Contributions
Abstract: P869
Type: Poster
Abstract Category: Clinical aspects of MS - MS symptoms
Background: Previous work has demonstrated that fatigue in multiple sclerosis (MS) increases with disability level and is worse in those with progressive disease and also varies with duration of nocturnal sleep, but is not clearly related to disease duration. However, little is known about these relationships within disease subtypes or disability bands (EDSS).
Objective: To assess parameters of fatigue and sleep dysfunction in different sub-populations of MS.
Method: Fatigue was assessed by administration of the Neurological Fatigue Index (NFI-MS) and sleep dysfunction by the Neurological Sleep Index (NSI-MS) in patients with clinically definite MS as part of the TONiC study, a multicentre, UK study of factors affecting quality of life in MS. Summed raw scores were converted to interval level data by application of the Rasch measurement model. Non-linear relationships were visualised with local polynomial regression fit.
Results: 1509 records were available for analysis. 73% were female, 69% had relapsing (RR), 9% primary progressive (PP) and 22% secondary progressive (SP) disease. 48% were fully ambulatory. There was a striking divergence in fatigue levels: clearly there was an increase in fatigue once ambulation was affected for those PP and RR disease, but the relationship was lost for those with SP disease with little variation seen across disability level. In the lowest EDSS band, PP subjects had the lowest levels of fatigue (particularly cognitive fatigue). Sleep became more restorative in SP patient at higher EDSS band less fragmented when compared to PP. All disease subtypes had the same, V shaped relationship between hours of nocturnal sleep and fatigue and the non-restorative nature of nocturnal sleep. Complex relationships, again divergent between disease subtypes, were seen between both fatigue and sleep parameters and disease duration.
Conclusion: The large scale of the TONiC study has allowed subgroup analysis of the relationships between fatigue, sleep dysfunction and clinical features of MS such as disease type, disability level and disease duration. Clear relationships could be seen but they were complex and non-linear. However, it was evident that relapsing disease modifies any subsequent progressive phase to behave differently from primary progressive disease in terms of fatigue and sleep dysfunction, but this is not simply a function of disease duration.
Disclosure:
C.A. Young has received honoraria and travel expenses for scientific meetings and advisory boards, or grants from Bayer, Biogen Idec, Merck Serono, Genzyme, Motor Neurone Disease Association, MS Trust, National Institute for Health Research, Novartis, Roche, Teva, and Wellcome Trust.
R.J. Mills has received conference expenses from Biogen Idec, Novartis and Teva.
A. Tennant has nothing to declare.
Abstract: P869
Type: Poster
Abstract Category: Clinical aspects of MS - MS symptoms
Background: Previous work has demonstrated that fatigue in multiple sclerosis (MS) increases with disability level and is worse in those with progressive disease and also varies with duration of nocturnal sleep, but is not clearly related to disease duration. However, little is known about these relationships within disease subtypes or disability bands (EDSS).
Objective: To assess parameters of fatigue and sleep dysfunction in different sub-populations of MS.
Method: Fatigue was assessed by administration of the Neurological Fatigue Index (NFI-MS) and sleep dysfunction by the Neurological Sleep Index (NSI-MS) in patients with clinically definite MS as part of the TONiC study, a multicentre, UK study of factors affecting quality of life in MS. Summed raw scores were converted to interval level data by application of the Rasch measurement model. Non-linear relationships were visualised with local polynomial regression fit.
Results: 1509 records were available for analysis. 73% were female, 69% had relapsing (RR), 9% primary progressive (PP) and 22% secondary progressive (SP) disease. 48% were fully ambulatory. There was a striking divergence in fatigue levels: clearly there was an increase in fatigue once ambulation was affected for those PP and RR disease, but the relationship was lost for those with SP disease with little variation seen across disability level. In the lowest EDSS band, PP subjects had the lowest levels of fatigue (particularly cognitive fatigue). Sleep became more restorative in SP patient at higher EDSS band less fragmented when compared to PP. All disease subtypes had the same, V shaped relationship between hours of nocturnal sleep and fatigue and the non-restorative nature of nocturnal sleep. Complex relationships, again divergent between disease subtypes, were seen between both fatigue and sleep parameters and disease duration.
Conclusion: The large scale of the TONiC study has allowed subgroup analysis of the relationships between fatigue, sleep dysfunction and clinical features of MS such as disease type, disability level and disease duration. Clear relationships could be seen but they were complex and non-linear. However, it was evident that relapsing disease modifies any subsequent progressive phase to behave differently from primary progressive disease in terms of fatigue and sleep dysfunction, but this is not simply a function of disease duration.
Disclosure:
C.A. Young has received honoraria and travel expenses for scientific meetings and advisory boards, or grants from Bayer, Biogen Idec, Merck Serono, Genzyme, Motor Neurone Disease Association, MS Trust, National Institute for Health Research, Novartis, Roche, Teva, and Wellcome Trust.
R.J. Mills has received conference expenses from Biogen Idec, Novartis and Teva.
A. Tennant has nothing to declare.