High prevalence of low arousal threshold endotype in obstructive sleep apnea with multiple sclerosis.

Jacob A Sloane, Ina Djonlagic, Vikrum Singh, Ursela Baber, Rikka Azuma, Nara Michaelson

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Article in Sleep & breathing = Schlaf & Atmung, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

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6 authors.

Jacob A SloaneDepartment of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA. jsloane@bidmc.harvard.edu.ORCID http://orcid.org/0000-0003-0028-3031

Ina DjonlagicDepartment of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.

Vikrum SinghDepartment of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.

Ursela BaberDepartment of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.

Rikka AzumaDepartment of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.

Nara MichaelsonDepartment of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.

Funding

National Multiple Sclerosis Society National Multiple Sclerosis Society

6 · The paper itself

Abstract

purposeWe sought to estimate the prevalence of low arousal threshold (LAT) in individuals with multiple sclerosis (MS).

methodsWe conducted a retrospective non-matched study of individuals with documented MS as well as non-MS controls who were diagnosed with obstructive sleep apnea (OSA). Demographic, clinical characteristics, and polysomnographic measurements were extracted from the medical records. LAT was estimated from overnight polysomnography and defined as 2 or more of the following conditions: apnea-hypopnea index (AHI) < 30 events/hour, minimum oxygen saturation > 82.5%, or frequency of hypopnea events > 58.3%. A multivariate analysis was conducted to assess predictors of LAT.

resultsLAT was identified in 87.5% of 64 patients with MS and OSA, which was significantly higher than OSA controls (71.4%). On univariate analysis, LAT was significantly associated with MS status, sex, and BMI. With logistic regression, only sex (OR 3.2, 95% CI 1.2-9.7, p = 0.03) and BMI (OR 0.87, 95% CI 0.80-0.94, p = 0.0007) were associated with LAT, although MS status trended towards significance (OR 2.64, 95% CI 0.91-8.51, p = 0.084). Without sex in analysis, MS status was significantly associated with LAT (OR 3.34, 95% CI 1.21-10.4, p = 0.026). Stratifying by OSA severity indicated that differences in LAT were even more pronounced in severe OSA, with 55.5% MS versus 20.8% non-MS exhibiting LAT.

conclusionThe estimated prevalence of LAT endotype is high in MS-OSA patients, significantly exceeding rates in non-MS controls, but female sex and lower BMI are the dominant predictors. Because sex strongly confounds the relationship between MS and LAT, whether MS independently contributes to LAT beyond its demographic profile requires larger, sex-matched cohorts.

Indexed as

ArousalMultiple SclerosisSleep Apnea, ObstructiveSleep Arousal DisordersAdultBody Mass IndexComorbidityFemaleHumansMaleMiddle AgedPolysomnographyRetrospective StudiesEndotypeLow arousal thresholdMultiple sclerosisObstructive sleep apnea

Identifiers

PMID42667478

DOI10.1007/s11325-026-03788-8

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.