, and depression and cardiovascular dysfunction risking for men were associated with EDS in the elderly. The variable sex is a confusion condition for the association with sleepiness.

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Excessive Daytime Sleepiness in Depression and Obstructive Sleep Apnea: More Than Just an Overlapping Symptom

Frontiers in Psychiatry ◽

10.3389/fpsyt.2021.710435 ◽

2021 ◽

Vol 12 ◽

Author(s):

Danwei Zhang ◽

Zhen Zhang ◽

Huihua Li ◽

Kaimo Ding

Keyword(s):

Obstructive Sleep Apnea ◽

Sleep Apnea ◽

General Population ◽

Excessive Daytime Sleepiness ◽

Daytime Sleepiness ◽

Health Concern ◽

Therapeutic Effects ◽

Obstructive Sleep ◽

Significant Public Health ◽

The Relationship

Excessive daytime sleepiness (EDS) is a significant public health concern, with obstructive sleep apnea (OSA) being a common cause, and a particular relationship exists with the severity of depression. A literature search on OSA, depression, and EDS was performed in PubMed. The chosen evidence was limited to human studies. Available evidence was systematically reviewed to ascertain the association of EDS with depression and OSA according to the general population and some specific population subgroups. In addition, effectiveness of continuous positive airway pressure (CPAP) was analyzed as a standard therapy for improving EDS and depression in patients with OSA. In the general population, patients with OSA, and some other subpopulations, the review contributed to: (1) delineating the prevalence of EDS; (2) substantiating the relationship of EDS and depression; (3) presenting the relationship between EDS and OSA; and (4) revealing that the duration of CPAP is crucial for its therapeutic effects in improving EDS and depressive symptoms in patients with OSA.

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Abstract WP190: Excessive Daytime Sleepiness and Depression in Stroke Survivors

Stroke ◽

10.1161/str.48.suppl_1.wp190 ◽

2017 ◽

Vol 48 (suppl_1) ◽

Author(s):

Quynh Huong Pham ◽

Anjail Sharrief ◽

Sean Savitz ◽

Amrou Sarraj ◽

Lauren Fournier ◽

...

Keyword(s):

Ischemic Stroke ◽

Excessive Daytime Sleepiness ◽

Daytime Sleepiness ◽

Severe Depression ◽

Stroke Survivors ◽

Stroke Patients ◽

Patient Health ◽

Post Stroke Depression ◽

The Relationship ◽

Concentration Table

Introduction: Excessive daytime sleepiness (EDS) and post-stroke depression (PSD) are risk factors for stroke morbidity and mortality. EDS is commonly seen after stroke, but is not routinely assessed after stroke. EDS may be related to sleep disordered breathing (SDB) including obstructive and central sleep apneas, but can also occur in the absence of SDB. The relationship between EDS and PSD is not well understood. Hypothesis: We sought to assess the association between EDS and PSD. We hypothesized that patients with EDS are more likely to demonstrate symptoms of moderate to severe depression compared to patients without EDS. Methods: We identified ischemic stroke patients from the outpatient clinic registry (06/2014 - 10/2015). We screened for depressive symptoms using the Patient Health Questionnaire-9 (PHQ-9; range 0-27, higher worse), and for EDS using the Epworth Sleepiness Scale (ESS; range 0-24, higher worse). Univariate and multivariate analyses were used to evaluate association between EDS and PHQ-9 (moderate to severe depression = PHQ-9 > 9). Regression analysis was also used to evaluate association between EDS and symptoms included in the PHQ-9. Results: Among 200 ischemic stroke patients, 166 completed ESS and PHQ-9 within 90 days of stroke occurrence. Mean age was 61.5 and 54.8% were male. EDS (ESS>9) and moderate to severe depression were each present in 28.9% of patients. Patients with EDS had 3.5 times odds of moderate to severe depression compared to patients without EDS (table 1). Moreover, EDS was associated with higher odds of anhedonia, impaired mood, sleep disturbance, low energy, poor appetite, and impaired concentration (table 1). Conclusion: The presence of EDS is associated with moderate to severe depression in stroke survivors. This is not related solely to SDB symptoms. Patients with fatigue and EDS should be screened for depression. Future studies are also needed to explore the role that SDB plays in this relationship.

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Comparing the effects of multi-session anodal trans-cranial direct current stimulation of primary motor and dorsolateral prefrontal cortices on fatigue and quality of life in patients with multiple sclerosis: a double-blind, randomized, sham-controlled trial

Clinical Rehabilitation ◽

10.1177/0269215520921506 ◽

2020 ◽

Vol 34 (8) ◽

pp. 1103-1111

Author(s):

Marzieh Mortezanejad ◽

Fatemeh Ehsani ◽

Nooshin Masoudian ◽

Maryam Zoghi ◽

Shapour Jaberzadeh

Keyword(s):

Quality Of Life ◽

Multiple Sclerosis ◽

Prefrontal Cortex ◽

Direct Current ◽

Dorsolateral Prefrontal Cortex ◽

Fatigue Severity Scale ◽

Severity Scale ◽

Dorsolateral Prefrontal ◽

Fatigue Severity

Objective: To compare the effects of anodal trans-cranial direct current stimulation (a-tDCS) over primary motor and dorsolateral prefrontal cortices on Fatigue Severity Scale and its lasting effect on fatigue reduction and improvement in quality of life in patients with multiple sclerosis. Design: A randomized, double-blinded, sham-controlled parallel clinical trial study. Setting: Neurological physiotherapy clinics. Subjects: Thirty-nine participants were randomly assigned to three groups: dorsolateral prefrontal cortex a-tDCS, primary motor a-tDCS (experimental groups) and sham a-tDCS. Finally, 36 participants completed the whole study ( n = 12 in each group). Interventions: Participants in the experimental groups received six-session a-tDCS (1.5 mA, 20 minutes) during two weeks (three sessions per week). The sham group received six sessions of 20-minute sham stimulation. Main measures: The Fatigue Severity Scale and quality of life were assessed before, immediately and four weeks after the intervention. Results: Findings indicated a significant reduction in the Fatigue Severity Scale and a significant increase in the quality of life in both experimental groups, immediately after the intervention ( P < 0.001), while Fatigue Severity Scale and quality of life changes were not significant in the sham a-tDCS group ( P > 0.05). In addition, improvement of the variables remained four weeks after the intervention in dorsolateral prefrontal cortex a-tDCS (mean differences (95% confidence interval): 0.03 (−0.63 to 0.68) as compared to primary motor (−0.62 (−0.11 to −1.14) and sham a-tDCS groups (−0.47 (−1.37 to 0.43)). Conclusion: Both primary motor and dorsolateral prefrontal cortex a-tDCS as compared to sham intervention can immediately improve fatigue and quality of life. However, the effects last up to four weeks only by the dorsolateral prefrontal cortex a-tDCS.

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Sleep problems, behavioural problems and respiratory health in children born extremely preterm: a parental questionnaire study

BMJ Paediatrics Open ◽

10.1136/bmjpo-2019-000534 ◽

2019 ◽

Vol 3 (1) ◽

pp. e000534

Author(s):

Kristine Marie Stangenes ◽

Mari Hysing ◽

Irene Bircow Elgen ◽

Thomas Halvorsen ◽

Trond Markestad ◽

...

Keyword(s):

Sleep Duration ◽

Daytime Sleepiness ◽

Inhaled Corticosteroids ◽

Sleep Problems ◽

Respiratory Health ◽

Health Problems ◽

Behavioural Problems ◽

Falling Asleep ◽

Extremely Preterm ◽

Different Types

ObjectiveTo explore whether children born extremely preterm (EPT) with different types of sleep problems had more behavioural and respiratory health problems than EPT children without sleep problems.DesignProspective, nationwide, questionnaire-based study. At 11 years of age, parents reported on four current sleep problems: difficulty falling asleep or frequent awakenings, snoring, daytime sleepiness and not recommended sleep duration (<9 hours). Behavioural problems were assessed by parents and teachers with the Strengths and Difficulties Questionnaire (SDQ). Parents assessed respiratory symptoms with the International Study of Asthma and Allergies in Childhood questionnaire and described use of asthma medication.SettingNorway.PatientsEPT children.Main outcome measuresSpecified sleep problems, behavioural problems and respiratory health.ResultsData were obtained from 216 of 372 (58 %) of eligible children. All four specified sleep problems were associated with significantly higher parent-reported SDQ total-score (OR 1.1 for all), and except for not recommended sleep duration, also with higher teacher-reported SDQ total-score (OR 1.1 for all). Daytime sleepiness was strongly associated with wheezing last 12 months (OR 3.4), disturbed sleep due to wheezing (OR 3.9), wheeze during or after exercise (OR 2.9), use of inhaled corticosteroids or oral leukotriene modifiers (OR 3.4) and use of bronchodilators (OR 3.9). Snoring was associated with wheezing during or after exercise (OR 2.8) and current asthma (OR 4.2).ConclusionEPT children with different types of sleep problems had more behavioural and respiratory health problems than EPT children without sleep problems.

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