Department of Psychiatry and Psychotherapy, Center of Sleep Medicine, University of Regensburg, Germany.
University Library of Regensburg, University of Regensburg, Germany.
Sleep Med Rev. 2017 Apr;32:95-108. doi: 10.1016/j.smrv.2016.03.004. Epub 2016 Mar 18.
Fatigue is a frequent and distressing symptom in patients with multiple sclerosis (MS). In contrast, sleepiness, characterized by difficulties to stay awake and alert during the day, seems to be less prevalent in MS; however, exact studies are lacking. In addition, there is a semantic confusion of the concepts of "fatigue" and "sleepiness", which are often used interchangeably. We conducted a systematic review of studies using the Epworth sleepiness scale (ESS) for the assessment of daytime sleepiness in patients with MS. The summarized results of 48 studies demonstrate that sleepiness, as indicated by elevated ESS scores, is less prevalent and less severe than fatigue but is present in a significant proportion of patients with MS. In most cross-sectional and longitudinal studies, there was a moderate association between ESS scores and various fatigue rating scales. Longitudinal studies on the effect of wakefulness-promoting agents failed to show a consistent improvement of sleepiness or fatigue as compared to placebo. It has also been shown that daytime sleepiness is frequently associated with comorbid sleep disorders that are often underrecognized and undertreated in MS. Sleepiness and potential sleep disorders may also precipitate and perpetuate fatigue in patients with MS and should be part of the differential diagnostic assessment. To support an appropriate decision-making process, we propose a stepwise evaluation of sleepiness as compared to fatigue in patients with MS.
疲劳是多发性硬化症（MS）患者常见且令人痛苦的症状。相比之下，嗜睡的特点是白天难以保持清醒和警觉，在 MS 中似乎不太常见；然而，确切的研究还很缺乏。此外，“疲劳”和“嗜睡”这两个概念存在语义混淆，经常被互换使用。我们对使用 Epworth 嗜睡量表（ESS）评估 MS 患者日间嗜睡的研究进行了系统回顾。48 项研究的总结结果表明，嗜睡（如 ESS 评分升高所表明的）的发生率和严重程度低于疲劳，但在相当一部分 MS 患者中存在。在大多数横断面和纵向研究中，ESS 评分与各种疲劳评定量表之间存在中度关联。关于促醒药物对嗜睡影响的纵向研究未能显示与安慰剂相比嗜睡或疲劳有一致改善。还表明，日间嗜睡常与合并睡眠障碍有关，而这些睡眠障碍在 MS 中常常未被识别和治疗不足。嗜睡和潜在的睡眠障碍也可能引发和持续 MS 患者的疲劳，应作为鉴别诊断评估的一部分。为了支持适当的决策过程，我们提出了一种针对 MS 患者的嗜睡与疲劳进行分步评估的方法。
