Abstract
Background:
Multiple sclerosis (MS) is a central nervous system disorder characterized by multifocal demyelinating lesions. It predominantly affects females between the ages of 20 and 40. Globally, MS affects 2.3 million people, with a prevalence rate in Saudi Arabia of 61.95 per 100,000 individuals, predominantly Saudis. Insomnia is a common complaint among adults with MS, significantly impacting health-related quality of life. Sleep disturbance, particularly sleep apnea syndrome, affects approximately half of the MS population. Sleep apnea syndrome, including obstructive sleep apnea (OSA) syndrome and central sleep apnea syndrome, can result in oxygen desaturation. Untreated sleep apnea can lead to fatigue, depression, and other health issues, necessitating multiple clinic visits and treatments. Addressing sleep apnea in MS patients not only improves their overall health but also reduces healthcare costs and enhances the economic situation of Saudi Arabia. This research aims to assess the occurrence of OSA and sleep quality among subjects diagnosed with MS in Saudi Arabia.
Methods:
A case control study inclusion criteria: subjects aged 18 or older with a confirmed MS diagnosis and healthy subjects with no history of MS were invited to participate. Exclusion criteria: Subjects diagnosed with OSA, BMI > 34, and any with chronic respiratory or neurological disorders. Participants underwent full-night diagnostic polysomnography. Insomnia was assessed by the Insomnia Severity Index and subjective sleepiness by the Epworth Sleepiness Scale. The institutional ethical committee approved the study at Batterjee Medical College (BMC) (RES 2022-42.)
Results:
The study included total of 36 participants in which of 28 participants were the MS case group, and 8 participants were included as control/healthy group. 57% of the MS group accounted as female with a mean BMI of 24.60 and the mean of disease duration was around 8.2 years. T-test was done to compare between sleep characteristics among case and control groups. Results of PSG indicated that 50% of the case group have OSA. There are significant differences among the case and control groups in sleep duration, apnea-hypopnea index ( AHI), sleep efficiency and insomnia severity index (ISI). with P value < .001, .01, .004, and .001 respectively.
Conclusions:
Our research indicated that MS patients have high risk of having OSA, we also found that sleep disturbances can occur highly among these patients leading to insomnia
Sleep Characteristics, ISI, and daytime symptoms
Variable
Cases- subjects diagnosed with MS ( N=28)
Control- Healthy Participants ( N=8)
P value
OSA diagnosed number (%)
14 (50)
3 (37)
---
Sleep duration mean (± SD)
5.07 (±1.39)
7.23 (± 0.91)
0.00
AHI mean (± SD)
5.740 (± 2.74)
3.55 (± 2.01)
0.01
ODI mean (± SD)
2.82 (± 1.98)
3.12 (± 1.91)
0.77
Sleep efficiency percentage mean (± SD)
68.30 (± 35.91)
74.80 (± 4.14)
0.004
Sleep latency (minute) mean (± SD)
23.56 (± 21.49)
20.23 (± 15.8)
0.65
Arousal Index mean (± SD)
5.36 (± 21.49)
4.25 (± 0.79)
0.02
Heart rate average mean (± SD)
65.40 (± 6.46)
66.65 (± 9.36)
0.68
ISI mean (± SD)
15 (± 9.63)
6.25 (± 4.62)
0.001
ESS mean (± SD)
10.80 ( ±5.75)
6.25 (± 2.05)
0.060
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