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Polysomnographic studies in amyotrophic lateral sclerosis
W S David1, S R Bundlie, Z Mahdavi
1Department of Neurology, Hennepin County Medical Center, Minneapolis, MN 55415, USA.
Journal of the Neurological Sciences
|January 7, 1998
Summary
Polysomnography (PSG) in amyotrophic lateral sclerosis (ALS) patients reveals frequent sleep disturbances, particularly in those with orthopnea and daytime sleepiness. Bi-level positive airway pressure (PAP) treatment offers significant benefits for these patients.
Area of Science:
- Neurology
- Pulmonology
- Sleep Medicine
Background:
- Amyotrophic lateral sclerosis (ALS) is a progressive neurodegenerative disease affecting motor neurons.
- Sleep disturbances are common in ALS patients, impacting quality of life and potentially disease progression.
- Understanding sleep disordered events is crucial for managing ALS symptoms and treatment response.
Purpose of the Study:
- To investigate the prevalence and types of sleep disordered events in symptomatic ALS patients using polysomnography (PSG).
- To correlate PSG findings with pulmonary function tests (PFTs), clinical complaints, bulbar dysfunction, and response to bi-level positive airway pressure (PAP) therapy.
- To determine the utility of PSG in guiding treatment decisions for ALS-related sleep issues.
Main Methods:
- Retrospective review of 17 polysomnograms (PSG) from symptomatic ALS patients.
- Analysis of sleep disordered events, correlating them with pulmonary function tests (forced vital capacity [FVC], negative inspiratory force [NIF]), presenting complaints (orthopnea, daytime sleepiness, morning headaches), and bulbar dysfunction.
- Assessment of patient response to bi-level PAP treatment.
Main Results:
- PSG revealed sleep abnormalities in 16 out of 17 ALS patients.
- Orthopnea, daytime sleepiness, and low negative inspiratory force (NIF) were associated with sleep disruption.
- Neither FVC nor NIF reliably predicted specific PSG findings, but 12 of 13 treated patients showed favorable response to bi-level PAP.
Conclusions:
- Sleep disturbances are highly prevalent in symptomatic ALS patients.
- Clinical features like orthopnea and daytime sleepiness, along with reduced NIF, suggest potential sleep disruption.
- Polysomnography is a valuable tool for identifying sleep disorders in ALS, and bi-level PAP therapy is often effective, warranting consideration for PSG in affected individuals.