Sleep and multiple sclerosis

Introduction
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By Antonio Culebras MD

Dr. Culebras of Upstate Medical University, SUNY, in Syracuse, NY, reviews sleep-related manifestations in patients with multiple sclerosis and points out the intimate relationship between this condition, fatigue, and excessive daytime sleepiness. Several cases of symptomatic narcolepsy have been described in patients with multiple sclerosis raising the question of demyelinating plaques involving hypothalamic centers. Other studies have indicated that disruption of nocturnal sleep as well as circadian rhythm disorders may underlie fatigue responsive to sleep management. Case studies have described REM sleep behavior disorder in association with acute multiple sclerosis. There is growing evidence that sleep-related respiratory disturbance is common in patients with multiple sclerosis and that in general the condition is underdiagnosed. Sleep disorders are significant contributors to fatigue in multiple sclerosis, and this notion highlights the desirability of conducting an in-depth evaluation of sleep-related manifestations, which are commonly multifactorial in patients with multiple sclerosis.

Key points

  • Contributing comorbid factors to fatigue in multiple sclerosis are sleep disturbance, depression, medication, and deconditioning.
  • Sleep disturbance in multiple sclerosis is commonly multifactorial and may include difficulty initiating or maintaining sleep, frequent awakenings due to leg spasms, habitual snoring, occasional sleep apnea, and nocturia.
  • Cases of symptomatic narcolepsy have been described in multiple sclerosis raising the question of demyelinating plaques involving hypothalamic centers.
  • Case studies have described REM sleep behavior disorder in association with acute multiple sclerosis and RLS in chronic multiple sclerosis, highlighting the desirability of conducting an in-depth evaluation of sleep-related manifestations, which includes polysomnography.
  • Patients with multiple sclerosis have a predisposition to develop sleep apnea, and this association may be underdiagnosed.

In This Article

Introduction
Historical note and nomenclature
Clinical manifestations
Clinical vignette
Etiology
Pathogenesis and pathophysiology
Epidemiology
Prevention
Differential diagnosis
Diagnostic workup
Prognosis
Management
References cited
Contributors