Review Article Clinical assessment and management of sleep disorders in multiple sclerosis: a literature review Lunde HMB, Bjorvatn B, Myhr K-M, Bø L. Clinical assessment and management of sleep disorders in multiple sclerosis: a literature review. Acta Neurol Scand 2013: 127 (Suppl. 196): 24–30. © 2012 John Wiley & Sons A/S. The major sleep disorders are common in multiple sclerosis (MS) and are associated with significant morbidity. Despite this, the rate of recognition and management of these conditions are low. All types of sleep disorders are seen in patients with MS: insomnia, circadian rhythm sleep disorders, sleep-related movement disorders, sleep- related breathing disorders, hypersomnia (narcolepsy), and parasomnia (REM sleep behavior disorder; RBD). This literature review covers the prevalence, clinical features, and treatment of sleep disorders in MS. Based on clinical experience, the spectrum of symptoms associated with MS, and the current knowledge of MS pathophysiology, we have also enclosed proposed strategies for clinical assessment and investigation of sleep disorders in MS patients. H. M. B. Lunde 1 , B. Bjorvatn 2,3 , K.-M. Myhr 1,4 , L. Bø 1,4 1 Department of Neurology, The Norwegian Multiple Sclerosis Competence Centre, Haukeland University Hospital, Bergen, Norway; 2 Norwegian Competence Center for Sleep Disorders, Haukeland University Hospital, Bergen, Norway; 3 Department of Public Health and Primary Health Care, University of Bergen, Bergen, Norway; 4 Department of Clinical Medicine, KG Jebsen Centre for MS-research, University of Bergen, Bergen, Norway Key words: circadian rhythm disorders; insomnia; multiple sclerosis; narcolepsy; obstructive sleep apnea; restless legs syndrome; REM sleep behavior disorder H. M. B. Lunde, MD, the Norwegian Multiple Sclerosis Competence Centre, Department of Neurology, Haukeland University Hospital, 5021-Bergen, Norway Tel.: +47 55975045 Fax: +47 55975164 e-mail: hmbl75@gmail.com Accepted for publication September 11, 2012 Introduction Unrestful sleep is a common complaint in patients with multiple sclerosis (MS). Several studies report that over 50% of MS patients suffer from poor sleep (1, 2). Despite the common occurrence, sleep disorders often go unrecognized from medical pro- fessionals that could have serious and unnecessary consequences for patients’ health. Major sleep dis- orders are associated with comorbid conditions like heart disease, obesity, stroke, and diabetes mellitus type 2 (3–5). Causes of poor sleep are multiple and may stem from specific sleep disor- ders, MS-related symptoms, and adverse effects from disease-modifying agents to the effect of MS lesions located in specific CNS regions involved in sleep regulation and sleep quality (6). Symptoms of narcolepsy, restless legs syndrome (RLS), sleep- related breathing disorders, and REM sleep behav- ior disorders (RBD) have all been related to spe- cific locations of MS lesions in the CNS (7, 8). The sleep disorders we discuss in this review can broadly be classified into six groups: insomnia, cir- cadian rhythm sleep disorders (CRSDs), sleep- related movement disorders, sleep-related breath- ing disorders, hypersomnia (narcolepsy), and para- somnia (REM sleep behavior disorder; RBD) (Table 1). The aim of this literature review is to raise knowledge about sleep disorders in MS, and the significant consequences they may have, if left untreated. We discuss the prevalence, clinical char- acteristics, and treatment of each individual sleep disorder in MS, and close with suggested strategies for clinical assessment and investigation of sleep disorders in MS. Methods We searched PubMed and Medline for articles published up to May of 2012 using the terms ‘sleep 24 Acta Neurol Scand 2013: 127 (Suppl. 196): 24–30 DOI: 10.1111/ane.12046 Ó 2012 John Wiley & Sons A/S ACTA NEUROLOGICA SCANDINAVICA