Quality sleep leads to better mental health and insufficient sleep often has a significant impact on cognitive and physical functions. For people with multiple sclerosis cognitive impairment often manifests in terms of having trouble with memory, attention, and mental processing. New research shows some of these issues could stem from sleep disorders.
The symptoms of multiple sclerosis vary from person to person. The most debilitating effects of the illness, however, can often be seen in the inability to retain a sense of self and to stay up intellectually.
Researchers from the University of Michigan looked at sleep as a potential treatment for MS patients’ cognitive problems, including memory, attention, and mental processing.
People with Multiple Sclerosis face a risk of sleep disorders
Obstructive sleep apnea (OSA) is a disorder in which the larynx closes during sleep, causing the patient to periodically stop breathing for durations of 10 seconds or longer throughout the night. People with MS are more likely to develop OSA. A reduction in mental functioning may result from OSA.
The first study to link the severity of sleep apnea and cognitive dysfunction in MS patients was a pilot project from the University of Michigan that was published in Sleep.
“Since obstructive sleep apnea is a treatable condition that is also commonly seen in MS, we wondered, ‘What if some of the thinking and processing difficulties that MS patients experience do not stem directly from the MS itself, but from the effects of sleep apnea or other sleep problems?'” says Tiffany Braley, M.D., M.S., the principal investigator and co-first author of the study, and an assistant professor of neurology at U-M.
Nearly half a million Americans suffer with multiple sclerosis (MS), which is the most common non-traumatic cause of neurological disability in young adults.
38 persons with MS who had concerns about their sleep or cognitive function were examined by Braley’s team. Seven cognitive tests were administered to the patients, including word list recall, math, and figure and picture replication.
Additionally, they spent a night in the Michael S. Aldrich Sleep Disorders Laboratory undergoing an overnight sleep test called polysomnography. Of the 38 patients, thirty-three satisfied the OSA criteria.
The severity of sleep apnea co-related with performance on cognitive tests
“Multiple measures of sleep apnea severity directly correlated with poorer performance on several cognitive tests,” said co-first author Anna Kratz, Ph.D., a clinical psychologist and assistant professor of physical medicine and rehabilitation. “Problems with attention and multiple aspects of memory, including memory for words and images, and working memory, which plays a role in problem-solving and decision making, were all associated with poorer sleep.”
Measures of apnea severity explained between 11% and 23% of the variation in test scores on cognitive tasks. The researchers also noticed connections between subpar cognitive function and other sleep quality indicators.
“Current MS treatments can prevent further neurological damage but do little to help existing MS symptoms and damage,” Braley says. “Our focus on sleep is part of a larger collaborative initiative to identify previously overlooked but nonetheless treatable conditions that could be affecting patients with MS. Identifying and successfully treating conditions like OSA could help us find new ways to improve the cognitive function in MS.”
Positive airway pressure therapy (CPAP), the first-line treatment for obstructive sleep apnea, will now be administered to individuals diagnosed with MS by the researchers to reproduce their findings in a wider sample of patients. The National Multiple Sclerosis Society is funding Braley’s new clinical trial, which aims to determine if treating sleep apnea helps MS patients’ cognitive function. The researchers hope to stimulate additional discussions in the neurology clinic in the interim.
“We hope neurologists will ask their patients with MS about sleep, and the patient should be encouraged to openly discuss sleep concerns with their neurologist,” says Neeraj Kaplish, M.D., assistant professor of neurology and medical director of the U-M Sleep Laboratories.
“Given the high prevalence of treatable sleep problems in MS patients, and the fact that many patients with MS rate fatigue as one of their most bothersome symptoms, physicians should have a low threshold to refer MS patients who report sleep disturbances to sleep specialists,” says last author Ronald Chervin, M.D., M.S., professor of neurology and director of U-M Sleep Disorders Centre.
The research was funded in part by the National Centre for Advancing Translational Sciences of the National Institutes of Health, the University of Michigan Sleep Disorders Centre, and the National Institute of Arthritis and Musculoskeletal and Skin Diseases.
Materials provided by the University of Michigan Health System. Note: Content may be edited for style and length.
University of Michigan Health System. “In MS, can better sleep improve cognition?.” ScienceDaily. ScienceDaily, 13 June 2016. <www.sciencedaily.com/releases/2016/06/160613164955.htm>.
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