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MS research update - Fatigue and sleep disorders - 18 January 2013

Fatigue is one of the commonest symptoms of MS and can have a major impact on daily life. The level of fatigue does not reflect the severity of someone's MS and people can experience fatigue that interrupts their daily life or that prevents them from working whilst having no other symptoms.

The underlying causes of fatigue in MS are poorly understood and it is not known how much sleep disorders such as sleep apnoea (interrupted breathing during sleep) or restless leg syndrome contribute to the overall levels of tiredness felt by some people with MS. Since fatigue is an expected consequence of MS, people with MS who report symptoms relating to tiredness tend not to be referred for sleep studies.

More research is needed to identify indicators that would help doctors spot those people with MS who are most likely to benefit from in-depth sleep evaluations and consequently get earlier treatment for an underlying sleep disorder.

The researchers wanted to see if there was any relationship between polysomnography findings and the frequency of daytime symptoms such as fatigue, tiredness, lack of energy and sleepiness. Polysomnography is a detailed sleep study which records the amount of time spent in different stages of sleep, arm or leg movements, breathing, heart rate etc.

How this study was carried out

This study compared two groups of people who had been referred to a sleep clinic, one group of 30 people who had MS and a second group of 30 who did not have MS (controls). All the participants underwent polysomnography. They were also asked to complete questionnaires rating symptoms of daytime fatigue.

What was found

More people with MS than controls reported fatigue, tiredness and lack of energy to occur often or almost always; sleepiness was reported similarly by both groups. Sleep efficiency is a measure of the time spent asleep compared to the amount of time spent in bed; decreased sleep efficiency in the MS group was associated with increased reports of tiredness, fatigue and lack of energy.

What does it mean?

The results suggest that people with MS are more sensitive to the consequences of reduced sleep efficiency. Measures to increase sleep efficiency in MS could improve daytime fatigue, regardless of whether underlying sleep disorders are present. The observation of reduced sleep efficiency in people with MS highlights the importance of considering sleep disorders as a cause of fatigue.

Braley TJ, Chervin RD, Segal BM.
Fatigue, tiredness, lack of energy, and sleepiness in multiple sclerosis patients referred for clinical polysomnography.
Mult Scler Int. 2012;2012:673936.
full text of article.

More about fatigue in MS

Living with fatigue our book which offers advice on how to cope and live with fatigue. It was written in conjunction with an MS specialist occupational therapist and illustrated with comments by people with MS who know what it is like to live with the symptom.

Research by topic areas...

Symptoms and symptom management

Foley PL, Vesterinen HM, Laird BJ, et al.
Prevalence and natural history of pain in adults with multiple sclerosis: Systematic review and meta-analysis.
Pain. 2012 Dec 14. doi:pii:S0304-3959(12)00647-1. 10.1016/j.pain.2012.12.002.

Disease modifying treatments

Carroll W, Saida T, Kim H, et al.
A guide to facilitate the early treatment of patients with idiopathic demyelinating disease (multiple sclerosis and neuromyelitis optica).
Mult Scler. 2013 Jan 16. [Epub ahead of print]

Tanaka M, Park K, Tanaka K.
Reduced fingolimod dosage treatment for patients with multiple sclerosis and lymphopenia or neutropenia.
Mult Scler. 2013 Jan 15. [Epub ahead of print]

Cree BA.
Update on reproductive safety of current and emerging disease-modifying therapies for multiple sclerosis.
Mult Scler. 2013 Jan 14. [Epub ahead of print]

Carvalho AT, Sá MJ.
Switching and escalating therapy in long-lasting multiple sclerosis: not always necessary.
ISRN Neurol. 2012;2012:451457. Epub 2012 Dec 22.
full text of article.

Zajicek J.
Multiple sclerosis.
Handb Clin Neurol. 2013;110:461-70.

Marousi S, Karkanis I, Kalamatas T, et al.
Immune cells after prolonged Natalizumab therapy: implications for effectiveness and safety.
Acta Neurol Scand. 2013 Jan 11. [Epub ahead of print]

Cadavid D, Jurgensen S, Lee S., et al.
Impact of natalizumab on ambulatory improvement in secondary progressive and disabled relapsing-remitting multiple sclerosis.
PLoS One. 2013;8(1):e53297. Epub 2013 Jan 4.
full text of article.

Chataway J, Miller DH.
Natalizumab Therapy for Multiple Sclerosis.
Neurotherapeutics. 2013 Jan 11. [Epub ahead of print]

Devonshire V, Arbizu T, Borre B, et al.
Patient-rated suitability of a novel electronic device for self-injection of subcutaneous interferon beta-1a in relapsing multiple sclerosis: an international, single-arm, multicentre, Phase IIIb study.
BMC Neurol. 2010 Apr 30;10:28.

Other treatments

Hedström A, Hillert J, Olsson T, et al.
Nicotine might have a protective effect in the etiology of multiple sclerosis.
Mult Scler. 2013 Jan 14. [Epub ahead of print]


Pugliatti M, Eskic D, Mikolcić T, et al.
Assess, compare and enhance the status of Persons with Multiple Sclerosis (MS) in Europe: a European Register for MS.
Acta Neurol Scand Suppl. 2012;(195):24-30.


Brichetto G, Spallarossa P, de Carvalho ML, et al.
The effect of Nintendo(R) Wii(R) on balance in people with multiple sclerosis: a pilot randomized control study.
Mult Scler. 2013 Jan 15. [Epub ahead of print]

Co-existing conditions

Dobson R, Giovannoni G.
Autoimmune disease in people with multiple sclerosis and their relatives: a systematic review and meta-analysis.
J Neurol. 2013 Jan 12. [Epub ahead of print]

Psychological aspects

Pöttgen J, Dziobek I, Reh S, et al.
Impaired social cognition in multiple sclerosis.
J Neurol Neurosurg Psychiatry. 2013 Jan 11. [Epub ahead of print]

Pakenham KI, Cox S.
Test of a model of the effects of parental illness on youth and family functioning.
Health Psychol. 2012 Sep;31(5):580-90.

Provision of care

Foley P, Hampton J, Hampton A, et al.
Lesley's story: a case report, and discussion of challenges faced in end-of-life care for progressive neurological disease.
Pract Neurol. 2012 Aug;12(4):244-8.

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