Sunday, 26 August 2012

Treatment of sleep problems reduces fatigue

EpubCôté et al. Impact of sleep disorder treatment on fatigue in multiple sclerosis. Mult Scler. 2012 Aug 22.

BACKGROUND: Sleep disorders are significantly associated with fatigue in MS.

OBJECTIVE: The objective of this paper is to assess the effects of sleep disorder treatment on fatigue and related clinical outcomes in MS.

METHODS: This was a controlled, non-randomized clinical treatment study. 62 MSers completed standardized questionnaires including the Fatigue Severity Scale (FSS), Multidimensional Fatigue Inventory (MFI), Epworth Sleepiness scale (ESS) and Pittsburgh Sleep Quality Index (PSQI), and underwent polysomnography (PSG). MSers with sleep disorders were offered standard treatment. 56 subjects repeated the questionnaires after ≥ three months, and were assigned to one of three groups: sleep disorders that were treated (SD-Tx, n=21), sleep disorders remaining untreated (SD-NonTx, n=18) and no sleep disorder (NoSD, n=17).

RESULTS: FSS and MFI general and mental fatigue scores improved significantly from baseline to follow-up in SD-Tx (p <0.03), but not SD-NonTx or NoSD subjects. ESS and PSQI scores also improved significantly in SD-Tx subjects (p <0.001). Adjusted multivariate analyses confirmed significant effects of sleep disorder treatment on FSS (-0.87, p = 0.005), MFI general fatigue score (p = 0.034), ESS (p = 0.042) and PSQI (p = 0.023).

CONCLUSION: Treatment of sleep disorders can improve fatigue and other clinical outcomes in MS.



"This is a massive and under appreciated problem. As we have highlighted on this blog before MSers often have multiple reasons for having poor sleep: pain, restless legs, leg spasms, nocturia (frequent getting up at night to pass urine), anxiety & depression, which causes early morning waking, over or inappropriate use of stimulants to treat daytime fatigue that don't wear off before bedtime, poor sleep hygiene (too much sleep in  the day), side effects from medications, excessive alcohol intake and finally primary sleep disorders, which are either due to MS lesions affecting the sleep pathways or simply a sleep disorder unrelated to MS, for example obstructive sleep apnoea."

"Do you wake in the morning feeling refreshed? If not, you should ask your neurologist for help. There is a lot we can do to improve things. We are about to start a service development in which use activity monitors to assess nocturnal activity to try an get a handle on sleep and fatigue. It is interesting that MSers often under-estimate or under-report  nocturia and legs spasms. By having an objective measure of motor activity at night we can then try and treat the problem and measure the effectiveness of our intervention."
"Please don't suffer in silence, virtually all the problems that contribute to poor sleep, that then have knock on effects and exacerbate fatigue, can be treated or at least improved."

7 comments:

  1. Suffering from the Restless legs syndrom, I always thought the kicking stops when I fall asleep. My wife tells me it doesn't. But is there a treatment for it?

    ReplyDelete
    Replies
    1. Yes, there are several options. Please discuss this with your neurology team.

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  2. Can I be used in a clinical trial for this a a lack of sleep, and nocturia, is a constant problem and exacerbates my symptoms ?

    ReplyDelete
    Replies
    1. You will need to discuss this with your neurology team.

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  3. Dear Dr G

    I'd like to know what kind of "standard treatment" they offered in this study? Do you know it?

    ReplyDelete
    Replies
    1. General sleep hygiene advice was given to all patients. For patients with obstructive sleep apnoea, treatment recommendations were
      based on the constellation of clinical and polysomnography findings, in keeping with standard clinical practice. Continuous positive airway pressure (CPAP) was the treatment of choice for obstructive sleep apnoea, though some subjects opted for conservative treatment including positioning devices and weight loss. CPAP was either fixed, with pressure based on a manual titration or auto-PAP (positive airway pressure). For restless legs syndrome, exacerbating factors were sought and corrected when present (e.g. caffeine use; iron or B12 deficiency). For persistent symptoms, treatment with pramipexole was prescribed. Patients with insomnia were referred for cognitive behavioural therapy. REM sleep behavioural disorder (RBD) was treated with clonazepam.

      Delete

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