Link Between Lesion Location and Obstructive Sleep Apnea in Multiple Sclerosis

STOCKHOLM — The risk for development of obstructive sleep apnea (OSA) and the severity of disease in patients with multiple sclerosis (MS) may be affected by the location of the lesions, according to study results presented at the 35th Congress of the European Committee for Treatment and Research in Multiple Sclerosis (ECTRIMS), held September 11-13, 2019 in Stockholm, Sweden.

One of the common complications of MS is OSA, which is frequently under recognized. Brainstem involvement is associated with higher apnea hypopnea indices, suggesting that MS lesions in this area may affect airway patency during sleep and increase OSA severity.

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The cross-sectional study included patients with MS with and without OSA, aiming to explore the prevalence and severity of OSA in patients with MS and fatigue, as well as to identify physical and radiographic risk factors for OSA.

After controlling for age, known MS-independent risk factors for OSA — including body mass index and male gender — there were significant associations between apnea hypopnea indices and number of lesions in the pons (P =.003), medulla (P =.048), and all infratentorial lesions (P =.013). The association between apnea hypopnea indices and midbrain lesions was not statistically significant.

After controlling for MS-independent risk factors for OSA, there was a positive correlation between apnea hypopnea indices and standardized third ventricular width, a surrogate measurement for total brain atrophy (P =.003).  Furthermore, increased brain atrophy was associated with increasing expanded disability status scale (P =.01).

“Lesion location in MS patients could contribute to development of increased apnea hypopnea indices and therefore presumably OSA severity. It is possible that early MS treatment may help prevent or moderate MS comorbidities such as OSA and decrease fatigue,” concluded the researchers. They added that OSA may contribute to brain atrophy seen in MS, and treatment of OSA could potentially decrease brain atrophy over time.


Levit E, Sloane J. Obstructive sleep apnea in multiple sclerosis: the relationship of lesion location, apnea hypopnea index, and brain atrophy. Poster presentation at: 35th Congress of the European Committee for Treatment and Research in Multiple Sclerosis; September 11-13, 2019; Stockholm, Sweden. Abstract: P419.