Brainstem involvement and sleep disorders in MS

#MSBlog: If you have had a brainstem attack you may be at risk of sleep abnormalities.

“This is a reposting in response to an email I received from a reader and correspondence recently published in Neurology in response to the following article.”

Braley et al. Sleep-disordered breathing in multiple sclerosis. Neurology. 2012 79:929-36.

BACKGROUND: The objectives of this cross-sectional study were to assess the prevalence and severity of sleep apnea in MSers referred for overnight polysomnography (PSG) and to explore the radiographic and clinical features that might signal risk for undiagnosed sleep apnea.

polysomnography = a diagnostic sleep study that assesses multiple parameters, hence the term poly.

METHODS: Apnea-hypopnea (AHI) and central apnea indices (CAI) from laboratory-based PSG among 48 MSers were compared with those of group A, 84 sleep laboratory-referred patients without MS matched for age, gender, and body mass index; and group B, a separate group of 48 randomly selected, referred patients.

  • Apnea = absence of breathing; this can be due to central or peripheral problems.
  • Central apnea  = failure of the autonomic breathing pacemaker in the brainstem to fire
  • Obstructive apnea = refers to obstruction of airflow despite attempts to breath. This usually occurs from obstruction in the back of the throat.
  • hypopnea = reduced breathing

RESULTS: Mean AHI was higher among MSers than among control groups A or B (2-way analysis of variance and multiple linear regression, p = 0.0011 and 0.0118, respectively). Median and mean CAI were also increased among MSers in comparison to control groups (Wilcoxon signed rank and multiple linear regression, p = 0.0064 and 0.0027, respectively). Among MSers with available data, those with evidence of brainstem involvement, compared with groups A and B, showed particularly robust differences in AHI (p = 0.0060 and 0.0016) and CAI (p = 0.0215 and <0.0001). In contrast, MSers without brainstem involvement, compared with groups A and B, showed diminished differences in AHI, and CAI did not significantly differ among groups.

CONCLUSIONS: These data suggest a predisposition for obstructive sleep apnea and accompanying central apneas among MSers, particularly among those with brainstem involvement.

Beran et al. Sleep-disordered breathing in multiple sclerosis.Neurology. 2013 Apr 2;80(14):1354-5. 

Braley et al. (above) investigated sleep-disordered breathing in multiple sclerosis (MS) using overnight polysomnography. MS produced increased apnea-hypopnea index (AHI) and central apnea index (CAI). Periodic limb movement in sleep (PLMS) with associated periodic limb movement causing arousal (PLMA) was not addressed by the authors.

“We are aware of the sleep problem in MSers, but we rarely test for them. Maybe we should change our practice and screen people more. What do you think? The following is a quick screening questionnaire to assess whether or not you have a sleep disorder. I have designed it as both a self screening tool and an anonymous survey so that we can use the data to see how common the different types of sleep disorders are among MSers who read this blog.”

Click here to complete sleep disorder questionnaire.

“It is interesting that when we completed a sleep survey via this blog the majority of MSers had a sleep problem. It will  therefore be interesting to see the results of this survey. Thanks.”

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