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  • Updated 12.23.2023
  • Released 06.30.1995
  • Expires For CME 12.23.2026

Sleep and multiple sclerosis



The author reviews sleep-related manifestations in patients with multiple sclerosis and points out the intimate relationship between this condition, fatigue, and excessive daytime sleepiness. Several cases of symptomatic narcolepsy have been described in patients with multiple sclerosis raising the question of demyelinating plaques involving hypothalamic centers. Other studies have indicated that disruption of nocturnal sleep as well as circadian rhythm disorders may underlie fatigue responsive to sleep management. Case studies have described REM sleep behavior disorder in association with acute multiple sclerosis. There is growing evidence that sleep-related respiratory disturbance is common in patients with multiple sclerosis and that in general the condition is underdiagnosed. Sleep disorders are significant contributors to fatigue in multiple sclerosis, and this notion highlights the desirability of conducting an in-depth evaluation of sleep-related manifestations, which are commonly multifactorial in patients with multiple sclerosis.

Historical note and terminology

European reports published in the first half of the 20th century cite cases of multiple sclerosis associated with sleep attacks variously termed as narcolepsy, drowsiness, and deep sleep (36; 35). In 1949 the association between multiple sclerosis and narcolepsy was mentioned in a review and case presentations of narcolepsy (24). Subsequently, cases of narcolepsy-cataplexy and multiple sclerosis (07) and of familial multiple sclerosis with narcolepsy-cataplexy were reported (27). Based on the presence of DR2 histocompatibility antigen in two patients with narcolepsy and multiple sclerosis, Younger and colleagues suggested a common inheritance for both conditions (102). Other authors have indicated that sleep disturbance is relatively common in multiple sclerosis, suggesting a multifactorial etiology that ranges from depression to lesion site (52). A polysomnographic study of 25 patients with definite multiple sclerosis showed significantly reduced sleep efficiency and more awakenings during sleep (30). Periodic leg movements were found in 36% of patients compared to 8% in controls. Central sleep apnea was found in two patients. MRI of the brain showed a greater load of lesions in cerebellum and brainstem in patients with periodic leg movements.

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