Contributions
Abstract: EP1699
Type: Poster Sessions
Abstract Category: Therapy - Symptomatic treatment
Introduction: Evidence suggests a relationship between obstructive sleep apnoea (OSA) and worsened cognitive performance in people with Multiple Sclerosis (pwMS). Fatigue is common, affecting up to 87% of pwMS. Sleep disturbance is an important factor contributing to fatigue in MS, and sleep disorders including OSA are more prevalent in MS, than the general population.
Study Aim: To investigate the effect of OSA management in pwMS on cognition using the Brief International Cognitive Assessment in MS (BICAMS); consisting of the Symbol Digit Modality Test (SDMT), California Verbal Learning Test (CVLT-2) and Brief Visuospatial Memory Test (BVMT-R), as well as 3-second Paced Auditory Serial Addition Test (PASAT-3).
Methods: 23 pwMS, aged 25-59, who reported significant fatigue were recruited from the MS outpatient clinic for overnight polysomnography and cognitive assessment between 01/03/2017 and 31/03/2018. Participants completed initial cognitive assessment with BICAMS and PASAT-3 on the day of polysomnography. Participants with OSA repeated cognitive tests after positional therapy or continuous positive airway pressure (C-PAP) were established. A cohort of participants with normal polysomnography also repeated cognitive testing for comparison.
Results: 6 of 23 participants (26%) received a diagnosis of OSA. 2 were mild (apnoea hypopnoea index [AHI] 5-15), and 4 moderate OSA (AHI 15-30). Self-reported fatigue did not predict the presence of OSA and no correlation was seen between initial cognitive results and presence of OSA. 5 participants with OSA underwent treatment, 3 with sleep position therapy belts and 2 with C-PAP. The treatment arm underwent repeat cognitive testing, mean 7 months following initial cognitive exam. 9 patients with normal polysomnography not receiving treatment also repeated cognitive tests, mean 4 months after initial assessment.There was a significant improvement in verbal memory measured by the CVLT-2 in the treatment arm (p=0.03). Improvement was seen in all cognitive domains in the treatment arm, but no other reached significance. There was no improvement seen in any cognitive domain in the control arm, except a non-significant increase in SDMT measuring information processing speed.
Conclusion: Treatment of OSA significantly improved verbal memory in this cohort. Results should be interpreted with caution, with low patient numbers in this pilot study, however they indicate that a more detailed investigation is warranted.
Disclosure: Dr. Nuala McNicholas has been awarded a Newman fellowship sponsored by Biogen Idec. Audrey Russell has no conflict of interest. Geraldine Nolan has no conflict of interest. Michael Hutchinson served on the advisory board (BG00012) for Biogen, he has received speaker's honoraria from Biogen, Bayer-Schering, Merck Serono and Novartis and receives research grants from Dystonia Ireland, the Health Research Board of Ireland (CSA-2012/5) and the Irish Institute of Clinical Neuroscience. Professor Niall Tubridy has received, on behalf of the Department of Neurology, St Vincent's University Hospital, educational and research grants from Novartis, Biogen, Teva and Bayer. Dr. John Garvey has no conflict of interest. Prof. Chris McGuigan has received honoraria, participated in advisory boards and/or received research funding from Biogen, Merck Serono, Novartis, Genzyme and Bayer.
Abstract: EP1699
Type: Poster Sessions
Abstract Category: Therapy - Symptomatic treatment
Introduction: Evidence suggests a relationship between obstructive sleep apnoea (OSA) and worsened cognitive performance in people with Multiple Sclerosis (pwMS). Fatigue is common, affecting up to 87% of pwMS. Sleep disturbance is an important factor contributing to fatigue in MS, and sleep disorders including OSA are more prevalent in MS, than the general population.
Study Aim: To investigate the effect of OSA management in pwMS on cognition using the Brief International Cognitive Assessment in MS (BICAMS); consisting of the Symbol Digit Modality Test (SDMT), California Verbal Learning Test (CVLT-2) and Brief Visuospatial Memory Test (BVMT-R), as well as 3-second Paced Auditory Serial Addition Test (PASAT-3).
Methods: 23 pwMS, aged 25-59, who reported significant fatigue were recruited from the MS outpatient clinic for overnight polysomnography and cognitive assessment between 01/03/2017 and 31/03/2018. Participants completed initial cognitive assessment with BICAMS and PASAT-3 on the day of polysomnography. Participants with OSA repeated cognitive tests after positional therapy or continuous positive airway pressure (C-PAP) were established. A cohort of participants with normal polysomnography also repeated cognitive testing for comparison.
Results: 6 of 23 participants (26%) received a diagnosis of OSA. 2 were mild (apnoea hypopnoea index [AHI] 5-15), and 4 moderate OSA (AHI 15-30). Self-reported fatigue did not predict the presence of OSA and no correlation was seen between initial cognitive results and presence of OSA. 5 participants with OSA underwent treatment, 3 with sleep position therapy belts and 2 with C-PAP. The treatment arm underwent repeat cognitive testing, mean 7 months following initial cognitive exam. 9 patients with normal polysomnography not receiving treatment also repeated cognitive tests, mean 4 months after initial assessment.There was a significant improvement in verbal memory measured by the CVLT-2 in the treatment arm (p=0.03). Improvement was seen in all cognitive domains in the treatment arm, but no other reached significance. There was no improvement seen in any cognitive domain in the control arm, except a non-significant increase in SDMT measuring information processing speed.
Conclusion: Treatment of OSA significantly improved verbal memory in this cohort. Results should be interpreted with caution, with low patient numbers in this pilot study, however they indicate that a more detailed investigation is warranted.
Disclosure: Dr. Nuala McNicholas has been awarded a Newman fellowship sponsored by Biogen Idec. Audrey Russell has no conflict of interest. Geraldine Nolan has no conflict of interest. Michael Hutchinson served on the advisory board (BG00012) for Biogen, he has received speaker's honoraria from Biogen, Bayer-Schering, Merck Serono and Novartis and receives research grants from Dystonia Ireland, the Health Research Board of Ireland (CSA-2012/5) and the Irish Institute of Clinical Neuroscience. Professor Niall Tubridy has received, on behalf of the Department of Neurology, St Vincent's University Hospital, educational and research grants from Novartis, Biogen, Teva and Bayer. Dr. John Garvey has no conflict of interest. Prof. Chris McGuigan has received honoraria, participated in advisory boards and/or received research funding from Biogen, Merck Serono, Novartis, Genzyme and Bayer.