Impact of a ketogenic diet on sleep quality in people with relapsing multiple sclerosis

Abstract

Background: Sleep disturbance in MS is common and can significantly impair overall quality of life. The ketogenic diet (KD) associates with improved sleep quality in people living with epilepsy and may have similar benefits when used within MS; however, the impact of a KD on sleep in this population remains poorly defined.

Methods: Forty-five patients with relapsing MS enrolled into a 6-month KD intervention trial and completed self-reported assessments of sleep quality and sleep disorder symptoms prior to diet initiation and while on diet, using the Epworth Sleepiness Scale (ESS) and Sleep Disorders Symptom Checklist-25 (SDS). Participants who did not complete sleep assessments at baseline and 6-months were excluded from analysis. In addition to sleep metrics, data collection included anthropometrics and MS-related fatigue scores.

Results: Thirty-nine of 45 (87 %) participants completed the required sleep assessments. There was a mean reduction in ESS score of 1.90 (95 % CI [-2.85, -0.94], p < 0.001). Total SDS score decreased at 6-months on KD (-4.4, 95 % CI [-7.1, -1.7], p = 0.002), with improvements noted in insomnia (-1.55, 95 % CI [-2.66, -0.43], p = 0.008), obstructive sleep apnea (-0.91, 95 % CI [-1.57, -0.25], p = 0.008), and restless leg syndrome screening scores (-1.00, 95 % CI [-1.95, -0.051], p = 0.04). Sleep duration was unchanged on KD.

Conclusion: KD associates with improvements in daytime sleepiness, independent of sleep duration, and common comorbid sleep disorders in people living with relapsing MS. The findings herein support the benefits of KD on sleep quality and highlight the potential role of dietary therapeutics for sleep disorders in neurological disease.

Trial registration information: Registered on Clinicaltrials.gov under registration number NCT03718247, posted on Oct 24, 2018. First patient enrollment date: Nov 1, 2018. Link: https://clinicaltrials.gov/ct2/show/NCT03718247?term=NCT03718247&draw=2&rank=1.

Keywords: Apnea; Diet; Insomnia; Obesity; Restless leg; Sleep.

Figure 1.. Proportion of positive screens for sleep disorders for the study cohort per the ESS and SDS assessments.

Values represent % of the cohort with error bars representing standard error. Cutoffs were derived from receiver operating characteristic (ROC) curve inflections per Klingman et al. EDS= excessive daytime sleepiness; SDS= Sleep Disorders Symptom Checklist-25; OSA= SDS obstructive sleep apnea score; RLS= SDS restless leg syndrome score; CRD= SDS circadian rhythm disorder score. EDS was defined as an Epworth Sleepiness Scale (ESS) score of >10.

Figure 2.. Changes in SDS sub-scores from baseline to 6 months on-diet.

For graphical purposes, this plot represents the average change as a proportion of the baseline average. For example, the average insomnia score at baseline is 7.2 and the average change is −1.54, so the average change is: −1.54 / 7.2 = −0.21. SDS= Sleep Disorders Symptom Checklist-25; OSA= obstructive sleep apnea; RLS= restless leg syndrome; PLMD= periodic limb movement disorder.