Clinical Neurology, Sleep Medicine Center, Udine University Hospital, Udine, Italy.
Neurology Unit, Hospital of Gorizia, Gorizia, Italy.
Sleep Med. 2023 Dec;112:181-187. doi: 10.1016/j.sleep.2023.10.016. Epub 2023 Oct 20.
OBJECTIVE/BACKGROUND: Patients with multiple sclerosis (MS) frequently report sleep complaints. The ketogenic diet (KD) is safe and tolerable in MS patients. Our aim was: 1) to investigate the effects of KD on sleep complaints in patients affected by relapsing-remitting MS and 2) to verify if sleep changes can positively impact on psychological status and quality of life (QoL) in these patients.
PATIENTS/METHODS: From January 2020 to November 2022, we consecutively enrolled 21 non-disabled or minimally disabled MS patients. We collected information regarding: 1) anthropometric measures; 2) psychological status by the Depression Anxiety Stress Scale-21; 3) QoL by the Multiple Sclerosis Quality of Life-54 (MSQOL-54); 4) subjective sleep complaints, i.e. sleep quality, by the Pittsburgh Sleep Quality Index (PSQI), and excessive daytime sleepiness (EDS), by the Epworth Sleepiness Scale (ESS).
After 6 months of KD therapy, anthropometric measures considerably changed, psychological status significantly improved, and almost all the MSQOL-54 subscales ameliorated. Regarding sleep, we observed that the global PSQI (T0: 7.7 ± 3.1 versus T1: 4.4 ± 3.1, p = 0.002) and the ESS (T0: 7.5 ± 3.9 versus T1: 4.9 ± 3.2, p = 0.001) scores significantly decreased after KD therapy. At T1, only the global PSQI score was an independent predictor of anxiety, stress, and mental health.
For the first time, we demonstrated that KD may improve sleep complaints in MS patients. In addition, KD seems to have a positive impact on psychological status and QoL of MS patients, mainly through improving sleep quality. Further controlled studies with larger sample sizes are needed to confirm these preliminary results.
目的/背景：多发性硬化症（MS）患者常报告睡眠问题。生酮饮食（KD）在 MS 患者中是安全且耐受良好的。我们的目的是：1）研究 KD 对缓解-复发型 MS 患者睡眠问题的影响，2）验证睡眠变化是否能积极影响这些患者的心理状态和生活质量（QoL）。
患者/方法：从 2020 年 1 月到 2022 年 11 月，我们连续纳入了 21 名非残疾或轻度残疾的 MS 患者。我们收集了以下信息：1）人体测量学指标；2）用抑郁焦虑压力量表-21 评估心理状态；3）用多发性硬化生活质量量表-54（MSQOL-54）评估 QoL；4）用匹兹堡睡眠质量指数（PSQI）评估主观睡眠问题，即睡眠质量，用 Epworth 嗜睡量表（ESS）评估白天过度嗜睡（EDS）。
KD 治疗 6 个月后，人体测量学指标有显著变化，心理状态明显改善，MSQOL-54 的几乎所有子量表都得到了改善。在睡眠方面，我们发现全球 PSQI（T0：7.7±3.1 与 T1：4.4±3.1，p=0.002）和 ESS（T0：7.5±3.9 与 T1：4.9±3.2，p=0.001）评分在 KD 治疗后显著降低。在 T1 时，只有全球 PSQI 评分是焦虑、压力和心理健康的独立预测因子。
这是首次证明 KD 可能改善 MS 患者的睡眠问题。此外，KD 似乎对 MS 患者的心理状态和 QoL 有积极影响，主要是通过改善睡眠质量。需要进一步的、有更大样本量的对照研究来证实这些初步结果。
