Contribution of sleep disturbances to fatigue in multiple sclerosis: a prospective study using clinical and polysomnographic parameters

Gianna C Riccitelli; Giulio Disanto; Rosaria Sacco; Davide Sparasci; Leonardo Sacco; Anna Castelnovo; Silvia Miano; Mauro Manconi; Claudio Gobbi; Chiara Zecca

doi:10.1111/ene.14984

Contribution of sleep disturbances to fatigue in multiple sclerosis: a prospective study using clinical and polysomnographic parameters

Eur J Neurol. 2021 Sep;28(9):3139-3146. doi: 10.1111/ene.14984. Epub 2021 Jun 30.

Authors

Gianna C Riccitelli^{1

2

3}, Giulio Disanto¹, Rosaria Sacco¹, Davide Sparasci⁴, Leonardo Sacco², Anna Castelnovo^{4

3

5}, Silvia Miano², Mauro Manconi^{4

3

6}, Claudio Gobbi^{1

3}, Chiara Zecca^{1

3}

Affiliations

¹ Multiple Sclerosis Center, Neurocenter of Southern Switzerland, Regional Hospital (EOC) of Lugano, Lugano, Switzerland.
² Neuropsychology and Behavioral Neurology Research Unit, Neurocenter of Southern Switzerland, Regional Hospital (EOC) of Lugano, Lugano, Switzerland.
³ Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland.
⁴ Sleep Medicine Unit, Neurocenter of Southern Switzerland, Regional Hospital (EOC) of Lugano, Lugano, Switzerland.
⁵ University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland.
⁶ Neurology Department Inselspital, Bern University Hospital, Bern, Switzerland.

Abstract

Background and purpose: Fatigue is amongst the most frequent and disabling symptoms of multiple sclerosis and a close relation between fatigue and sleep quality has been hypothesized. In this study the contribution of sleep disturbances measured by clinical and polysomnographic parameters to fatigue in multiple sclerosis was investigated.

Methods: This was a prospective instrumental study performed at the Neurocenter of Southern Switzerland. Demographic data and clinical characteristics including fatigue (as measured by the modified fatigue impact scale [MFIS]), neurological disability, psychiatric symptoms, medications and sleep-related variables were collected at baseline visit and by a home full-night polysomnography. The associations between sleep-related variables and the MFIS were tested using partial correlations adjusted by demographic and sleep-unrelated clinical factors.

Results: Seventy-six patients were included in the study, of whom 53 (69.7%) had an MFIS ≥38 points (median 49.5, interquartile range 31.0-62.0). MFIS scores were positively associated with age, neurological disability, symptoms of depression and anxiety, and use of benzodiazepines and selective serotonin reuptake inhibitors. When adjusting for these variables, the presence of restless legs syndrome (RLS) (r = 0.37, p = 0.005) and periodic leg movements index (r = -0.33, p = 0.014) were associated with MFIS. Excessive daytime sleepiness, total sleep time, sleep efficiency, respiratory disturbances, and percentage of time spent in the different sleep stages (N1, N2, N3 and rapid eye movement) were not associated with fatigue.

Conclusions: Multiple sclerosis patients with a diagnosis of RLS had significantly higher global fatigue scores compared to those without RLS. Future studies should investigate whether medical treatment of RLS can ameliorate fatigue.

Keywords: fatigue; multiple sclerosis; polysomnography; sleep disorders.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Fatigue / epidemiology
Fatigue / etiology
Humans
Multiple Sclerosis* / complications
Multiple Sclerosis* / epidemiology
Prospective Studies
Restless Legs Syndrome* / complications
Restless Legs Syndrome* / epidemiology
Sleep
Sleep Wake Disorders* / epidemiology
Sleep Wake Disorders* / etiology