Fatigue, sleepiness and depression in multiple sclerosis

Sparasci, Davide; Gobbi, Claudio; Castelnovo, Anna; Riccitelli, Gianna Carla; Disanto, Giulio; Zecca, Chiara; Manconi, Mauro

doi:10.1007/s00415-022-11143-6

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Journal article

Fatigue, sleepiness and depression in multiple sclerosis : defining the overlaps for a better phenotyping

Sparasci, Davide ORCID Sleep Medicine Unit, Neurocenter of Southern Switzerland, Ospedale Civico, Lugano, Switzerland
Gobbi, Claudio ORCID Multiple Sclerosis Center, Neurocenter of Southern Switzerland, Ospedale Regionale di Lugano, EOC, Lugano, Switzerland ; Faculty of Biomedical Sciences, Università della Svizzera italiana, Switzerland
Castelnovo, Anna ORCID Sleep Medicine Unit, Neurocenter of Southern Switzerland, Ospedale Civico, Lugano, Switzerland ; University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland ; Faculty of Biomedical Sciences, Università della Svizzera italiana, Switzerland
Riccitelli, Gianna Carla Multiple Sclerosis Center, Neurocenter of Southern Switzerland, Ospedale Regionale di Lugano, EOC, Lugano, Switzerland ; Neuropsychology and Behavioural Neurology Research Unit, Neurocenter of Southern Switzerland, Ospedale Civico, Lugano, Switzerland
Disanto, Giulio Multiple Sclerosis Center, Neurocenter of Southern Switzerland, Ospedale Regionale di Lugano, EOC, Lugano, Switzerland
Zecca, Chiara ORCID Multiple Sclerosis Center, Neurocenter of Southern Switzerland, Ospedale Regionale di Lugano, EOC, Lugano, Switzerland ; Faculty of Biomedical Sciences, Università della Svizzera italiana, Switzerland
Manconi, Mauro ORCID Sleep Medicine Unit, Neurocenter of Southern Switzerland, Ospedale Civico, Lugano, Switzerland ; Faculty of Biomedical Sciences, Università della Svizzera italiana, Switzerland

2022

Published in:

Journal of neurology . - 2022, vol. 269, p. 4961–4971

Maintenance of wakefulness test

English Background and objectives: To define the boundaries and the overlaps between fatigue, sleepiness and depression in patients with multiple sclerosis (MS) by using different tools for each dimension, including instrumental sleep analysis. Methods: In this cross-sectional, observational study, 71 MS patients (males/females: 20/51; mean age: 48.9 ± 10.5 years) filled in clinical questionnaires and performed polysomnography followed by maintenance of wakefulness test (MWT). Frequency and reciprocal overlap of sleepiness, fatigue and depression in MS were expressed by Eulero-Venn diagrams; standard multiple regression was used to assess the ability of symptoms to predict each other. Results: There was a high percentage of fatigued (70%), somnolent (45%) and depressed (27%) patients. Fatigue had the strongest overlap and correlated with both depression (beta: 0.52, p < 0.001) and sleepiness (beta: 0.74, p < 0.001). Somno- lence and depression were nearly always accompanied by fatigue and were well differentiated from each other by MWT. Four MS subgroups were identified that had: (1) fatigue only; (2) fatigue and sleepiness (3) fatigue and depression; (4) fatigue, sleepiness and depression. Discussion: The subjective and objective tools are not able to clearly distinguish fatigue from sleepiness and depression, while only a test of vigilance can be helpful in separating somnolence and depression from each other.

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