Daytime sleepiness and driving in MS
The study in brief
Daytime sleepiness is described as an inability to remain awake during the day and is considered to be distinct from fatigue. Although daytime sleepiness affects about one third of people with MS and can have a real impact on daily life, it is often overlooked in the clinic and in research. Monotonous driving can trigger daytime sleepiness so this study used a simulated drive to assess differences between people with and without MS.
Fifteen people with and fifteen people without MS were recruited by researchers at an MS clinic in the United States. They completed questionnaires on fatigue, quality of sleep and daytime sleepiness. They then completed a 25 minute boring drive on a simulator; to measure alertness during the drive, an eye tracker recorded the amount of time that their eyes were 80% to 100% closed (excluding blinks).
In both groups, daytime sleepiness increased during the course of the drive. However, people with MS experienced a greater increase in daytime sleepiness towards the end of the drive; people with MS closed their eyes an average 2.5% of the time at the end of the drive, compared to 1.5% for people without MS.
The results indicate that lack of mental stimulation from monotonous driving increases daytime sleepiness in people with and without MS, underlining the importance for both groups to take regular breaks while driving. People with MS show increased symptoms of daytime sleepiness towards the end of the drive compared to people without MS. Further studies with more participants and longer driving times are needed to confirm and build on these results.
The study in more detail
Background
Daytime sleepiness is described as an inability to remain awake during the day and is considered to be distinct from fatigue. Although daytime sleepiness affects about one third of people with MS and can have a real impact on daily life, it is often overlooked in the clinic and in research. Monotonous car driving can induce daytime sleepiness so this study used a simulated drive as a way to compare differences in susceptibility between people with and without MS.
How this study was carried out
Researchers at an MS clinic in the United States recruited 15 people with MS and 15 people without MS; all had a valid driver’s licence and were driving regularly at the time that they took part in the study. The participants were asked to complete questionnaires to rate their levels of fatigue and quality of sleep. They also completed the Epworth Sleepiness Scale (ESS) to assess daytime sleepiness. The ESS has eight questions which ask about the likelihood of falling asleep or dozing off (in comparison to just feeling tired) in different everyday situations, such as watching TV, sitting and reading, or talking to someone. The scores are in a range of 0-24 and a score greater than 10 indicates increased daytime sleepiness. Use this online version to find your own score.
Participants then completed a 25 minute monotonous simulated drive, similar to driving on motorways with low levels of traffic. When someone experiences a period of daytime sleepiness, their eyelid droops, so to measure alertness during the drive, a screen-mounted eye tracker recorded the amount of time that the eyes were 80% to 100% closed (excluding blinks).
What was found?
Responses to the questionnaires indicated that people with MS reported worse symptoms of fatigue and poorer sleep quality. Based on responses to the ESS questionnaire, 33% of people with MS experienced daytime sleepiness, compared to 20% of those without MS, although this was not statistically significant.
During the driving simulation, real-time daytime sleepiness, measured by eyelid closure, did not largely differ between the groups. In both groups, daytime sleepiness increased during the course of the drive. However, people with MS experienced a greater increase in daytime sleepiness towards the end of the drive; people with MS closed their eyes an average 2.5% of the time at the end of the drive, compared to 1.5 % for people without MS. In people with MS, eyelid closure was closely associated with disease duration and the total distance travelled out of the correct lane, either across the centre line or road edge.
What does it mean?
The researchers conclude that monitoring eyelid closure while driving provides a valuable real-time measure of daytime sleepiness in MS. The results indicate that lack of mental stimulation from monotonous driving increases daytime sleepiness in people with and without MS, underlining the importance for both groups to take regular breaks while driving. People with MS show increased symptoms of daytime sleepiness towards the end of the drive compared to people without MS. Further studies with more participants and longer driving times will be needed to confirm the results.
Devos H, et al.
Real-time assessment of daytime sleepiness in drivers with multiple sclerosis.
Mult Scler Relat Disord 2020 Oct 31; 47: 102607.
Read the full study
More about daytime sleepiness
Daytime sleepiness is defined as the “inability to stay awake and alert during the day, resulting in periods of irrepressible need for sleep or unintended lapses into drowsiness or sleep”. Although fatigue and daytime sleepiness are two different symptoms, they are related; higher levels of daytime sleepiness were often accompanied by higher levels of fatigue. Daytime sleepiness may be overlooked in someone who has fatigue, as it may be considered part of their fatigue, but could be a sign of poor sleep quality or sleep disorders such as sleep apnoea (abnormal pauses in breathing). Treating the underlying sleep problem could improve daytime sleepiness and potentially improve levels of fatigue too. Find out more about sleep problems and tips for improving sleep quality.
You can assess your level of daytime sleepiness using the Epworth Sleepiness Scale.
Find out more about driving and MS.
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Optical coherence tomography outcomes from SPRINT-MS, a multicenter, randomized, double-blind trial of ibudilast in progressive multiple sclerosis
Mult Scler. 2020 Oct 15:1352458520964409. doi: 10.1177/1352458520964409. Online ahead of print.
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Giovannoni G, Knappertz V, Steinerman JR, Tansy AP, Li T, Krieger S, Uccelli A, Uitdehaag BMJ, Montalban X, Hartung HP, Pia Sormani M, Cree BAC, Lublin F, Barkhof F.
A randomized, placebo-controlled, phase 2 trial of laquinimod in primary progressive multiple sclerosis
Neurology. 2020 Aug 25;95(8):e1027-e1040. doi: 10.1212/WNL.0000000000010284. Epub 2020 Jul 10.
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Wang Y, Bhargava P.
Diroximel fumarate to treat multiple sclerosis
Drugs Today (Barc). 2020 Jul;56(7):431-437. doi: 10.1358/dot.2020.56.7.3151521.
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Economics
Kavaliunas A, Manouchehrinia A, Gyllensten H, Alexanderson K, Hillert J.
Importance of early treatment decisions on future income of multiple sclerosis patients
Mult Scler J Exp Transl Clin. 2020 Oct 7;6(4):2055217320959116. doi: 10.1177/2055217320959116. eCollection 2020 Oct-Dec.
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Epidemiology
Rommer PS, Ellenberger D, Hellwig K, Haas J, Pöhlau D, Stahmann A, Zettl UK; Scientific Advisory Group of the German MS-Register by the German MS Society.
Relapsing and progressive MS: the sex-specific perspective
Ther Adv Neurol Disord. 2020 Sep 23;13:1756286420956495. doi: 10.1177/1756286420956495. eCollection 2020.
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Belbasis L, Bellou V, Tzoulaki I, Evangelou E.
Early-life factors and risk of multiple sclerosis: an MR-EWAS
Neuroepidemiology. 2020;54(6):433-445. doi: 10.1159/000508229. Epub 2020 Oct 23.
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Pathophysiology
Kapoor R, Smith KE, Allegretta M, Arnold DL, Carroll W, Comabella M, Furlan R, Harp C, Kuhle J, Leppert D, Plavina T, Sellebjerg F, Sincock C, Teunissen CE, Topalli I, von Raison F, Walker E, Fox RJ.
Serum neurofilament light as a biomarker in progressive multiple sclerosis
Neurology. 2020 Sep 8;95(10):436-444. doi: 10.1212/WNL.0000000000010346. Epub 2020 Jul 16.
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Prognosis
Kosch R, Schiffmann I, Daumer M, Lederer C, Scalfari A, Galea I, Scheiderbauer J, Rahn A, Heesen C.
Long-term prognostic counselling in people with multiple sclerosis using an online analytical processing tool
Mult Scler. 2020 Oct 26:1352458520964774. doi: 10.1177/1352458520964774. Online ahead of print.
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Provision of care
Cottrell L, Economos G, Evans C, Silber E, Burman R, Nicholas R, Farsides B, Ashford S, Koffman JS.
A realist review of advance care planning for people with multiple sclerosis and their families
PLoS One. 2020 Oct 16;15(10):e0240815. doi: 10.1371/journal.pone.0240815. eCollection 2020.
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Ben-Zacharia AB, Bethoux FA, Volandes A.
Self-perceived knowledge and comfort discussing palliative care and end-of-life issues among professionals managing neuroinflammatory diseases
J Palliat Med. 2020 Oct 16. doi: 10.1089/jpm.2020.0268. Online ahead of print.
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Mésidor M, Sylvestre MP, Marrie RA, Rousseau MC.
Does age at diagnosis influence the use of health services for multiple sclerosis?
Mult Scler Relat Disord. 2020 Nov;46:102555. doi: 10.1016/j.msard.2020.102555. Epub 2020 Oct 1.
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Pétrin J, Donnelly C, McColl MA, Finlayson M.
Is it worth it?: The experiences of persons with multiple sclerosis as they access health care to manage their condition
Health Expect. 2020 Oct;23(5):1269-1279. doi: 10.1111/hex.13109. Epub 2020 Jul 22.
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Miller DM, Moss B, Rose S, Li H, Schindler D, Weber M, Planchon SM, Alberts J, Boissy A, Bermel R.
Obtaining patient priorities in a multiple sclerosis comprehensive care center: beyond patient-reported outcomes
J Patient Exp. 2020 Aug;7(4):541-548. doi: 10.1177/2374373519864011. Epub 2019 Jul 24.
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Psychological aspects
Brambila-Tapia AJL, Gutiérrez-García MM, Ruiz-Sandoval JL, Vázquez-Vázquez D, Ramírez-Martínez JF, Macias-Islas MÁ, Mireles-Ramírez MA, De-Santos-Fonseca AD, Palomera-Chávez A, Meda-Lara RM.
Using hypnoanalysis and guided imagery to identify and manage emotional aspects of multiple sclerosis
Explore (NY). 2020 Oct 13:S1550-8307(20)30314-1. doi: 10.1016/j.explore.2020.10.002. Online ahead of print.
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Maggio MG, Cuzzola MF, Latella D, Impellizzeri F, Todaro A, Rao G, Manuli A, Calabrò RS.
How personality traits affect functional outcomes in patients with multiple sclerosis: A scoping review on a poorly understood topic
Mult Scler Relat Disord. 2020 Nov;46:102560. doi: 10.1016/j.msard.2020.102560. Epub 2020 Oct 7.
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Levin SN, Riley CS, Dhand A, White CC, Venkatesh S, Boehm B, Nassif C, Socia L, Onomichi K, Leavitt VM, Levine L, Heyman R, Farber RS, Vargas WS, Xia Z, De Jager PL.
Association of social network structure and physical function in patients with multiple sclerosis
Neurology. 2020 Sep 15;95(11):e1565-e1574. doi: 10.1212/WNL.0000000000010460. Epub 2020 Aug 7.
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Kellerman QD, Hartoonian N, Beier ML, Leipertz SL, Maynard C, Hostetter TA, Haselkorn JK, Turner AP.
Risk factors for suicide in a national sample of veterans with multiple sclerosis
Arch Phys Med Rehabil. 2020 Jul;101(7):1138-1143. doi: 10.1016/j.apmr.2020.03.013. Epub 2020 Apr 20.
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Reyes S, Suarez S, Allen-Philbey K, Thomson A, Giovannoni G.
The impact of social capital on patients with multiple sclerosis
Acta Neurol Scand. 2020 Jul;142(1):58-65. doi: 10.1111/ane.13244. Epub 2020 Apr 7.
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Rehabilitation
Molhemi F, Monjezi S, Mehravar M, Shaterzadeh-Yazdi MJ, Salehi R, Hesam S, Mohammadianinejad E.
Effects of virtual reality vs conventional balance training on balance and falls in people with multiple sclerosis: a randomized controlled trial
Arch Phys Med Rehabil. 2020 Nov 5:S0003-9993(20)31212-0. doi: 10.1016/j.apmr.2020.09.395. Online ahead of print.
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Dennett R, Hendrie W, Jarrett L, Creanor S, Barton A, Hawton A, Freeman JA.
"I'm in a very good frame of mind": a qualitative exploration of the experience of standing frame use in people with progressive multiple sclerosis
BMJ Open. 2020 Oct 28;10(10):e037680. doi: 10.1136/bmjopen-2020-037680.
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Plow M, Motl RW, Finlayson M, Bethoux F.
Response heterogeneity in a randomized controlled trial of telerehabilitation interventions among adults with multiple sclerosis
J Telemed Telecare. 2020 Oct 25:1357633X20964693. doi: 10.1177/1357633X20964693. Online ahead of print.
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Pilloni G, Choi C, Shaw MT, Coghe G, Krupp L, Moffat M, Cocco E, Pau M, Charvet L.
Walking in multiple sclerosis improves with tDCS: a randomized, double-blind, sham-controlled study
Ann Clin Transl Neurol. 2020 Nov;7(11):2310-2319. doi: 10.1002/acn3.51224. Epub 2020 Oct 20.
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Chanpimol S, Benson K, Maloni H, Conroy S, Wallin M.
Acceptability and outcomes of an individualized exergaming telePT program for veterans with multiple sclerosis: a pilot study
Arch Physiother. 2020 Oct 1;10:18. doi: 10.1186/s40945-020-00089-5. eCollection 2020.
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Flachenecker P, Bures AK, Gawlik A, Weiland AC, Kuld S, Gusowski K, Streber R, Pfeifer K, Tallner A.
Efficacy of an internet-based program to promote physical activity and exercise after inpatient rehabilitation in persons with multiple sclerosis: a randomized, single-blind, controlled study
Int J Environ Res Public Health. 2020 Jun 24;17(12):4544. doi: 10.3390/ijerph17124544.
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Kim Y, Mehta T, Lai B, Motl RW.
Immediate and sustained effects of interventions for changing physical activity in people with multiple sclerosis: meta-analysis of randomized controlled trials
Arch Phys Med Rehabil. 2020 Aug;101(8):1414-1436. doi: 10.1016/j.apmr.2020.03.017. Epub 2020 Apr 25.
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Paolucci T, Bernetti A, Sbardella S, La Russa C, Murgia M, Salomè A, Villani C, Altieri M, Santilli V, Paoloni M, Agostini F, Mangone M.
Straighten your back! Self-correction posture and postural balance in "non rehabilitative instructed" multiple sclerosis patients
NeuroRehabilitation. 2020;46(3):333-341. doi: 10.3233/NRE-192987.
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Self-management
Lin X, Yu M, Jelinek GA, Simpson-Yap S, Neate S, Nag N.
Greater engagement with health information is associated with adoption and maintenance of healthy lifestyle behaviours in people with MS
Int J Environ Res Public Health. 2020 Aug 15;17(16):5935. doi: 10.3390/ijerph17165935.
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Wilski M, Kocur P, Brola W, Tasiemski T.
Psychological factors associated with self-management in multiple sclerosis
Acta Neurol Scand. 2020 Jul;142(1):50-57. doi: 10.1111/ane.13236. Epub 2020 Mar 23.
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Stem cells
Zhukovsky C, Sandgren S, Silfverberg T, Einarsdottir S, Tolf A, Landtblom AM, Novakova L, Axelsson M, Malmestrom C, Cherif H, Carlson K, Lycke J, Burman J.
Autologous haematopoietic stem cell transplantation compared with alemtuzumab for relapsing-remitting multiple sclerosis: an observational study
J Neurol Neurosurg Psychiatry. 2020 Oct 26:jnnp-2020-323992. doi: 10.1136/jnnp-2020-323992. Online ahead of print.
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Miller AE, Chitnis T, Cohen BA, Costello K, Sicotte NL, Stacom R; National Medical Advisory Committee of the National Multiple Sclerosis Society.
Autologous hematopoietic stem cell transplant in multiple sclerosis: recommendations of the National Multiple Sclerosis Society
JAMA Neurol. 2020 Oct 26. doi: 10.1001/jamaneurol.2020.4025. Online ahead of print.
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Lu Z, Zhu L, Liu Z, Wu J, Xu Y, Zhang CJ.
IV/IT hUC-MSCs infusion in RRMS and NMO: A 10-Year follow-up study
Front Neurol. 2020 Sep 8;11:967. doi: 10.3389/fneur.2020.00967. eCollection 2020.
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Abi Chahine N, Lu P.
Stem cells therapy for multiple sclerosis
Adv Exp Med Biol. 2020;1266:99-115. doi: 10.1007/978-981-15-4370-8_7.
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Symptoms and symptom management
McNicholas N, Tubridy N, Hutchinson M, McGuigan C.
Perceived and objective cognitive impairment in newly diagnosed versus established multiple sclerosis: impact of disease duration
Ir J Med Sci. 2020 Oct 27. doi: 10.1007/s11845-020-02404-2. Online ahead of print.
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Knowles LM, Esselman EC, Turner AP, Phillips KM, Herring TE, Alschuler KN, Ehde DM.
Depressive symptoms and suicidal ideation in progressive multiple sclerosis compared with relapsing-remitting multiple sclerosis: results from a cross-sectional survey
Arch Phys Med Rehabil. 2020 Oct 17:S0003-9993(20)31125-4. doi: 10.1016/j.apmr.2020.09.385. Online ahead of print.
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Sirbu CA, Mezei RM, Falup-Pecurariu C, Bratu OG, Sirbu AM, Ghinescu MC, Radu FI.
Autonomic dysfunctions in multiple sclerosis: Challenges of clinical practice (Review)
Exp Ther Med. 2020 Dec;20(6):196. doi: 10.3892/etm.2020.9326. Epub 2020 Oct 14.
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Makhoul K, Ahdab R, Riachi N, Chalah MA, Ayache SS.
Tremor in multiple sclerosis-an overview and future perspectives
Brain Sci. 2020 Oct 12;10(10):722. doi: 10.3390/brainsci10100722.
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Perez DQ, Espiritu AI, Jamora RDG.
Efficacy and safety of amantadine for the treatment of fatigue in multiple sclerosis: a systematic review and meta-analysis
Neurodegener Dis Manag. 2020 Dec;10(6):383-395. doi: 10.2217/nmt-2020-0030. Epub 2020 Oct 5.
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Eizaguirre MB, Ciufia N, Roman MS, Martínez Canyazo C, Alonso R, Silva B, Pita C, Garcea O, Vanotti S.
Perceived fatigue in multiple sclerosis: The importance of highlighting its impact on quality of life, social network and cognition
Clin Neurol Neurosurg. 2020 Dec;199:106265. doi: 10.1016/j.clineuro.2020.106265. Epub 2020 Oct 2.
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Freiha J, Riachi N, Chalah MA, Zoghaib R, Ayache SS, Ahdab R.
Paroxysmal symptoms in multiple sclerosis-a review of the literature
J Clin Med. 2020 Sep 25;9(10):3100. doi: 10.3390/jcm9103100.
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Sammaraiee Y, Stevenson VL, Keenan E, Buchanan K, Lee H, Padilla H, Farrell RA.
Evaluation of the impact of intrathecal baclofen on the walking ability of people with Multiple Sclerosis related spasticity
Mult Scler Relat Disord. 2020 Nov;46:102503. doi: 10.1016/j.msard.2020.102503. Epub 2020 Sep 20.
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Goverover Y, Chen MH, Costa SL, Chiaravalloti ND, DeLuca J.
Smell as a clinical-marker for functional limitations in multiple sclerosis: A pilot study
Mult Scler Relat Disord. 2020 Nov;46:102508. doi: 10.1016/j.msard.2020.102508. Epub 2020 Sep 18.
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Benedict RHB, Amato MP, DeLuca J, Geurts JJG.
Cognitive impairment in multiple sclerosis: clinical management, MRI, and therapeutic avenues
Lancet Neurol. 2020 Oct;19(10):860-871. doi: 10.1016/S1474-4422(20)30277-5. Epub 2020 Sep 16.
Summary(link is external)
Pust GEA, Dettmers C, Randerath J, Rahn AC, Heesen C, Schmidt R, Gold SM.
Fatigue in multiple sclerosis is associated with childhood adversities
Front Psychiatry. 2020 Aug 28;11:811. doi: 10.3389/fpsyt.2020.00811. eCollection 2020.
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Covello F, Ruoppolo G, Carissimo C, Zumbo G, Ferrara C, Polimeni A, Vozza I.
Multiple sclerosis: impact on oral hygiene, dysphagia, and quality of life
Int J Environ Res Public Health. 2020 Jun 4;17(11):3979. doi: 10.3390/ijerph17113979.
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Siengsukon C, Karahan AY, Strober L.
Practical sleep information for people with multiple sclerosis
Arch Phys Med Rehabil. 2020 Jul;101(7):1271-1274. doi: 10.1016/j.apmr.2020.03.009. Epub 2020 May 8.
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Laakso SM, Hekali O, Kurdo G, Martola J, Sairanen T, Atula S.
Trigeminal neuralgia in multiple sclerosis: Prevalence and association with demyelination
Acta Neurol Scand. 2020 Aug;142(2):139-144. doi: 10.1111/ane.13243. Epub 2020 Apr 3.
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Work
Renner A, Baetge SJ, Filser M, Penner IK.
Working ability in individuals with different disease courses of multiple sclerosis: Factors beyond physical impairment
Mult Scler Relat Disord. 2020 Nov;46:102559. doi: 10.1016/j.msard.2020.102559. Epub 2020 Oct 2.
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Researchers develop mRNA vaccine to treat MS-like condition in mice
14 Jan 2021 - 00:00
A potential treatment for multiple sclerosis uses mRNA technology, similar to two of the Covid-19 vaccines. Find out more about this research.


Remyelination research: what it means for people with MS
22 Dec 2020 - 00:00
Most people with MS will have heard of demyelination but perhaps not remyelination. We spoke with Dr Nick Cunniffe, who has been involved in some of the recent remyelination research, to find out more.


Covid-19 vaccine and MS: Your questions answered
8 Dec 2020 - 00:00
There's been a lot of interest around the new Covid-19 vaccines and how they might affect people with multiple sclerosis (MS). We've collected some common questions and answers from the MS Trust Enquiry Service this week to share with you.

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