Got MS? Watch for These Symptoms

Multiple sclerosis patients may be at risk for fatigue from obstructive sleep apnea

/ Author:  / Reviewed by: Robert Carlson, M.D Beth Bolt, RPh

(RxWiki News) People with multiple sclerosis already may feel tired during the day or have difficulty sleeping. But an undiagnosed sleep problem could make matters worse.

A recent study found that at least one in five individuals with multiple sclerosis may have obstructive sleep apnea.

During obstructive sleep apnea, a person stops breathing or breathes very shallowly for many seconds at a time throughout the night. The condition can contribute to other health problems, such as high blood pressure and obesity, if not treated.

"Get treatment for sleep apnea."

This study, led by Tiffany J. Braley, MD, of the University of Michigan Department of Neurology and Multiple Sclerosis Center, aimed to understand how many patients with multiple sclerosis (MS) also had obstructive sleep apnea.

The researchers gave 195 patients with MS questionnaires related to being diagnosed with obstructive sleep apnea and their sleep in general.

The questionnaires included questions about their quality and quantity of sleep and their sleepiness or fatigue during the day.

About one in five participants (21 percent) had been officially diagnosed with obstructive sleep apnea.

In addition, just over half of all the participants (56 percent), including the majority of those with obstructive sleep apnea diagnoses, had high enough scores on an eight-question screening to indicate that they had a high risk of having obstructive sleep apnea.

Meanwhile, the three characteristics most associated with having a high score on a scale related to fatigue were having high scores on the eight-question screen, having a higher level of disability and having a higher number of nighttime symptoms related to sleep apnea.

The authors of this study concluded that individuals with MS may be at higher risk than realized for sleep apnea and sleep disturbances in general.

It's possible that obstructive sleep apnea or other nighttime symptoms could be contributing to the fatigue that MS patients experience but are going undiagnosed.

"Clinicians caring for these patients should maintain a low threshold to screen MS patients for [obstructive sleep apnea]," the researchers wrote.

Clinicians should also try to better understand underlying nighttime symptoms that might affect the sleep quality and daytime fatigue of patients with multiple sclerosis.

According to William Kohler, MD, the medical director of the Florida Sleep Institute in Spring Hill, Florida, this article shows how important it is to screen patients with MS for possible sleep problems, including obstructive sleep apnea.

"The treatment of obstructive sleep apnea can potentially significantly improve their symptoms of fatigue when it is found to be present," Dr. Kohler said.

"There was a relatively high percentage of patients with sleep apnea in this study – 21 percent," he said. "On the other hand, one would need to see whether that is higher than in the normal population."

The most common first-line treatment for obstructive sleep apnea is the use of continuous positive airway pressure, or CPAP.

CPAP involves wearing a mask while asleep. The CPAP machine and mask pump air into the person's air passageways. CPAP machines require a prescription and can cost anywhere from $150 to over $5,500, though most insurance plans will cover some or all of the expense. CPAP masks range from $30 to $200.

This study was published February 14 in the Journal of Clinical Sleep Medicine. The study was not funded by any industry sponsors.

Three authors have worked with a wide range of industry and pharmaceutical companies as consultants, study investigators or in similar capacities. These companies include Sanofi-Genzyme, Hoffmann-La Roche, Biogen-Idec, AB Science, Novartis, Genzyme, Philips Respironics, Fisher Paykel, Proctor & Gamble, MC3 and Zansors.

Review Date: 
February 13, 2014
Last Updated:
February 24, 2014