Contributions
Abstract: EP1405
Type: Poster Sessions
Abstract Category: Clinical aspects of MS - Clinical assessment tools
Background: Fatigue is a common and disabling symptom in people with MS (PwMS). Presence and degree of fatigue in PwMS primarily relies on patient self-reported outcomes (PRO). PRO fatigue, sleep disturbance/OSA may be unreliable. Prior studies utilizing polysomnography (PSG) to evaluate fatigue in a population of PwMS are typically limited by the small patient sample size, limiting characterization of the spectrum of sleep disorders. Epworth Sleepiness Scale (ESS) is commonly used to screen for the presence of sleep disorders (ESS>10) and the FSS has been utilized to screen PwMS for the presence of high fatigue (FSS>36). The presence of OSA is defined by PSG (Apnea-Hypopnea Index (AHI) ≥5). The relationship of these PRO in PwMS with the presence or absence of OSA PwMS who report fatigue has not been explored.
Objective: To explore the relationship of both FSS and ESS in PwMS who report fatigue to PSG identified obstructive sleep apnea (OSA).
Methods: Retrospective analysis of PwMS who reported fatigue, and were not previously diagnosed as having OSA, and who agreed to have overnight PSG studies.
Results: 292 PwMS (average age 47.3 ± 10.7 years, 81.4% female). 61% (n=177) of PwMS had PSG OSA (AHI ≥5). Of these, 55% had ESS≤10 and 45% had ESS>10 (n=95). OSA severity (None: AHI< 4.9, Mild: 5< AHI< 19.9, Moderate: 20< AHI< 39.9, Severe: AHI>40) relationship to ESS score revealed: 24% ESS≤10 and 20% with ESS>10 had no OSA; 46% ESS≤10 and 44% with ESS>10 had mild OSA; 19% ESS≤10 and 17% with ESS>10 had moderate OSA; and 11% ESS≤10 and 20% with ESS>10 had severe OSA. Of the 61% PwMS with OSA: 18% FSS< 36 and 82% had FSS≥36 (n=148). However, when the OSA severity and FSS scores are explored along a continuum: 46% FSS< 36 and 43% with FSS≥36 had no OSA; 29% FSS< 36 and 37% with FSS≥36 had mild OSA; 18% FSS< 36 and 12% with FSS≥36 had moderate OSA, and 7% FSS< 36 and 9% with FSS≥36 had severe OSA.
Conclusions: PRO investigation in PwMS by either/both FSS and ESS are insufficient to predict the presence of PSG documented OSA in PwMS. Overnight PSG is required to identify the presence and degree of OSA in PwMS. Since fatigue related to OSA is treatable, a high index of suspicion for OSA in PwMS who report fatigue should be present regardless of the FSS or ESS scores. Comprehensive evaluation of all factors potentially contributing to fatigue in PwMS, is warranted so that appropriate treatment intervention can be addressed.
Disclosure: (This study was supported by Teva):
MG- Research support (Biogen, EMD Serono, Novartis, Sanofi, Teva); speaker fees/consultant (Acorda, Amgen, Biogen, EMD Serono, Medtronic, Novartis, Sanofi, Saol Therapeutics, Teva).
AG- Nothing to disclose
JS- Nothing to disclose
MZ- Speaker fees (Acorda, Biogen, Genzyme and Teva)
BB- Speaker fees (Biogen, Genotech, Genzyme and Teva). MG: Research support (Biogen, EMD Serono, Novartis, Sanofi, Teva); speaker fees/consultant (Acorda, Amgen, Biogen, EMD Serono, Medtronic, Novartis, Sanofi, Saol Therapeutics, Teva).
AC: Nothing to disclose
KW: Nothing to disclose
LF- Nothing to disclose
MB- Nothing to disclose
Abstract: EP1405
Type: Poster Sessions
Abstract Category: Clinical aspects of MS - Clinical assessment tools
Background: Fatigue is a common and disabling symptom in people with MS (PwMS). Presence and degree of fatigue in PwMS primarily relies on patient self-reported outcomes (PRO). PRO fatigue, sleep disturbance/OSA may be unreliable. Prior studies utilizing polysomnography (PSG) to evaluate fatigue in a population of PwMS are typically limited by the small patient sample size, limiting characterization of the spectrum of sleep disorders. Epworth Sleepiness Scale (ESS) is commonly used to screen for the presence of sleep disorders (ESS>10) and the FSS has been utilized to screen PwMS for the presence of high fatigue (FSS>36). The presence of OSA is defined by PSG (Apnea-Hypopnea Index (AHI) ≥5). The relationship of these PRO in PwMS with the presence or absence of OSA PwMS who report fatigue has not been explored.
Objective: To explore the relationship of both FSS and ESS in PwMS who report fatigue to PSG identified obstructive sleep apnea (OSA).
Methods: Retrospective analysis of PwMS who reported fatigue, and were not previously diagnosed as having OSA, and who agreed to have overnight PSG studies.
Results: 292 PwMS (average age 47.3 ± 10.7 years, 81.4% female). 61% (n=177) of PwMS had PSG OSA (AHI ≥5). Of these, 55% had ESS≤10 and 45% had ESS>10 (n=95). OSA severity (None: AHI< 4.9, Mild: 5< AHI< 19.9, Moderate: 20< AHI< 39.9, Severe: AHI>40) relationship to ESS score revealed: 24% ESS≤10 and 20% with ESS>10 had no OSA; 46% ESS≤10 and 44% with ESS>10 had mild OSA; 19% ESS≤10 and 17% with ESS>10 had moderate OSA; and 11% ESS≤10 and 20% with ESS>10 had severe OSA. Of the 61% PwMS with OSA: 18% FSS< 36 and 82% had FSS≥36 (n=148). However, when the OSA severity and FSS scores are explored along a continuum: 46% FSS< 36 and 43% with FSS≥36 had no OSA; 29% FSS< 36 and 37% with FSS≥36 had mild OSA; 18% FSS< 36 and 12% with FSS≥36 had moderate OSA, and 7% FSS< 36 and 9% with FSS≥36 had severe OSA.
Conclusions: PRO investigation in PwMS by either/both FSS and ESS are insufficient to predict the presence of PSG documented OSA in PwMS. Overnight PSG is required to identify the presence and degree of OSA in PwMS. Since fatigue related to OSA is treatable, a high index of suspicion for OSA in PwMS who report fatigue should be present regardless of the FSS or ESS scores. Comprehensive evaluation of all factors potentially contributing to fatigue in PwMS, is warranted so that appropriate treatment intervention can be addressed.
Disclosure: (This study was supported by Teva):
MG- Research support (Biogen, EMD Serono, Novartis, Sanofi, Teva); speaker fees/consultant (Acorda, Amgen, Biogen, EMD Serono, Medtronic, Novartis, Sanofi, Saol Therapeutics, Teva).
AG- Nothing to disclose
JS- Nothing to disclose
MZ- Speaker fees (Acorda, Biogen, Genzyme and Teva)
BB- Speaker fees (Biogen, Genotech, Genzyme and Teva). MG: Research support (Biogen, EMD Serono, Novartis, Sanofi, Teva); speaker fees/consultant (Acorda, Amgen, Biogen, EMD Serono, Medtronic, Novartis, Sanofi, Saol Therapeutics, Teva).
AC: Nothing to disclose
KW: Nothing to disclose
LF- Nothing to disclose
MB- Nothing to disclose