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Fatigue and Sleep-Disordered Breathing in Multiple Sclerosis: A Clinically Relevant Association?

DOI: 10.1155/2013/286581

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Background. Fatigue in patients with multiple sclerosis (MS) is highly prevalent and severely impacts quality of life. Recent studies suggested that sleep-disordered breathing (SDB) significantly contributes to fatigue in MS. Study Objective. To evaluate the importance of routine respirography in MS patients with severe fatigue and to explore the effects of treatment with continuous positive airway pressure (CPAP). Patients and Methods. We prospectively assessed the presence of severe fatigue, as defined by a score of ≥5.0 on the Fatigue Severity Scale (FSS), in 258 consecutive MS patients. Ninety-seven patients (38%) suffered from severe fatigue, whereof 69 underwent overnight respirography. Results. We diagnosed SDB in 28 patients (41%). Male sex was the only independent associate of SDB severity ( ). CPAP therapy in 6 patients was associated with a significant reduction of FSS scores ( versus , ), but the scores remained pathological (≥4.0) in all patients. Conclusion. Respirography in MS patients with severe fatigue should be considered in daily medical practice, because SDB frequency is high and CPAP therapy reduces fatigue severity. However, future work is needed to understand the real impact of CPAP therapy on quality of life in this patient group. 1. Introduction Although fatigue has been increasingly recognized over the past two decades as one of the most frequent and most debilitating symptoms in patients with MS, there are still no insights into its neurobiological mechanisms, and current treatment options are highly frustrating [1–4]. In clinical practice, MS patients complaining about fatigue are usually first scrutinized for additional and potentially treatable comorbidities, such as depression, pain, anemia, or sleep-wake disturbances [5]. If there is no such cause of fatigue, the patient is considered to suffer from “MS-related fatigue,” that is, a disease-inherent symptom related to the underlying neuroimmunological and neurodegenerative processes, and off-label symptomatic treatment with stimulants of the central nervous system may be recommended [3]. Recently, the need to search for sleep-wake disorders in MS patients has been reemphasized, as several groups observed a significant correlation with fatigue [6–10]. Specifically, sleep-disordered breathing (SDB) has been proposed as a potential risk factor for fatigue in MS. In the last year, a cross-sectional study in 48 MS patients suggested a predisposition for SDB [11], and two studies found that severe fatigue in MS was significantly associated with SDB and respiratory-related

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