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Beyond fatigue: Assessing variables associated with sleep problems and use of sleep medications in multiple sclerosis  [cached]
Alyssa M Bamer,Kurt L Johnson,Dagmar A Amtmann,et al
Clinical Epidemiology , 2010,
Abstract: Alyssa M Bamer, Kurt L Johnson, Dagmar A Amtmann, George H KraftDepartment of Rehabilitation Medicine, University of Washington, Seattle, WA, USABackground: Recent research indicates that sleep disturbances are common in persons with multiple sclerosis (MS), though research to date has primarily focused on the relationship between fatigue and sleep. In order to improve treatment of sleep disorders in MS, a better understanding of other factors that contribute to MS sleep disturbance and use of sleep medications in this population is needed.Methods: Individuals with MS (N = 473) involved in an ongoing self-report survey study were asked to report on use of over-the-counter and prescription sleep medications. Participants completed the Medical Outcomes Study Sleep (MOSS) scale and other common self-report symptom measures. Multiple regression was used to evaluate factors associated with sleep problems and descriptive statistics were generated to examine use of sleep medications.Results: The mean score on the MOSS scale was 35.9 (standard deviation, 20.2) and 46.8% of the sample had moderate or severe sleep problems. The majority of participants did not use over-the-counter (78%) or prescription (70%) sleep medications. In a regression model variables statistically significantly associated with sleep problems included depression, nighttime leg cramps, younger age, pain, female sex, fatigue, shorter duration of MS, and nocturia. The model explained 45% of the variance in sleep problems. Of the variance explained, depression accounted for the majority of variance in sleep problems (33%), with other variables explaining significantly less variance.Conclusions: Regression results indicate that fatigue may play a minor role in sleep disturbance in MS and that clinicians should consider the interrelationship between depression and sleep problems when treating either symptom in this population. More research is needed to explore the possibility of under-treatment of sleep disorders in MS and examine the potential effectiveness of nonpharmaceutical treatment options.Keywords: multiple sclerosis, sleep, depression, fatigue, nonpharmaceutical treatments, selfmedication
Beyond fatigue: Assessing variables associated with sleep problems and use of sleep medications in multiple sclerosis
Alyssa M Bamer, Kurt L Johnson, Dagmar A Amtmann, et al
Clinical Epidemiology , 2010, DOI: http://dx.doi.org/10.2147/CLEP.S10425
Abstract: eyond fatigue: Assessing variables associated with sleep problems and use of sleep medications in multiple sclerosis Original Research (4334) Total Article Views Authors: Alyssa M Bamer, Kurt L Johnson, Dagmar A Amtmann, et al Published Date May 2010 Volume 2010:2 Pages 99 - 106 DOI: http://dx.doi.org/10.2147/CLEP.S10425 Alyssa M Bamer, Kurt L Johnson, Dagmar A Amtmann, George H Kraft Department of Rehabilitation Medicine, University of Washington, Seattle, WA, USA Background: Recent research indicates that sleep disturbances are common in persons with multiple sclerosis (MS), though research to date has primarily focused on the relationship between fatigue and sleep. In order to improve treatment of sleep disorders in MS, a better understanding of other factors that contribute to MS sleep disturbance and use of sleep medications in this population is needed. Methods: Individuals with MS (N = 473) involved in an ongoing self-report survey study were asked to report on use of over-the-counter and prescription sleep medications. Participants completed the Medical Outcomes Study Sleep (MOSS) scale and other common self-report symptom measures. Multiple regression was used to evaluate factors associated with sleep problems and descriptive statistics were generated to examine use of sleep medications. Results: The mean score on the MOSS scale was 35.9 (standard deviation, 20.2) and 46.8% of the sample had moderate or severe sleep problems. The majority of participants did not use over-the-counter (78%) or prescription (70%) sleep medications. In a regression model variables statistically significantly associated with sleep problems included depression, nighttime leg cramps, younger age, pain, female sex, fatigue, shorter duration of MS, and nocturia. The model explained 45% of the variance in sleep problems. Of the variance explained, depression accounted for the majority of variance in sleep problems (33%), with other variables explaining significantly less variance. Conclusions: Regression results indicate that fatigue may play a minor role in sleep disturbance in MS and that clinicians should consider the interrelationship between depression and sleep problems when treating either symptom in this population. More research is needed to explore the possibility of under-treatment of sleep disorders in MS and examine the potential effectiveness of nonpharmaceutical treatment options.
Remission of severe restless legs syndrome and periodic limb movements in sleep after bilateral excision of multiple foot neuromas: a case report
Ludwig A Lettau, Charles J Gudas, Thomas D Kaelin
Journal of Medical Case Reports , 2010, DOI: 10.1186/1752-1947-4-306
Abstract: A 42-year-old Caucasian woman with severe restless legs syndrome and periodic limb movements in sleep and bilateral neuropathic foot dysesthesias was diagnosed as having neuromas in the second, third, and fourth metatarsal head interspaces of both feet. The third interspace neuromas represented regrowth (or 'stump') neuromas that had developed since bilateral third interspace neuroma excision five years earlier. Because intensive conservative treatments including repeated neuroma injections and various restless legs syndrome medications had failed, radical surgery was recommended. All six neuromas were excised. Leg restlessness, foot dysesthesias and subjective sleep quality improved immediately. Assessment after 18 days showed an 84 to 100 percent reduction of visual analog scale scores for specific dysesthesias and marked reductions of pre-operative scores of the Pittsburgh sleep quality index, fatigue severity scale, and the international restless legs syndrome rating scale (36 to 4). Polysomnography six weeks post-operatively showed improved sleep efficiency, a marked increase in rapid eye movement sleep, and marked reductions in hourly rates of both periodic limb movements in sleep with arousal (135.3 to 3.3) and spontaneous arousals (17.3 to 0).The immediate and near complete remission of symptoms, the histopathology of the excised tissues, and the marked improvement in polysomnographic parameters documented six weeks after surgery together indicate that this patient's severe restless legs syndrome and periodic limb movements in sleep was of peripheral nerve (foot neuroma) origin. Further study of foot neuromas as a source of periodic limb movements in sleep and as a cause of sleep dysfunction in patients with or without concomitant restless legs syndrome, is warranted.Restless legs syndrome (RLS) is a sensorimotor neurological disorder characterized by an urge to move the legs in response to uncomfortable leg sensations [1]. While asleep, 70% to 90% of patien
Outcome of sleepiness and fatigue scores in obstructive sleep apnea syndrome patients with and without restless legs syndrome after nasal CPAP
Rodrigues, Raimundo Nonato Delgado;Rodrigues, Aída Alexandra Alvim de Abreu e Silva;Pratesi, Riccardo;Gomes, Marília Miranda Fortes;Vasconcelos, Ana Maria Nogales;Erhardt, Christine;Krieger, Jean;
Arquivos de Neuro-Psiquiatria , 2007, DOI: 10.1590/S0004-282X2007000100012
Abstract: background & purpose: the association of obstructive sleep apnea syndrome (osas) and restless legs syndrome (rls) has been reported in the literature for many years. both conditions may be responsible for fatigue and somnolence complaints secondary to nocturnal sleep disruption. the primary concern of this study is to evaluate the outcome of fatigue and daytime sleepiness symptoms at baseline and after continuous positive air pressure (cpap) treatment in osas patients with and without rls. method: a prospective and comparative study between a group of 13 patients with osas and a group of 17 patients with osas+rls. laboratory blood tests and polysomnography were performed at baseline. the epworth sleepiness scale (ess) and the pichot?s questionnaire of fatigue/depression (pic) were applied before and after 3 months of cpap treatment. results were compared. results: no significant differences were found on psg and laboratory results at baseline. both groups had similar ess and pic scores at baseline (p=0.73 and 0.08, respectively). after n-cpap, osas+rls patients showed higher ess and pic scores (p=0.017 and 0.03, respectively). conclusions: despite a favorable general response, n-cpap seemed less effective in treating fatigue and sleepiness in the osas+rls group.
The impact of disability, fatigue and sleep quality on the quality of life in multiple sclerosis
Ghaem Haleh,Haghighi Afshin
Annals of Indian Academy of Neurology , 2008,
Abstract: Background: Only few papers have investigated the impact of multiple sclerosis (MS), especially MS-related fatigue and the impact of the quality of sleep on the quality of life (QoL) in MS patients. Objective: The objective of this study was to measure the quality of life in MS patients and the impact of disability, fatigue and sleep quality, using statistical modeling. Materials and Methods: A cross-sectional study was conducted and data was collected from 141 MS patients, who were referred to the Mottahari Clinic, Shiraz, Iran, in 2005. Data on health-related quality of life (MSQoL-54), fatigue severity scale (FSS), and Pittsburgh sleep quality Index (PSQI) were obtained in the case of all the patients. Epidemiology data concerning MS type, MS functional system score, expanded disability status scale (EDSS) etc. were also provided by a qualified neurologist. Spearman a coefficient, Mann-Whitney U test, and linear regression model were used to analyze the data. Results : The mean ±SD age of 141 MS patients was 32.6±9.6 year. Thirty five (24.8%) of them were male and the others were female. Eighty two (58.1%) of the patients had EDSS score of ≤ 2, 36 (25.5%) between 2.5 and 4.5, and 23 (16.3%) ≥ 5. As per PSQI scores, two (1.4%) of the patients had good sleep, 16 (11.3%) had moderate sleep and 123 (87.2%) had poor sleep. There was a significant high positive correlation between the quality of mental and physical health composite scores (r = 0.791, P < 0.001). There was a significant negative correlation between the quality of physical score and age (r = -0.88, P < 0.001), fatigue score (r = -0.640, P < 0.001), EDSS score (r = -0.476, P < 0.001) and PSQI (sleep quality r = -0.514, P < 0.000). Linear regression analysis showed that PSQI score, EDSS, and fatigue score were predictors in the model between the quality of physical score and covariates ( P < 0.001). Linear regression model showed that fatigue score and PSQI were predictors in the model between the quality of mental score and covariates ( P < 0.001). Discussion and Conclusion: In conclusion, it may be said that MS patients had poor and moderate quality of mental and physical health. The quality of life was impaired as seen by PSQI, EDSS, and FSS. It is our suggestion that these patients require the attention of health care professionals, to be observed for the need of possible psychological support.
Fatigue, Depression and Sleep Disturbances in Iranian Patients with Multiple Sclerosis
Mahsa Ghajarzadeh,Mohammad Ali Sahraian,Rouzbeh Fateh,Ali Daneshmand
Acta Medica Iranica , 2012,
Abstract: Fatigue is one of the most frequent symptoms in patients with multiple sclerosis (MS) and it is difficult to clarify the nature of this symptom and manage it. This study was aimed to evaluate the frequency of fatigue, depression and sleep disturbances in Iranian patients with MS. 100 patients from the outpatient MS clinic of Sina hospital were asked to complete Beck Depression Inventory (BDI), Pittsburg Sleep Quality Index (PSQI), Sleep Disorder Questionnaire (SDQ), Modified Fatigue Impact Scale (MFIS) and Epworth Sleepiness Scale (ESS) questionnaires. Student's t-test, ANOVA, Spearman correlation and Stepwise multiple linear regressions by SPSS version 15.0 were used for data analysis. From participants, 64 had fatigue complaint during day time and 36 did not feel fatigued. BDI, PSQI, MFIS and SDQ scores were significantly higher in fatigued patients than non-fatigued group but there were no statistically significant differences in ESS, EDSS and duration of disease between fatigued and non-fatigued cases. There were significant correlations between MFIS and BDI scores (r=0.49, P=0.01), MFIS and PSQI scores (r=0.399, P=0.01) and MFIS and ESS (r=0.25, P=0.01). This study demonstrates that depression is not the only cause of fatigue in patients with MS and it is also associated with sleep disorders, so this complaint should be carefully evaluated and managed in these patients.
Circadian fatigue or unrecognized restless legs syndrome? The post-polio syndrome model.  [PDF]
Andrea Romigi
Frontiers in Neurology , 2014, DOI: 10.3389/fneur.2014.00115
Abstract: A comment on Circadian variation of fatigue in both patients with paralytic poliomyelitis and post-polio syndrome. by Viana CF, Pradella-Hallinan M, Quadros AA, Marin LF, Oliveira AS (2013). Arq Neuropsiquiatr; 71: 442-445. “It ought to be generally known that the source of our pleasure, merriment, laughter, amusement, as of our grief, pain, anxiety and tears, is none other than the brain” Hippocrates The discussion of this research paper may represent the starting point of the debate about the influence of sleep disorders on fatigue perception. These authors observed in a small cohort of patients with paralytic poliomyelitis (PP) and post-polio syndrome (PPS) a significant circadian variation of subjective fatigue evaluated by means of a validated scale. These authors showed a progressive worsening of fatigue during afternoon in both PP and PPS [1]. Polysomnographic variables did not correlate with fatigue, albeit restless legs syndrome (RLS) symptoms were not evaluated. PP is an acute poliovirus infection resulting in flaccid paralysis, due to poliovirus-induced apoptosis and consequent central nervous system injury, which leads to paralysis. Therefore, during its clinical course an increasing and progressive fatigue may represent an integral part of PP motor symptoms. In addition, more than 90% of patients with PP develop a delayed syndrome characterized by excessive fatigue [2]. PPS circadian impairment of fatigue may be more puzzling. it may be related to the presence of sleep disorders (i.e. sleep apnea, RLS and periodic limb movements of sleep (PLMS) previously described in PPS [3-5]. RLS and other sleep disorders have been reported in small PPS uncontrolled cohorts or single case reports, and in selected samples complaining of fatigue and sleepiness. In addition, fatigue represents a cardinal symptom of PPS, marked by a progressive course, and able to affect significantly patient quality of life [6]. Moreover, fatigue in PPS may be characterized by circadian changes, as recently showed by Viana and colleagues in a small cohort of PPS patients [1]. Although these authors did not explore clinical RLS in these PPS sample, it is intriguing to note that fatigue could resemble the circadian pattern of RLS symptoms. Therefore, RLS may represent an interesting model and a possible unifying hypothesis for fatigue in PPS similarly to other diseases both neurological (i.e. multiple sclerosis, myotonic dystrophies) and non-neurological (COPD, liver disorders) [2, 7-9]. Prevalence of RLS in these disorders has been reported as higher than in the general
Fatigue and Sleep-Disordered Breathing in Multiple Sclerosis: A Clinically Relevant Association?  [PDF]
Ulf Kallweit,Christian R. Baumann,Michael Harzheim,Hildegard Hidalgo,Dieter P?hlau,Claudio L. Bassetti,Michael Linnebank,Philipp O. Valko
Multiple Sclerosis International , 2013, DOI: 10.1155/2013/286581
Abstract: 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
Sleep disturbances in Parkinson's disease patients and management options
Claassen DO,Kutscher SJ
Nature and Science of Sleep , 2011,
Abstract: Daniel O Claassen, Scott J KutscherDepartment of Neurology, Vanderbilt University, Nashville, TN, USAAbstract: Sleep disturbances are among the most common nonmotor complaints of patients with Parkinson's disease (PD), and can have a great impact on quality of life. These disturbances manifest in a variety of ways; for instance, insomnia, sleep fragmentation, and excessive daytime sleepiness. Sleep-related movement disorders such as restless legs syndrome and periodic leg movements may share a common pathophysiology, and occurrence of rapid eye movement behavior disorder may predate the onset of PD or other synucleinopathies by several years. Medications for PD can have a significant impact on sleep, representing a great challenge to the treating physician. Awareness of the complex relationship between PD and sleep disorders, as well as the varied way in which sleep disturbances appear, is imperative for successful long-term management.Keywords: sleep disorders, insomnia, restless legs syndrome, Parkinson disease, fatigue, REM behavior disorder
Review of periodic limb movement and restless leg syndrome  [cached]
Natarajan R
Journal of Postgraduate Medicine , 2010,
Abstract: Periodic limb movement (PLM) and Restless leg syndrome (RLS) are types of sleep disorders that are not very well recognized in clinical practice. While RLS is a clinical diagnosis, the diagnosis of PLM is made by polysomnography. They share the same pathophysiology and often respond to the same treatment. To date all the epidemiological studies have reported the prevalence between 2% and 15%. It has recently become known that mild obstructive sleep apnea and upper airway resistance syndrome (UARS) can masquerade as PLM syndrome. New discoveries have been made with regard to genetics and PLM and RLS. Detailed review on this subject should improve the awareness of these disorders, both among general physicians and specialists. Extensive review of journals in the past 20 years was made using Medline search.
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