Effects of Long-term CPAP Therapy in Multiple Sclerosis: Daria Trojan, MD, MSc

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"Our study indicates that CPAP treatment in patients with MS and sleep apnea is associated with a reduction in fatigue and an improvement in physical quality of life, offering potential benefits for long-term symptom management. Clinicians should consider exploring sleep apnea as a factor contributing to fatigue and poor sleep quality in patients with MS, as adequate treatment may lead to noticeable symptom improvement."

Fatigue, a prevalent symptom in multiple sclerosis (MS), is frequently associated with underrecognized sleep disturbances, which significantly contributes to the symptom’s impact.¹ In a new post-randomized controlled trial observational study, long-term continuous positive airway pressure (CPAP) use was associated with significant improvements in fatigue and physical quality of life in patients with MS and obstructive sleep apneahypopnea.² Senior author Daria Trojan, MD, MSc, associate professor in the department of neurology and neurosurgery at McGill University, presented the findings in a scientific session at MSMilan 2023, the 9th Joint ECTRIMS-ACTRIMS meeting, held October 11–13, in Milan, Italy.

In the analysis, investigators observed significant improvements in CPAP-treated patients (n = 16) compared with nonCPAP-treated patients (n = 12) for the Fatigue Severity Scale (P = .03) and MS Quality of Life-54 physical component score (P = .02). In addition, morning fatigue improved significantly (P = .048) in CPAP-treated patients compared with nonCPAP-treated patients. Also, investigators observed no significant improvements in the other outcome measures with CPAP treatment. Notably, measures of better CPAP adherence were associated with improvement on the Pittsburgh Sleep Quality Index (P = .039) and MS Quality of Life-54 physical component score (P = .049).

At the meeting, Trojan spoke an interview with NeurologyLive^® to discuss how CPAP treatment can impact fatigue, sleep quality, and overall well-being in patients with MS, as well as shared the key considerations for long-term adherence. She also talked about the measures that clinicians can take to address the challenges of CPAP adherence in patients with MS, and the alternative sleep apnea treatments that should be explored. In addition, Trojan spoke about the lack of data on other treatments for sleep apnea in MS, an area she suggests should be studied further in the future as well as CPAP therapy in this patient population.

REFERENCES
1. Khadadah S, Kimoff RJ, Duquette P, et al. Effect of continuous positive airway pressure treatment of obstructive sleep apnea-hypopnea in multiple sclerosis: A randomized, double-blind, placebo-controlled trial (SAMS-PAP study). Mult Scler. 2022;28(1):82-92. doi:10.1177/13524585211010390
2. Mazerolle M, Kimoff RJ, Khadadah S, et al. Long term treatment with continuous positive airway pressure of obstructive sleep apnea-hypopnea in multiple sclerosis patients is associated with improved fatigue and quality of life. Presented at: 2023 MSMilan; October 11-12; Milan, Italy. Abstract 534.