Sleep-disordered breathing and fatigue in multiple sclerosis
Bibliographic record
Abstract
Fatigue is common and disabling in multiple sclerosis (MS). It is distinct from sleepiness. Both fatigue and sleepiness have been associated with sleep-disordered breathing, particularly obstructive sleep apnea (OSA) in other populations. While fatigue in MS is probably multi-factorial, OSA may play an important role. The main objectives of this project were to evaluate the relationship of OSA to fatigue and sleepiness in MS patients vs. normal controls, and to evaluate predictors of severe fatigue in MS subjects. Stable, ambulatory MS patients without known sleep disorders were recruited from the Montreal Neurological Hospital MS clinic. Normal controls were age and sex frequency-matched. All participants underwent diagnostic overnight polysomnography and a multiple sleep latency test (objective measure of daytime sleepiness). Fatigue was measured with the Fatigue Severity Scale (FSS) and the Multidimensional Fatigue Inventory (MFI), and subjective sleepiness with the Epworth Sleepiness Scale (ESS). Covariates included age, sex, body mass index, MS disability level, depression, pain and restless legs syndrome severity. OSA, defined as an apnea-hypopnea index (AHI) ≥ 15, was found in 36 of 62 (58%) MS subjects and 15 of 32 (47%) control subjects – OR (95% CI) 1.57 (0.67, 3.74). After adjusting for confounders, severe fatigue (FSS > 5) and the MFI-mental fatigue scale (> group median) were associated with AHI and respiratory-related arousals, in MS but not in control subjects. MFI-mental fatigue, in MS subjects, was also associated with intermittent hypoxemia. Subjective and objective sleepiness were not related to OSA in either group. In a multivariate model for MS subjects alone, the significant predictors of severe fatigue were the MS disability level – OR (95% CI) 1.88 (1.18, 3.33) and severe OSA (AHI ≥ 30) – OR (95% CI) 19.55 (2.31, 322.09). In summary, while OSA was not more frequent in MS than in control subjects, it was associated with severe fatigue only in MS subjects. No association was found with sleepiness. Severe fatigue in MS subjects showed a marked association with severe OSA, and a less pronounced association with MS disability level. In that OSA is a treatable condition, these findings open the door to further research that may lead to important changes in management of severely fatigued MS subjects.
Fetched live from OpenAlex and de-inverted. Abstracts are not stored in this database: the inverted indexes are 8.6 GB of the frame’s 9.3 GB of text, and the host has 13 GB free.
How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.001 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".