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Assessment Of Sleep Disorders In Remitting-Relapsing Multiple Sclerosis Patients J.F. Mekky, H.O. Sadallah, A. Elkersh, F.M. Marei Neuropsychiatry, faculty of medicine Alexandria University, Alexandria, Egypt
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Subjects
Background
Methods
RESULTS
It was conducted upon 30 subjects who were divided into two groups:
· Group of multiple sclerosis patients: 15 patients
· Group of healthy individuals: 15 individual MRI lesions
Informed Consent was taken from every participate.
· History taking, general and neurological examination.
· Assessment of MS severity by expanded disability scoring scale (EDSS). .
· MRI brain and posterior fossa.
· Overnight polysomnography.
Multiple sclerosis is a chronic degenerative inflammatory disease of the central nervous system with a wide range of signs and symptoms, including neurological, menta and sleep disorders .
One puzzling aspect of MS for clinicians and researchers alike is the nature of the relation between sleep disorders and MS.
Comparing the pateint and control group sleep studies there was a difference in the sleep efficiency , which was significantly lower among the MS patients (p < ).
The sleep latency was longer , the arousal index and the total sleep change were higher also in the patient group .MRI findings in 13 patients who had longer sleep latency and , were plaques at centrum semioval, corona radiate, forceps major, periventricular parietal, cerebellum, pons, medulla and spinal cord.
There was an evident statistically significant difference between the two group regarding the sleep stages . The MS patients had longer stage one, two and REM sleep but significantly shorter deep sleep .REM latency was also significantly higher amaong pateints .MRI findings in 5 patients who had decreased REM sleep% and latency were plaques at centrum semioval, periventricular parietal and pons.
Objective
CONCLUSION
Relation between duration of illness with different studied parameters in patients group
χ2: Chi square for Kruskal Wallis test
p1: p value for Mann Whitney test for comparing between 1 – 3 category and each other category
p2: p value for Mann Whitney test for comparing between 3 – 5 with ≥5 category
*: Statistically significant at p ≤ 0.05
Duration of illness χ2 p
1 - 3 (n=4)
3 - 5 (n=7)
≥5 (n=4)
Total stages changes
Min. – Max.
35.0 – 61.0
49.0 – 97.0
58.0 – 164.0
6.663*
0.036*
Mean ± SD.
45.25 ± 11.27
72.29 ± 19.01
98.50 ± 47.93
Median
42.50
75.0
86.0 p1
0.023*
0.043* p2
0.345
Arousal index
8.0 – 37.0
25.0 – 95.0
45.0 – 98.0
5.767
0.056
25.25 ± 12.37
62.43 ± 25.36
70.50 ± 22.75
28.0
66.0
69.50
0.058
0.021*
0.705
REM latency
100.0 – 122.0
80.0 – 175.0
17.0 – 179.0
1.521
0.467
± 9.47
125.57±33.12
93.25 ± 68.86
108.0
129.0
88.50
AHI
0.0 – 2.0
1.0 – 81.0
1.0 – 30.0
3.718
0.156
0.75 ± 0.96
16.86 ± 28.77
8.50 ± 14.34
0.50
10.0
1.50
Snoring index
16.0 – 48.0
17.0 – 250.0
218.0 –
8.314*
0.016*
30.25 ± 13.28
82.71 ± 83.13
± 389.8
28.50
47.0
309.5
0.131
PL index
0.0 – 1.0
2.0 – 6.0
10.650*
0.005*
0.0 ± 0.0
0.43 ± 0.53
3.25 ± 1.89
0.0
2.50
0.143
0.013*
0.006*
To study the sleep disorders in clinically definite RRMS patients during remission as regard the duration of illness , the EDSS score and the sites of
The apnea hypopnea index, snoring index , denoting higher chance of sleep disordered breathing during the course of the illness.MRI findings in 3 patients who had Sleep-disordered breathing were plaques at centrum semioval, periventricular parietal, cerebellum and medulla. The periodic limb movements index was also significantly higher in MS pateints.6 patients who had PLMD had plaques at centrum semioval, periventricular parietal, cerebellum, spinal cord and optic nerve.
MFIS Z p
<38 (n=5)
≥38 (n=10)
Total stages changes
Min. – Max.
35.0 – 61.0
49.0 – 164.0
2.694*
0.007*
Mean ± SD.
46.20 ± 9.98
85.0 ± 32.82
Median
45.0
80.50
Arousal index
8.0 – 37.0
34.0 – 98.0
2.942*
0.003*
25.20 ± 10.71
69.40 ± 20.51
26.0
66.0
REM latency
90.0 – 122.0
17.0 – 179.0
0.982
0.326 ± ±
105.0
125.50
AHI
0.0 – 2.0
1.0 – 81.0
2.091*
0.037*
0.80 ± 0.84
15.10 ± 24.90
1.0
6.0
Snoring index
16.0 – 48.0
34.0 –
27.60 ± 12.93 ±
27.0
177.50
PL index
0.0 – 6.0
2.337*
0.019*
0.0 ± 0.0
1.60 ± 1.84
0.0
patients group
Z: Z for Mann Whitney test
*: Statistically significant at p ≤ 0.05
Relation between BDI with demographic data in patients group
Of 15patients ,3 were normal according to BDI (≤10) and 12 were with mood changes(>10),one had mild mood disturbance ,2 had borderline clinical depression and 10 had moderate depression(score21-30
Sleep disorders are common in MS and should be screened for carefully in all MS patients,taking into consideration sites of the lesion, duration of illness or EDSS score .
References
Journal Article, Name of Journal
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