Respiratory Division and Sleep Laboratory, McGill University Health Centre, McGill University, Montreal, QC, Canada; Respiratory Epidemiology and Clinical Research Unit, Research Institute of McGill University Health Centre, Montreal, QC, Canada.
Respiratory Division and Sleep Laboratory, McGill University Health Centre, McGill University, Montreal, QC, Canada; Respiratory Epidemiology and Clinical Research Unit, Research Institute of McGill University Health Centre, Montreal, QC, Canada.
Handb Clin Neurol. 2022;189:177-200. doi: 10.1016/B978-0-323-91532-8.00013-6.
Multiple Sclerosis (MS) is a common neuroinflammatory disorder which is associated with disabling clinical consequences. The MS disease process may involve neural centers implicated in the control of breathing, leading to ventilatory disturbances during both wakefulness and sleep. In this chapter, a brief overview of MS disease mechanisms and clinical sequelae including sleep disorders is provided. The chapter then focuses on obstructive sleep apnea-hypopnea (OSAH) which is the most prevalent respiratory control abnormality encountered in ambulatory MS patients. The diagnosis, prevalence, and clinical consequences as well as data on effects of OSAH treatment in MS patients are discussed, including the impact on the disabling symptom of fatigue and other clinical sequelae. We also review pathophysiologic mechanisms contributing to OSAH in MS, and in turn mechanisms by which OSAH may impact on the MS disease process, resulting in a bidirectional relationship between these two conditions. We then discuss central sleep apnea, other respiratory control disturbances, and the pathogenesis and management of respiratory muscle weakness and chronic hypoventilation in MS. We also provide a brief overview of Neuromyelitis Optica Spectrum Disorders and review current data on respiratory control disturbances and sleep-disordered breathing in that condition.
多发性硬化症（MS）是一种常见的神经炎症性疾病，与致残的临床后果有关。MS 疾病过程可能涉及呼吸控制中涉及的神经中枢，导致清醒和睡眠期间的通气障碍。在本章中，简要概述了 MS 疾病机制和包括睡眠障碍在内的临床后果。然后，本章重点介绍了阻塞性睡眠呼吸暂停低通气（OSAH），这是在活动期 MS 患者中最常见的呼吸控制异常。讨论了 OSAH 的诊断、患病率和临床后果以及 OSAH 治疗对 MS 患者的影响的数据，包括对致残症状疲劳和其他临床后果的影响。我们还回顾了导致 MS 中 OSAH 的病理生理机制，以及反过来 OSAH 可能对 MS 疾病过程产生影响的机制，导致这两种情况之间存在双向关系。然后，我们讨论了中枢性睡眠呼吸暂停、其他呼吸控制障碍以及 MS 中呼吸肌无力和慢性低通气的发病机制和管理。我们还简要概述了视神经脊髓炎谱系疾病，并回顾了该疾病中呼吸控制障碍和睡眠呼吸障碍的现有数据。
