Contributions
Abstract: P414
Type: Poster
Abstract Category: Clinical aspects of MS - 11 Comorbidity
Background: We have previously described a relationship between severe fatigue and obstructive sleep apnea (OSA) in MS patients (Mult. Scler. J. Vol 18; 1159 - 1169). SAMSPAP (NCT01746342) is a randomized, controlled trial evaluating the effects of PAP treatment of OSA on fatigue in MS patients. The objective of the present analysis was to assess the prevalence of OSA among MS patients meeting the clinical eligibility criteria for this study.
Methods: Patients with confirmed MS on stable immunomodulating medication were recruited from the MS clinics at our institutions. Clinical eligibility criteria included: Expanded Disability Status Scale score (EDSS) ≤7, severe fatigue (Fatigue Severity Scale (FSS) score ≥ 4), poor subjective sleep quality (Pittsburgh Sleep Quality Index (PSQI) >5) and no more than minimal cognitive impairment (Montreal Cognitive Assessment (MoCA) ≥26). OSA was defined by an Apnea-Hypopnea Index (AHI) ≥ 15 events/h on complete overnight polysomnography (PSG) scored using American academy of sleep medicine research (Chicago) criteria.
Results: 87 subjects (35% male) were evaluated in an initial screening visit. Of these, 74 (83%) met the clinical eligibility criteria and underwent PSG. Reasons for exclusion included (n); withdrawal before completing screening (4); low FSS (5); low MoCA (5); and low PSQI (1). Subjects undergoing PSG had mean(±SD) age=49±9 y, BMI=28±6 kg/m2, EDSS=4±2, MoCA=28±1, FSS=6±1 and PSQI=11±4, and on PSG had total sleep time=5.5±1.1h, AHI=30±22/h, 4% Oxygen Desaturation Index (ODI) =5±8/h and Central apnea index = 1±2/h. 54 of 74 subjects had OSA (mean AHI = 37±21/h, ODI 6.4 ±8.5, respiratory arousal index =34±20/h), of whom 9 surpassed our pre-specified OSA safety threshold for randomization to this 6-month, sham PAP-controlled trial (AHI > 30 with either 4% ODI>15/h (n=8) or Epworth Sleepiness score ≥ 15 (n=1)). The positive predictive value for OSA of our clinical eligibility criteria was 73% (95% CI 61-83%), and for severe OSA (AHI >30/h) was 40% (95%CI 29-53%).
Conclusion: These findings suggest that a diagnosis of OSA should be considered among ambulatory MS patients presenting with severe fatigue and poor subjective sleep quality. The results of the ongoing SAMSPAP trial will provide new insights into the impact of OSA treatment on severe fatigue in MS patients.
Disclosure:
Funded by the Multiple Sclerosis Society of Canada. We are also receiving in kind support for the study from VitalAire Inc. and Philips Respironics.
Daria A. Trojan : Research support from the Multiple Sclerosis Society of Canada, Instituto Grifols S.A., Vitalaire Inc., and Philips Respironics.
Pierre Duquette: Received honoraria to organize advisory boards, has accepted financial assistance to attend meetings, and has received funds to conduct investigator-initiated studies from Biogen, Novartis, Genzyme, and EMD Serono. He holds grants from the MS Society of Canada, and from the CIFR.
Sulaiman Khadadah: nothing to disclose
R John Kimoff: nothing to disclose
Vincent Jobin: nothing to disclose
Yves Lapierre: nothing to disclose
Andrea Benedetti: nothing to disclose
Ann Robinson: nothing to disclose
Elaine Roger: nothing to disclose
Amit Bar-Or: nothing to disclose
Marta Kaminska: nothing to disclose
Abstract: P414
Type: Poster
Abstract Category: Clinical aspects of MS - 11 Comorbidity
Background: We have previously described a relationship between severe fatigue and obstructive sleep apnea (OSA) in MS patients (Mult. Scler. J. Vol 18; 1159 - 1169). SAMSPAP (NCT01746342) is a randomized, controlled trial evaluating the effects of PAP treatment of OSA on fatigue in MS patients. The objective of the present analysis was to assess the prevalence of OSA among MS patients meeting the clinical eligibility criteria for this study.
Methods: Patients with confirmed MS on stable immunomodulating medication were recruited from the MS clinics at our institutions. Clinical eligibility criteria included: Expanded Disability Status Scale score (EDSS) ≤7, severe fatigue (Fatigue Severity Scale (FSS) score ≥ 4), poor subjective sleep quality (Pittsburgh Sleep Quality Index (PSQI) >5) and no more than minimal cognitive impairment (Montreal Cognitive Assessment (MoCA) ≥26). OSA was defined by an Apnea-Hypopnea Index (AHI) ≥ 15 events/h on complete overnight polysomnography (PSG) scored using American academy of sleep medicine research (Chicago) criteria.
Results: 87 subjects (35% male) were evaluated in an initial screening visit. Of these, 74 (83%) met the clinical eligibility criteria and underwent PSG. Reasons for exclusion included (n); withdrawal before completing screening (4); low FSS (5); low MoCA (5); and low PSQI (1). Subjects undergoing PSG had mean(±SD) age=49±9 y, BMI=28±6 kg/m2, EDSS=4±2, MoCA=28±1, FSS=6±1 and PSQI=11±4, and on PSG had total sleep time=5.5±1.1h, AHI=30±22/h, 4% Oxygen Desaturation Index (ODI) =5±8/h and Central apnea index = 1±2/h. 54 of 74 subjects had OSA (mean AHI = 37±21/h, ODI 6.4 ±8.5, respiratory arousal index =34±20/h), of whom 9 surpassed our pre-specified OSA safety threshold for randomization to this 6-month, sham PAP-controlled trial (AHI > 30 with either 4% ODI>15/h (n=8) or Epworth Sleepiness score ≥ 15 (n=1)). The positive predictive value for OSA of our clinical eligibility criteria was 73% (95% CI 61-83%), and for severe OSA (AHI >30/h) was 40% (95%CI 29-53%).
Conclusion: These findings suggest that a diagnosis of OSA should be considered among ambulatory MS patients presenting with severe fatigue and poor subjective sleep quality. The results of the ongoing SAMSPAP trial will provide new insights into the impact of OSA treatment on severe fatigue in MS patients.
Disclosure:
Funded by the Multiple Sclerosis Society of Canada. We are also receiving in kind support for the study from VitalAire Inc. and Philips Respironics.
Daria A. Trojan : Research support from the Multiple Sclerosis Society of Canada, Instituto Grifols S.A., Vitalaire Inc., and Philips Respironics.
Pierre Duquette: Received honoraria to organize advisory boards, has accepted financial assistance to attend meetings, and has received funds to conduct investigator-initiated studies from Biogen, Novartis, Genzyme, and EMD Serono. He holds grants from the MS Society of Canada, and from the CIFR.
Sulaiman Khadadah: nothing to disclose
R John Kimoff: nothing to disclose
Vincent Jobin: nothing to disclose
Yves Lapierre: nothing to disclose
Andrea Benedetti: nothing to disclose
Ann Robinson: nothing to disclose
Elaine Roger: nothing to disclose
Amit Bar-Or: nothing to disclose
Marta Kaminska: nothing to disclose