Saturday, 1 March 2014

Sleep: fatigue and obstructive sleep apnoea

Sleep is a BIG problem in MS. Do you have a sleep problem? #MSBlog #MSResearch

"Sleep is a common topic of discussion on this blog. Why? Because it such a big problem in MSers. Sleep disorders, and poor sleep hygiene, are a major contributor to fatigue in MS. Anyone who wants to practice the holistic care model that I aspire to needs to think sleep disorders. The study below is remarkable in that of 195 MSers who completed a panel of questionnaires 21% had obstructive sleep apnoea (OSA). OSA is a serious, but treatable condition. This study will change my practice and I am now going to start routine screening of MSers to see how common this problem is."

"Some of you may remember the sleep survey that is running on the blog. I never analysed the results as I had too few respondents. It would be great if we could increase the numbers and I will then ask someone in my group to analyse the results to see how common the problem is in readers of the blog. If you don't want to participate you can simply download the sleep disorder screening questionnaire at the end of this post and complete it yourself. If you identify a sleep problem you can raise it with your neurologist when you next see him/her."

Braley et al. Obstructive sleep apnea and fatigue in patients with multiple sclerosis. J Clin Sleep Med. 2014 Feb ;10(2):155-62.

STUDY OBJECTIVES: The prevalence of obstructive sleep apnea (OSA) in MSers remains unknown, and little information exists regarding the relative contributions of OSA to symptoms of MS-related fatigue in the presence of other clinical and sleep-related confounders. The objectives of this study were to investigate the prevalence of diagnosed OSA and OSA risk among MSers, and to assess relationships between fatigue severity, OSA, OSA risk, and sleep quality among persons with MS.

METHODS: N = 195 MSers completed a questionnaire comprised of items regarding OSA diagnosis, sleep quality and quantity, daytime symptoms, and 4 validated scales: the Epworth Sleepiness Scale, Fatigue Severity Scale, Insomnia Severity Index, and STOP-Bang questionnaire. Medical records were also accessed to examine clinical characteristics that may predict fatigue or OSA risk.

RESULTS: N = 41 MSers (21%) carried a formal diagnosis of OSA. N = 110 (56%) of all MSers, and 38 (93%) of those with diagnosed OSA had STOP-Bang scores ≥ 3, indicating an elevated OSA risk. In regression models, the most significant predictors of higher FSS scores were higher STOP-Bang scores (p = 0.01), higher number of nocturnal symptoms (p < 0.0001), and higher disability level (p < 0.0001).

CONCLUSIONS: Sleep disturbances, and OSA in particular, may be highly prevalent yet under recognized contributors to fatigue in MSers.

"For new readers there are lot of other posts about sleep on the blog; to access them simply do a search using the term sleep in the web app; to access the latter you will need to view the web version of the blog."


  1. Thank you for making me aware of this. A very helpful post. I have a sleep problem and will definitely bring it the attention of my neurologist. Is it easy to treated for sleep apnea?

  2. Very interesting! Thanks.


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