The first night effect in multiple sclerosis patients undergoing home-based polysomnography

Background: The first night effect (FNE) is a polysomnography (PSG) habituation effect in the first of several consecutive in-laboratory PSGs (I-PSGs). The ENE is caused by the discomfort provoked by electrodes and cables and the exposure to an unfamiliar environment. A reverse ENE (RENT) with an improved sleep in the first night is characteristic of insomnia, presumably because the video PSG in the sleep laboratory leads to a decrease in the negatively toned cognitive activity. Therefore, two or more I-PSGs are required for an accurate diagnosis. Although the FNE is well documented in I-PSG, little is known about the FNE and the RFNE in home-based PSGs (H-PSGs). Methods: This is a retrospective analysis of a recently published cross-sectional study using H-PSG. Sixty-three consecutive patients suffering from multiple sclerosis (MS) were investigated by two consecutive H-PSGs without video. The differences between the first and second H-PSGs were analyzed. The patients were classified into four subgroups: no sleep disorder, insomnia, sleep-related breathing disorders (SRBDs), and periodic limb movement disorder or restless legs syndrome (PLMD/RLS). Results: MS patients suffering from insomnia showed no RFNE. MS patients with SKIM or PLMD/RLS showed no reduced sleep efficiency but significantly less slow wave sleep. Furthermore, SRBD patients showed significantly less non-rapid eye movement (N REM) sleep, and PLMD/RLS patients were significantly awake longer in the first night after sleep onset (increased wake-after-sleep-onset time) and showed a higher rapid eye movement (REM) latency. Conclusion: SRBD and PLMD/RLS patients showed a significant FNE. Two consecutive H-PSGs are required in these patients to obtain a precise hypnogram even in the ambulatory field. In MS patients suffering from insomnia, no RFNE was found, and in insomnia patients one H-PSG seems to be sufficient

a previously undescribed entity

Background: There are few studies describing periodic limb movement syndrome (PLMS) in rapid eye movement (REM) sleep in patients with narcolepsy, restless legs syndrome, REM sleep behavior disorder, and spinal cord injury, and to a lesser extent, in insomnia patients and healthy controls, but no published cases in multiple sclerosis (MS). The aim of this study was to investigate PLMS in REM sleep in MS and to analyze whether it is associated with age, sex, disability, and laboratory findings. Methods: From a study of MS patients originally published in 2011, we retrospectively analyzed periodic limb movements (PLMs) during REM sleep by classifying patients into two subgroups: PLM during REM sleep greater than or equal to ten per hour of REM sleep (n=7) vs less than ten per hour of REM sleep (n=59). A univariate analysis between PLM and disability, age, sex, laboratory findings, and polysomnographic data was performed. Results: MS patients with more than ten PLMs per hour of REM sleep showed a significantly higher disability measured by the Kurtzke expanded disability status scale (EDSS) (P=0.023). The presence of more than ten PLMs per hour of REM sleep was associated with a greater likelihood of disability (odds ratio 22.1; 95% confidence interval 3.5–139.7; P<0.0001), whereas there were no differences in laboratory and other polysomnographic findings. Conclusion: PLMs during REM sleep were not described in MS earlier, and they are associated with disability measured by the EDSS

Fatigue bei Multipler Sklerose unter besonderer Berücksichtigung komorbider schlafmedizinischer Erkrankungen

Schlafmedizinische Erkrankungen sind häufig bei MS-Patienten, welche unter einer MS-Fatigue leiden. Es existiert ein signifikanter Zusammenhang zwischen erhöhten Werten in der Modified Fatigue Impact Scale (MFIS) und der Fatigue Severity Scale (FSS) und dem Vorliegen einer schlafmedizinischen Erkrankung. In zukünftigen MS-Fatigue-Studien sollten schlafmedizinische Erkrankungen als wichtiger Störfaktor regelhaft untersucht und berücksichtigt werden. Die Behandlung einer komorbiden schlafmedizinischen Erkrankung scheint die MS-Fatigue zu bessern. Die Verbesserung der Lebensqualität und die Erhaltung der Erwerbsfähigkeit stellen weitere Gründe dar, welche für die konsequente Behandlung einer komorbiden schlafmedizinischen Erkrankung sprechen. Schlafmedizinische Untersuchungen wie die Polysomnographie können zudem möglicherweise neue Erkenntnisse über eine Beeinträchtigung des motorischen Systems bei MS-Patienten liefern, da ein erhöhter Index an periodischen Beinbewegungen im REM-Schlaf einen Risikofaktor für einen erhöhten Grad der Behinderung darstellt. Ambulante Polysomnographien, welche bei den Patienten zu Hause durchgeführt werden, weisen nur einen geringen Habituationseffekt (First-Night-Effect) auf

Contactless recording of sleep apnea and periodic leg movements by nocturnal 3-D-video and subsequent visual perceptive computing

Contactless measurements during the night by a 3-D-camera are less time-consuming in comparison to polysomnography because they do not require sophisticated wiring. However, it is not clear what might be the diagnostic benefit and accuracy of this technology. We investigated 59 persons simultaneously by polysomnography and 3-D-camera and visual perceptive computing (19 patients with restless legs syndrome (RLS), 21 patients with obstructive sleep apnea (OSA), and 19 healthy volunteers). There was a significant correlation between the apnea hypopnea index (AHI) measured by polysomnography and respiratory events measured with the 3-D-camera in OSA patients (r = 0.823; p < 0.001). The receiver operating characteristic curve yielded a sensitivity of 90% for OSA with a specificity of 71.4%. In RLS patients 72.8% of leg movements confirmed by polysomnography could be detected by 3-D-video and a significant moderate correlation was found between PLM measured by polysomnography and by the 3-D-camera (RLS: r = 0.654; p = 0.004). In total, 95.4% of the sleep epochs were correctly classified by the machine learning approach, but only 32.5% of awake epochs. Further studies should investigate, if this technique might be an alternative to home sleep testing in persons with an increased pre-test probability for OSA

Poor Sleep in Multiple Sclerosis Correlates with Beck Depression Inventory Values, but Not with Polysomnographic Data

Objectives. Pittsburgh Sleep Quality Index (PSQI) values correlate with depression, but studies investigating the relationship between PSQI values and polysomnographic (PSG) data showed inconsistent findings. Methods. Sixty-five consecutive patients with multiple sclerosis (MS) were retrospectively classified as “good sleepers” (GS) (PSQI ≤ 5) and “poor sleepers” (PS) (PSQI > 5). The PSG data and the values of the Visual Analog Scale (VAS) of fatigue, Modified Fatigue Impact Scale (MFIS), Fatigue Severity Scale (FSS), Epworth Sleepiness Scale (ESS), and the Beck Depression Inventory (BDI) were compared. Results. No significant differences were found either for PSG data or for ESS, MFIS, and FSS values; but PS showed significantly increased BDI and VAS values. Conclusions. Poor sleep is associated with increased depression and fatigue scale values

Contrasting disease patterns in seropositive and seronegative neuromyelitis optica: A multicentre study of 175 patients

BACKGROUND: The diagnostic and pathophysiological relevance of antibodies to aquaporin-4 (AQP4-Ab) in patients with neuromyelitis optica spectrum disorders (NMOSD) has been intensively studied. However, little is known so far about the clinical impact of AQP4-Ab seropositivity. OBJECTIVE: To analyse systematically the clinical and paraclinical features associated with NMO spectrum disorders in Caucasians in a stratified fashion according to the patients' AQP4-Ab serostatus. METHODS: Retrospective study of 175 Caucasian patients (AQP4-Ab positive in 78.3%). RESULTS: Seropositive patients were found to be predominantly female (p 1 myelitis attacks in the first year were identified as possible predictors of a worse outcome. CONCLUSION: This study provides an overview of the clinical and paraclinical features of NMOSD in Caucasians and demonstrates a number of distinct disease characteristics in seropositive and seronegative patients

Understanding, diagnosing, and treating Myalgic encephalomyelitis/chronic fatigue syndrome - State of the art: Report of the 2nd international meeting at the Charité fatigue center.

Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) is a devastating disease affecting millions of people worldwide. Due to the 2019 pandemic of coronavirus disease (COVID-19), we are facing a significant increase of ME/CFS prevalence. On May 11th to 12th, 2023, the second international ME/CFS conference of the Charité Fatigue Center was held in Berlin, Germany, focusing on pathomechanisms, diagnosis, and treatment. During the two-day conference, more than 100 researchers from various research fields met on-site and over 700 attendees participated online to discuss the state of the art and novel findings in this field. Key topics from the conference included: the role of the immune system, dysfunction of endothelial and autonomic nervous system, and viral reactivation. Furthermore, there were presentations on innovative diagnostic measures and assessments for this complex disease, cutting-edge treatment approaches, and clinical studies. Despite the increased public attention due to the COVID-19 pandemic, the subsequent rise of Long COVID-19 cases, and the rise of funding opportunities to unravel the pathomechanisms underlying ME/CFS, this severe disease remains highly underresearched. Future adequately funded research efforts are needed to further explore the disease etiology and to identify diagnostic markers and targeted therapies

Schlafstörungen bei Multipler Sklerose

ZusammenfassungGegenstand und Ziel: Patienten mit Multipler Sklerose (MS) leiden häufig an einer die Lebensqualität deutlich beeinträchtigenden Schlafstörung. Es soll ein Überblick über den gegenwärtigen Stand der Literatur gegeben werden. Material und Methoden: Übersichtsarbeit. Ergebnisse: Mehrere Studien haben bei der MS im Vergleich zur Allgemeinbevölkerung eine erhöhte Prävalenz für ein Restless-legs-Syndrom (RLS) gezeigt, im Besonderen bei MS-Patienten mit einem erhöhten Grad der Behinderung. Rund ein Viertel der MS-Patienten leidet an einer chronischen Insomnie. Es existieren symptomatische Formen der Narkolepsie und der REM-Schlaf-Verhaltensstörung (RBD), am ehesten durch akute Läsionen hervorgerufen. Ob Läsionen auch schlafbezogene Atmungsstörungen verursachen können, kann noch nicht ausreichend beurteilt werden. Schlussfolgerung und klinische Relevanz: Beim Neuauftreten einer Narkolepsie oder eines RBD sollte zügig eine kraniale Kernspintomografie mit Kontrastmittel erfolgen. Bei der Behandlung schlafmedizinischer Erkrankungen kommen die von den Fachgesellschaften empfohlenen Behandlungsrichtlinien zur Anwendung (die Behandlung unterscheidet sich bei MS-Patienten nicht grundsätzlich von der Behandlung dieser Erkrankungen in der Allgemeinbevölkerung). MS-Fatigue-Patienten sollten niedrigschwellig eine Polygrafie oder Polysomnografie erhalten.</jats:p

Sleep Disorders Reduce Health-Related Quality of Life in Multiple Sclerosis (Nottingham Health Profile Data in Patients with Multiple Sclerosis)

Quality of Life (QoL) is decreased in multiple sclerosis (MS), but studies about the impact of sleep disorders (SD) on health-related quality of Life (HRQoL) are lacking. From our original cohort, a cross-sectional polysomnographic (PSG) study in consecutive MS patients, we retrospectively analysed the previously unpublished data of the Nottingham Health Profile (NHP). Those MS patients suffering from sleep disorders (n = 49) showed significantly lower HRQoL compared to MS patients without sleep disorders (n = 17). Subsequently, we classified the patients into four subgroups: insomnia (n = 17), restless-legs syndrome, periodic limb movement disorder and SD due to leg pain (n = 24), obstructive sleep apnea (n = 8) and patients without sleep disorder (n = 17). OSA and insomnia patients showed significantly higher NHP values and decreased HRQoL not only for the sleep subscale but also for the “energy” and “emotional” area of the NHP. In addition, OSA patients also showed increased NHP values in the “physical abilities” area. Interestingly, we did not find a correlation between the objective PSG parameters and the subjective sleep items of the NHP. However, this study demonstrates that sleep disorders can reduce HRQoL in MS patients and should be considered as an important confounder in all studies investigating HRQoL in MS