Sleep disorders in a cohort of Amyotrophic Lateral Sclerosis patients

Amyotrophic Lateral Sclerosis (ALS) is a progressive neurodegenerative disease involving ultimately the respiratory muscles, resulting in alveolar hypoventilation and the need for ventilatory support. The aim was to evaluate sleep disturbances in a cohort of ALS patients, regardless of the disease stage. We retrospectively reviewed a group of 34 patients, collecting demographic and biometric parameters, lung and muscular function data, polysomnography with capnography and arterial blood gases analyze performed on average 12 months after diagnosis. Statistical analysis by SPSS 24 version. The studied patient sample was predominantly male gender (n=23/67.6%) and with bulbar onset (n=18/52.9%); mean age was 64 years (Max.83; Min.30) and mean body mass index (BMI) of 26 kg/m2. The mean FVC was 78.6% (Max.124; Min. 15) and the mean PImax was 43 cmH2O (Max.120; Min.3). A total of 5 subjects (14.7%) presented with diurnal hypercapnia. The majority of patients (n=34/97%) had sleep disturbances with decreased REM sleep and frequent arousals (17.9 arousals per hour), and an average sleep efficiency of 43.7% (Max.92.8%; Min.14.7%). Twenty-three patients (67.4%) presented with obstructive sleep apnea (OSA). Only 5 subjects (14.7%) reported excessive daytime sleepiness (Epworth>10). Twenty-one patients have been ventilated with positive pressure, continuous in 4 of them and ventilatory support in sixteen ALS patients. The 5-year mortality was 70.6%. This study suggests that sleep disturbances may be present in ALS patients, even with conserved lung function and without sleepiness. Obstructive events should be solved, even with ventilatory support to correct the nocturnal hypoventilation or obstructive events.