Prevalence of and risk factors for severe cognitive and sleep symptoms in ME/CFS and MS.
Prevalence of and risk factors for severe cognitive and sleep symptoms in ME/CFS and MS.
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DOI：
10.1186/s12883-017-0896-0
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发表时间：
2017-06-20
期刊：
影响因子：
2.6
通讯作者：
Nacul L
中科院分区：
文献类型：
--
作者：
Jain V;Arunkumar A;Kingdon C;Lacerda E;Nacul L
肌痛性脑脊髓炎/慢性疲劳综合征（ME/CFS）和多发性硬化症（MS）之间有相当多的表型和神经免疫重叠。虽然MS和ME/CFS的确切病因尚不清楚，但有证据表明，认知功能的恶化在患有任何一种疾病的患者中普遍存在。人们对不同的风险因素或暴露知之甚少，这些因素可能导致严重的认知或睡眠症状。本研究旨在评估参与英国ME/CFS生物库的ME/CFS和MS患者的认知和睡眠症状的程度，并确定那些经历严重症状的患者的特征。这是一项对395名英国ME/CFS生物银行参与者的横断面研究，这些参与者从初级保健和社区招募，使用类似的标准化方案，并按年龄，性别和地理区域进行匹配。在临床访视时使用标准化书面问卷从参与者中收集数据。认知症状包括短期记忆、注意力和执行功能的问题。睡眠症状包括睡眠质量差或睡眠时间不足。所有参与者都报告了基于顺序严重程度量表的症状。在ME/CFS组中进行多变量logistic回归，以调查与严重症状相关的社会人口统计学因素。所有认知和睡眠症状在ME/CFS组中更普遍，其中“注意力不集中”（98.3%）是最常见的症状。严重症状在ME/CFS组中也更常见，55%的人报告“严重，不清醒的睡眠”。同样，在MS组中，最常报告的严重症状与睡眠有关。Logistic回归分析显示，50岁以上的ME/CFS患者出现严重症状的可能性是30岁以下患者的3倍多（OR 3.23，p = 0.031）。目前吸烟与严重症状相关，风险增加约3倍（OR 2.93，p = 0.003），与收入低于此的人相比，家庭年收入超过15，000英镑的人不太可能出现严重症状（OR 0.31，p = 0.017）。认知和睡眠症状在ME/CFS患者中比MS患者和健康对照更常见，为ME/CFS中枢神经系统异常的现有证据提供了进一步的支持。我们的研究结果表明，ME/CFS吸烟者或低收入者更有可能报告严重的认知和睡眠症状。未来的研究应旨在制定策略，通过早期干预措施预防严重认知和睡眠症状的进展，优先考虑被确定为风险最高的患者。
There are considerable phenotypic and neuroimmune overlaps between myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) and multiple sclerosis (MS). While the precise aetiologies of both MS and ME/CFS are unclear, evidence suggests that deterioration in cognitive function is widely prevalent in patients with either condition. Little is known about differing risk factors or exposures, which may lead to severe cognitive or sleep symptoms. This study aims to gauge the extent of cognitive and sleep symptoms in ME/CFS and MS patients participating in the UK ME/CFS Biobank and identify the characteristics of those experiencing severe symptoms. This was a cross-sectional study of 395 UK ME/CFS Biobank participants, recruited from primary care and the community, using similar standardised protocols, and matched by age, sex and geographical area. Data were collected from participants using a standardized written questionnaire at clinical visits. Cognitive symptoms included problems with short-term memory, attention, and executive function. Sleep symptoms included unrefreshing sleep and poor quality or inadequate duration of sleep. All participants reported symptoms based on an ordinal severity scale. Multivariable logistic regression was carried out in the ME/CFS group to investigate socio-demographic factors associated with severe symptoms. All cognitive and sleep symptoms were more prevalent in the ME/CFS group, with ‘trouble concentrating’ (98.3%) the most commonly reported symptom. Severe symptoms were also more commonly reported in the ME/CFS group, with 55% reporting ‘severe, unrefreshing sleep’. Similarly, in the MS group, the most commonly reported severe symptoms were sleep-related. Logistic regression analysis revealed that ME/CFS patients aged over 50 years were more than three times as likely to experience severe symptoms than those younger than 30 (OR 3.23, p = 0.031). Current smoking was associated with severe symptoms, increasing the risk by approximately three times (OR 2.93, p = 0.003) and those with household incomes of more than £15,000 per year were less likely to experience severe symptoms compared to those earning less than this (OR 0.31, p = 0.017). Cognitive and sleep symptoms are more common in ME/CFS patients than in MS patients and healthy controls, providing further support for existing evidence of central nervous system abnormalities in ME/CFS. Our findings suggest that people with ME/CFS who are smokers, or have a low income, are more likely to report severe cognitive and sleep symptoms. Future research should aim to develop strategies to prevent the progression of severe cognitive and sleep symptoms through early interventions that prioritise patients identified as being at highest risk.