Central sleep apnea in multiple sclerosis: a pilot study

The purpose of the present study is to investigate sleep-disordered breathing and symptoms of sleepiness in a consecutive clinical cohort of multiple sclerosis (MS) patients.

Twenty-one (16 females) community-dwelling adults aged 18-75 years with MS and an Expanded Disability Status Scale score between 2 and 6 were recruited consecutively from an academic teaching hospital MS clinic. Participants performed a home sleep study (ResMed ApneaLink Plus) to objectively quantify sleep-disordered breathing. Subjective sleepiness and its impact were assessed using the Epworth Sleepiness Scale, Pittsburgh Sleep Quality Index, and Functional Outcomes of Sleep Questionnaire.

Three (one female) of the 19 participants who completed home overnight testing had central sleep apnea (median apnea-hypopnea index = 15 [range = 8-36] events/h sleep, median nadir SaO₂ = 88 % [range = 81-88]). There were no cases of obstructive sleep apnea. Thirty-three percent of participants reported excessive daytime sleepiness, and 71% reported poor sleep quality.

Home sleep testing was well tolerated, and a high proportion of central rather than obstructive sleep apnea was observed in a clinical MS sample. Possible reasons include brainstem or spinal cord lesions from MS affecting the control of breathing. Poor sleep quality and daytime sleepiness were common in this group.