Long-Term Effects of CPAP Treatment of Obstructive Sleep Apnea in Multiple Sclerosis Patients
Authors List
1,2S Khadadah, 3M Mazerolle, 4DA Trojan, 5P Duquette, 6V Jobin, 4Y Lapierre, 7A Benedetti, 7K Majetic, 4A Robinson, 5E Roger, 1 M Kaminska, 4G Leonard, 1RJ Kimoff
1Respiratory Division and Sleep Laboratory, McGill University Health Centre,
2Mubarak AlKabeer Hospital, Dept of Medicine, Kuwait City, Kuwait,
3Faculté de médecine, Université de Montréal,
4Dept. of Neurology & Neurosurgery, Montreal Neurological Institute-Hospital, McGill University Health Centre,
5Department of Neuroscience, Centre Hospitalier de l'Université de Montréal,
6Pulmonary Division, Centre Hospitalier de l'Université de Montréal,
7Department of Epidemiology, Biostatistics & Occupational Health, McGill University, Montreal, Canada.
Objectives
To evaluate the long-term effects of CPAP treatment on fatigue (Fatigue Severity Scale, FSS, primary outcome) and other outcomes in multiple sclerosis (MS) patients with concomitant obstructive sleep apnea-hypopnea (OSAH).
Methods
We recently published a randomized, controlled trial (RCT) of active vs sham CPAP treatment in MS patients with fatigue, poor sleep quality, and OSAH (Mult Scl J 2022; 28:82-92). Following the RCT, participants were offered treatment with CPAP as well as participation in an open-label follow-up study re-evaluating the RCT outcome measures ≥ 6 months later. Comparisons were made between values for participants using versus not using CPAP treatment at follow-up.
Results
Twenty-eight (82%) of the original 34 RCT-completers participated in the follow-up study, undergoing re-evaluation of outcomes at a mean of 2.8 years after the RCT. Sixteen (57%) patients were treated with CPAP (mean use 5.4 ± 1.0 h/night during the 6 months prior to followup), while the other 12 patients elected not to pursue CPAP and received no other OSA treatment. CPAP-treated patients demonstrated significant improvements from pre-RCT baseline in values for FSS (p=0.005), Fatigue Scale for Motor and Cognitive Functions (Motor and Total subscales p=0.008, p=0.012, respectively), Morning Fatigue (-55%, p=0.007), Pittsburg Sleep Quality Index (PSQI) (p=0.016), Center for Epidemiologic Studies Depression score (p=0.05)
and MS Quality of Life-54 (MSQOL-54) physical and mental component scores (p=0.012, p=0.023, respectively). However, there were no significant improvements with CPAP treatment in Epworth Sleepiness Scores (ESS), visual analogue pain scales, Montreal Cognitive Assessment or Tower of London Scores, or MS-related disability score. In contrast, untreated patients demonstrated no significant improvement in any outcome measure compared with preRCT baseline. Using a linear mixed model, there were significant improvements in CPAPtreated patients compared with non-CPAP treated patients in adjusted values for FSS (p=0.03) and the physical component score of MSQOL-54 (p=0.02). Morning fatigue also improved significantly in CPAP-treated patients (p = 0.048). Measures of CPAP adherence were positively associated with improvements in PSQI (p=0.039) and MSQOL-54 physical component score (p=0.049).
Conclusion
In this post-RCT observational study, long-term CPAP use was associated with significant improvements in fatigue and physical quality of life in MS patients with OSAH.
Funded by: Multiple Sclerosis Society of Canada; Programme de Médecine Physique et de Réadapatation, Université de Montréal; In-kind support for RCT from VitalAire Inc and PhilipsRespironics Inc.
1,2S Khadadah, 3M Mazerolle, 4DA Trojan, 5P Duquette, 6V Jobin, 4Y Lapierre, 7A Benedetti, 7K Majetic, 4A Robinson, 5E Roger, 1 M Kaminska, 4G Leonard, 1RJ Kimoff
1Respiratory Division and Sleep Laboratory, McGill University Health Centre,
2Mubarak AlKabeer Hospital, Dept of Medicine, Kuwait City, Kuwait,
3Faculté de médecine, Université de Montréal,
4Dept. of Neurology & Neurosurgery, Montreal Neurological Institute-Hospital, McGill University Health Centre,
5Department of Neuroscience, Centre Hospitalier de l'Université de Montréal,
6Pulmonary Division, Centre Hospitalier de l'Université de Montréal,
7Department of Epidemiology, Biostatistics & Occupational Health, McGill University, Montreal, Canada.
Objectives
To evaluate the long-term effects of CPAP treatment on fatigue (Fatigue Severity Scale, FSS, primary outcome) and other outcomes in multiple sclerosis (MS) patients with concomitant obstructive sleep apnea-hypopnea (OSAH).
Methods
We recently published a randomized, controlled trial (RCT) of active vs sham CPAP treatment in MS patients with fatigue, poor sleep quality, and OSAH (Mult Scl J 2022; 28:82-92). Following the RCT, participants were offered treatment with CPAP as well as participation in an open-label follow-up study re-evaluating the RCT outcome measures ≥ 6 months later. Comparisons were made between values for participants using versus not using CPAP treatment at follow-up.
Results
Twenty-eight (82%) of the original 34 RCT-completers participated in the follow-up study, undergoing re-evaluation of outcomes at a mean of 2.8 years after the RCT. Sixteen (57%) patients were treated with CPAP (mean use 5.4 ± 1.0 h/night during the 6 months prior to followup), while the other 12 patients elected not to pursue CPAP and received no other OSA treatment. CPAP-treated patients demonstrated significant improvements from pre-RCT baseline in values for FSS (p=0.005), Fatigue Scale for Motor and Cognitive Functions (Motor and Total subscales p=0.008, p=0.012, respectively), Morning Fatigue (-55%, p=0.007), Pittsburg Sleep Quality Index (PSQI) (p=0.016), Center for Epidemiologic Studies Depression score (p=0.05)
and MS Quality of Life-54 (MSQOL-54) physical and mental component scores (p=0.012, p=0.023, respectively). However, there were no significant improvements with CPAP treatment in Epworth Sleepiness Scores (ESS), visual analogue pain scales, Montreal Cognitive Assessment or Tower of London Scores, or MS-related disability score. In contrast, untreated patients demonstrated no significant improvement in any outcome measure compared with preRCT baseline. Using a linear mixed model, there were significant improvements in CPAPtreated patients compared with non-CPAP treated patients in adjusted values for FSS (p=0.03) and the physical component score of MSQOL-54 (p=0.02). Morning fatigue also improved significantly in CPAP-treated patients (p = 0.048). Measures of CPAP adherence were positively associated with improvements in PSQI (p=0.039) and MSQOL-54 physical component score (p=0.049).
Conclusion
In this post-RCT observational study, long-term CPAP use was associated with significant improvements in fatigue and physical quality of life in MS patients with OSAH.
Funded by: Multiple Sclerosis Society of Canada; Programme de Médecine Physique et de Réadapatation, Université de Montréal; In-kind support for RCT from VitalAire Inc and PhilipsRespironics Inc.
