Fatigue is common in children with multiple sclerosis. This cross-sectional study aimed to determine the prevalence of fatigue, sleep disorders, and subjective sleep quality in children with multiple sclerosis, along with their relationships to mood, quality of life, physical activity, and multiple sclerosis disease characteristics. Validated questionnaires were completed, and objective sleep quality was evaluated with polysomnography. Of the 18 children recruited (median age 16.0 years), 72% reported fatigue and 61% experienced subjective sleep disturbance. Fourteen sleep studies were completed, from which 3 children (21%) were diagnosed with sleep disorders: 2 with periodic limb movement disorder and 1 with mild obstructive sleep apnea. Sleep architecture was fragmented in 13 children (93%). Fatigue correlated with subjective sleep disturbance measures. This study demonstrates an increased frequency of subjective and objective sleep disturbance in children with multiple sclerosis. Polysomnography should be considered in children with multiple sclerosis who report fatigue and subjective sleep disturbance.
MacAllisterWSChristodoulouCTroxellR, et al.Fatigue and quality of life in pediatric multiple sclerosis. Mult Scler J. 2009;15(12):1502–1508. doi:10.1177/1352458509345902
3.
BraleyTJChervinRD. Fatigue in multiple sclerosis: mechanisms, evaluation, and treatment. Sleep. Aug 2010;33(8):1061–1067. doi:10.1093/sleep/33.8.1061
4.
VeauthierCRadbruchHGaedeG, et al.Fatigue in multiple sclerosis is closely related to sleep disorders: a polysomnographic cross-sectional study. Mult Scler J. 2011;17(5):613–622. doi:10.1177/1352458510393772
5.
CederbergKLJJengBSasakiJEBraleyTJWaltersASMotlRW. Restless legs syndrome and health-related quality of life in adults with multiple sclerosis. J Sleep Res. 2020;29(3):e12880. doi:10.1111/jsr.12880
6.
GorettiBPortaccioEGhezziA, et al.Fatigue and its relationships with cognitive functioning and depression in paediatric multiple sclerosis. Mult Scler J. 2012;18(3):329–334. doi:10.1177/1352458511420846
7.
GroverSASawickiCPKinnett-HopkinsD, et al.Physical activity and its correlates in youth with multiple sclerosis. J Pediatr.2016;179:197–203.e2. doi:10.1016/j.jpeds.2016.08.104
8.
ZafarABNessJDowdySAvisKBashirK. Examining sleep, fatigue, and daytime sleepiness in pediatric multiple sclerosis patients. Mult Scler. 2012;18(4):481–488. doi:10.1177/1352458511424307
9.
StephensSMotlRWNarangIWeissSFinlaysonMYehEA. Sleep, physical activity, and psychological outcomes in children and adolescents with pediatric onset multiple sclerosis. Mult Scler Relat Disord.2023;79:105025. doi:10.1016/j.msard.2023.105025
10.
SmithMTMcCraeCSCheungJ, et al.Use of actigraphy for the evaluation of sleep disorders and circadian rhythm sleep-wake disorders: an American Academy of Sleep Medicine systematic review, meta-analysis, and GRADE assessment. J Clin Sleep Med. 2018;14(7):1209–1230. doi:10.5664/jcsm.7228
11.
ThompsonAJBanwellBLBarkhofF, et al.Diagnosis of multiple sclerosis: 2017 revisions of the McDonald criteria. Lancet Neurol. 2018;17(2):162–173. doi:10.1016/s1474-4422(17)30470-2
12.
KurtzkeJF. Rating neurologic impairment in multiple sclerosis: an Expanded Disability Status Scale (EDSS). Neurology. 1983;33(11):1444–1452. doi:10.1212/wnl.33.11.1444
13.
CharvetLEBeekmanRAmadiumeNBelmanALKruppLB. The Symbol Digit Modalities Test is an effective cognitive screen in pediatric onset multiple sclerosis (MS). J Neurol Sci. 2014;341(1-2):79–84. doi:10.1016/j.jns.2014.04.006
14.
VarniJWBurwinkleTMSzerIS. The PedsQL Multidimensional Fatigue Scale in pediatric rheumatology: reliability and validity. J Rheumatol. 2004;31(12):2494–2500.
15.
HollandAAGravesDGreenbergBMHarderLL. Fatigue, emotional functioning, and executive dysfunction in pediatric multiple sclerosis. Child Neuropsychol. 2014;20(1):71–85. doi:10.1080/09297049.2012.748888
16.
BruniOOttavianoSGuidettiV, et al.The Sleep Disturbance Scale for Children (SDSC): construction and validation of an instrument to evaluate sleep disturbances in childhood and adolescence. J Sleep Res. 1996;5(4):251–261. doi:10.1111/j.1365-2869.1996.00251.x
17.
DrakeCNickelCBurduvaliERothTJeffersonCPietroB. The Pediatric Daytime Sleepiness Scale (PDSS): sleep habits and school outcomes in middle-school children. Sleep. 2003;26(4):455–458.
18.
VarniJWSeidMKurtinPS. PedsQL 4.0: reliability and validity of the Pediatric Quality of Life Inventory version 4.0 generic core scales in healthy and patient populations. Med Care. 2001;39(8):800–812. doi:10.1097/00005650-200108000-00006
19.
FrancoJr.RARosenfeldRMRaoM. First place-resident clinical science award 1999. Quality of life for children with obstructive sleep apnea. Otolaryngol Head Neck Surg. 2000;123(1 Pt 1):9–16. doi:10.1067/mhn.2000.105254
EbesutaniCReiseSPChorpitaBF, et al.The Revised Child Anxiety and Depression Scale-Short Version: scale reduction via exploratory bifactor modeling of the broad anxiety factor. Psychol Assess. Dec 2012;24(4):833–845. doi:10.1037/a0027283
22.
GodinGShephardRJ. A simple method to assess exercise behavior in the community. Can J Appl Sport Sci. Sep 1985;10(3):141–146.
23.
MarcusCLBrooksLJWardSD, et al.Diagnosis and management of childhood obstructive sleep apnea syndrome. Pediatrics. 2012;130(3):e714–e755. doi:10.1542/peds.2012-1672
24.
BerryRBAlbertarioCLHardingSM, et al; for the American Academy of Sleep Medicine. The AASM Manual for the Scoring of Sleep and Associated Events: Rules, Terminology and Technical Specifications. Version 2.5. American Academy of Sleep Medicine; 2018.
25.
SmurraMVDuryMAubertGRodensteinDOLiistroG. Sleep fragmentation: comparison of two definitions of short arousals during sleep in OSAS patients. Eur Respir J.2001;17(4):723–727. doi:10.1183/09031936.01.17407230
26.
KirkVGBohnS. Periodic limb movements in children: prevalence in a referred population. Sleep. 2004;27(2):313–315. doi:10.1093/sleep/27.2.313
27.
MarcusCLTraylorJGallagherPR, et al.Prevalence of periodic limb movements during sleep in normal children. Sleep. 2014;37(8):1349–1352. doi:10.5665/sleep.3928
28.
LaslettLLHonanCTurnerJA, et al.Poor sleep and multiple sclerosis: associations with symptoms of multiple sclerosis and quality of life. J Neurol Neurosurg Psychiatry.2022;93(11):1162–1165. doi:10.1136/jnnp-2022-329227
29.
ParuthiSBrooksLJD'AmbrosioC, et al.Recommended amount of sleep for pediatric populations: a consensus statement of the American Academy of Sleep Medicine. J Clin Sleep Med. 2016;12(6):785–786. doi:10.5664/jcsm.5866
30.
The Royal Children’s Hospital,Melbourne. Mental health of children and parents in Victoria during the COVID-19 pandemic. The Royal Children’s Hospital National Child Health Poll. Published May 2022, Accessed October 2 2021) URL: chrome-extension://efaidnbmnnnibpcajpcglclefindmkaj/https://www.rchpoll.org.au/wp-content/uploads/2022/06/2208-NCHP-COVID-Report-FINAL-ART.pdf
31.
BeckmannYTureSDumanSU. Vitamin D deficiency and its association with fatigue and quality of life in multiple sclerosis patients. EPMA J. 2020;11(1):65–72. doi:10.1007/s13167-019-00191-0
32.
Lopez-MunozPTorres-CostosoAIFernandez-RodriguezR, et al.Effect of vitamin D supplementation on fatigue in multiple sclerosis: a systematic review and meta-analysis. Nutrients. 2023;15(13):2861. doi:10.3390/nu15132861
33.
BeyazgulGBagOYurtsevenI, et al.How vitamin D levels of children changed during COVID-19 pandemic: a comparison of pre-pandemic and pandemic periods. J Clin Res Pediatr Endocrinol. 2022;14(2):188–195. doi:10.4274/jcrpe.galenos.2022.2021-10-6
34.
DyeTJJainSVSimakajornboonN. Outcomes of long-term iron supplementation in pediatric restless legs syndrome/periodic limb movement disorder (RLS/PLMD). Sleep Med. 2017;32:213–219. doi:10.1016/j.sleep.2016.01.008
35.
VeauthierCGaedeGRadbruchHGottschalkSWerneckeKDPaulF. Treatment of sleep disorders may improve fatigue in multiple sclerosis. Clin Neurol Neurosurg. Sep 2013;115(9):1826–1830. doi:10.1016/j.clineuro.2013.05.018
36.
ChawlaJMcLayLVandeleurM. Editorial: Current issues in sleep in children with neurodisability.Front Sleep. 2023;2:2023. doi:10.3389/frsle.2023.1317714
37.
TolaymatALiuZ. Sleep disorders in childhood neurological diseases. Children (Basel). 2017;4(10):84. doi:10.3390/children4100084
38.
ScholleSBeyerUBernhardM, et al.Normative values of polysomnographic parameters in childhood and adolescence: quantitative sleep parameters. Sleep Med. 2011;12(6):542–549. doi:10.1016/j.sleep.2010.11.011
