Mark Gudesblatt, MD
,
South Shore Neurologic Associates, Patchogue, NY
Steven Xian, BA
,
South Shore Neurologic Associates, Patchogue, NY
Barbara Bumstead, NP-C
,
South Shore Neurologic, Patchogue, NY
Myassar Zarif, MD
,
South Shore Neurologic Associates, Patchogue, NY
Smitha Thotam, ANP
,
South Shore Neurologic Associates, Patchogue, NY
Lori Fafard, RN
,
South Shore Neurologic Associates, Patchogue, NY
Marijean Buhse, PhD, NP-C
,
School of Nursing, State University of New York @ Stony Brook, Stony Brook, NY
Konstantina Bardhi, BA
,
South Shore Neurologic Associates, Patchogue, NY
Background: Fatigue is a common and often disabling symptom reported in patients with MS. Fatigue likely reflects a complex heterogeneous disorder even though reported as a mono-dimensional complaint. More effective understanding of underlying aspects contributing to the pathogenesis of fatigue reported might lead to improved treatment efficacy and patient satisfaction. Patients with MS also report symptoms of insomnia. The time to sleep onset relies on patient report and can be unreliable. Analysis of time to sleep onset by polysomnography (PSG) in MS patient reporting fatigue is not well characterized. Sleep Latency (SL) is defined as: time in bed to time of sleep onset. A normal SL is defined as <30 minutes. REM Latency (REM-L) is defined as: Time from Sleep Onset to REM sleep. A normal REM-L is defined as occurring between 80–110 minutes. The normal range for REM sleep is defined as: 17–28 % of Total Sleep/night. The longer it takes to get to sleep, the less time you have to sleep at night. The longer it takes to get to REM sleep, the less time there is for REM sleep. Reduction of both total night sleep and REM sleep might impact daytime fatigue, mood, and cognition.
Objectives: To identify polysomnography documented first night sleep abnormalities related to sleep latency and REM latency in a large cohort of patients with Multiple Sclerosis (MS) who report fatigue.
Methods: Retrospective analysis of patients with MS who reported fatigue, and underwent overnight PSG studies.
Results: 206 patients with MS who reported fatigue completed overnight PSG. Analysis of SL in these patients identified <30 Minutes in 102/207 (49%), SL >30 Minutes 105/207 (51%), and >60 Minutes 52/207(25%). No REM sleep was identified in 25/206 (12%) of these patients. In those patients who reached REM sleep: 115/181 (63%) had REM-L>110 minutes, 63/181 (35%) had REM-L>180 minutes. Of those patient who achieved REM sleep, Normal % REM sleep range was identified in 67/180 (37%); 105/180 (58%) had <17% total REM sleep; and 50/180 (28%) had <10% REM.
Conclusions: Fatigue is a common in patients with MS. Sleep disorders are common in patients with MS with fatigue. Prolonged sleep latency and REM latency are common in patients with MS. Prolonged latency to sleep onset and REM sleep onset can result in less time available for sleep and for REM sleep and might directly contribute to daytime fatigue in patients with MS by directly reducing the available time to sleep per night.
