Clinical features of sleep apnea syndrome and cognitive impairment in multiple sclerosis

Takahiro Terauchi; Masanori Mizuno; Masako Suzuki; Hiroshi Akasaka; Manami Maeta; Kenichi Tamura; Keisuke Hosokawa; Tsuguo Nishijima; Tetsuya Maeda

doi:10.1016/j.msard.2023.105407

Clinical features of sleep apnea syndrome and cognitive impairment in multiple sclerosis

Mult Scler Relat Disord. 2024 Feb:82:105407. doi: 10.1016/j.msard.2023.105407. Epub 2023 Dec 23.

Authors

Takahiro Terauchi¹, Masanori Mizuno¹, Masako Suzuki¹, Hiroshi Akasaka¹, Manami Maeta¹, Kenichi Tamura², Keisuke Hosokawa³, Tsuguo Nishijima³, Tetsuya Maeda⁴

Affiliations

¹ Division of Neurology and Gerontology, Department of Internal Medicine, School of Medicine, Iwate Medical University, 1-1-1 Idaidori, Yahaba, Shiwa, Iwate, 0283694, Japan.
² Department of Neurology, Iwate Prefectural Chubu Hospital, 17-10 Murasakino, Kitakami, Iwate, 0248507, Japan.
³ Division of Behavioral Sleep Medicine, School of Medicine, Iwate Medical University, 1-1-1 Idaidori, Yahaba, Shiwa, Iwate, 0283694, Japan.
⁴ Division of Neurology and Gerontology, Department of Internal Medicine, School of Medicine, Iwate Medical University, 1-1-1 Idaidori, Yahaba, Shiwa, Iwate, 0283694, Japan. Electronic address: maeda@iwate-med.ac.jp.

PMID: 38160637
DOI: 10.1016/j.msard.2023.105407

Abstract

Background: Complications of obstructive sleep apnea (OSA) have been reported in patients with multiple sclerosis (MS). Patients with sleep apnea syndrome (SAS) due to OSA also show cognitive decline, with similar clinical characteristics to that manifested in MS. SAS due to OSA is a treatable condition, and the associated cognitive decline is expected to improve. This study investigates clinical features of SAS in people living with MS and contribute to improve cognitive dysfunction of MS.

Methods: A case-control study was conducted. Cognitive functions were evaluated by the Symbol Digit Modalities Test (SDMT) and the Paced Auditory Serial Addition Test 2 (PASAT-2) and 3 (PASAT-3). The Respiratory Event Index (REI) was measured using Out of Center Sleep Testing (OCST). We defined subjects with REI ≥ 5 as OSA and divided participants into two groups with or without SAS due to OSA. Cognitive and respiratory characteristics were statistically compared between patients with MS and healthy controls.

Results: We enrolled 67 people living with MS and 31 age- and sex-matched controls. OCST detected OSA in people living with MS and controls, and the prevalence rates were 28.4 % and 25.8 %, respectively. REI values (5.2 ± 7.9 vs 3.9 ± 5.2, p = 0.509) and number of participants with REI ≥ 5 (19 vs 8, p = 0.793) were similar between the MS and control group. The SDMT, PASAT-2, and PASAT-3 scores were significantly lower in the MS group than the control group (p < 0.001, p = 0.001, and p < 0.001, respectively). The interaction effect of MS and SAS on cognitive function was not significant in the SDMT (p = 0.078), but in the PASAT-2 (p = 0.043) and PASAT-3 (p = 0.020).

Conclusion: This study revealed the prevalence rates of SAS in Japanese people living with MS and the usefulness of OCST for detection of SAS. This study also revealed that concomitant SAS can facilitate cognitive decline in people living with MS. These findings suggest that an appropriate intervention for OSA can be beneficial for people living with MS with cognitive decline.

Keywords: Cognitive decline; Multiple sclerosis; Obstructive sleep apnea; Out of center sleep testing; Sleep apnea syndrome.

MeSH terms

Case-Control Studies
Cognitive Dysfunction* / complications
Cognitive Dysfunction* / etiology
East Asian People*
Humans
Multiple Sclerosis* / complications
Multiple Sclerosis* / epidemiology
Sleep Apnea, Obstructive* / complications
Sleep Apnea, Obstructive* / epidemiology

Supplementary concepts

Japanese people