Sleep-disordered breathing at an early stage of amyotrophic lateral sclerosis

Kimura, Kohji; Tachibana, Naoko; Kimura, Jun; Shibasaki, Hiroshi

doi:10.1016/s0022-510x(99)00044-1

Cited by 95 publications

(58 citation statements)

References 18 publications

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“…[4][5][6][7] In the presence of diaphragmatic dysfunction, REM sleep decreases. 8 Furthermore, sleep disturbances and nocturnal desaturations have been observed in ALS patients with normal respiratory function and preserved diaphragmatic innervation.…”

Section: Discussionmentioning

confidence: 99%

Noninvasive Ventilation Improves Sleep in Amyotrophic Lateral Sclerosis: A Prospective Polysomnographic Study

Vrijsen

Buyse

Belge

et al. 2015

Journal of Clinical Sleep Medicine

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Section: Discussionmentioning

confidence: 99%

Noninvasive Ventilation Improves Sleep in Amyotrophic Lateral Sclerosis: A Prospective Polysomnographic Study

Vrijsen

Buyse

Belge

et al. 2015

Journal of Clinical Sleep Medicine

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“…[3][4][5][6] The 2009 American Academy of Neurology Practice Parameter on ALS treatment recommended the use of NIV for patients demonstrating evidence of respiratory compromise. 7 A recent Cochrane Review also evaluated the effects of night-time mechanical ventilation in patients with neuromuscular or chest wall disorders, including patients with ALS.…”

Section: S C I E N T I F I C I N V E S T I G a T I O N Smentioning

confidence: 99%

Effects of Noninvasive Ventilation on Sleep Outcomes in Amyotrophic Lateral Sclerosis

Katzberg

Selegiman

Guion³

et al. 2013

Journal of Clinical Sleep Medicine

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ing respiratory dysfunction, the goal of this study is not to fi nd a new indication for NIV in ALS, but rather to better understand its effects on sleep outcomes and sleep disordered breathing. The specifi c study aims are to evaluate the effects of NIV on oxygenation, overall sleep quality and other parameters such as apnea index, sleep latency, arousals, and total sleep time. METHODS Study DesignWe performed a pilot, self-controlled study in patients with a confi rmed diagnosis of ALS who were starting noninvasive ventilation (NIV) for impaired respiratory or sleep function. Study Objectives:The objective was to study the effects on noninvasive ventilation on sleep outcomes in patient with ALS, specifi cally oxygenation and overall sleep quality. Methods: Patients with ALS who met criteria for initiation of NIV were studied with a series of 2 home PSG studies, one without NIV and a follow-up study while using NIV. Primary outcome was a change in the maximum overnight oxygen saturation; secondary outcomes included change in mean overnight oxygen saturation, apnea and hypopnea indexes, sleep latency, sleep effi ciency, sleep arousals, and sleep architecture. Results: A total of 94 patients with ALS were screened for eligibility; 15 were enrolled; and 12 completed study procedures. Maximum overnight oxygen saturation improved by 7.0% (p = 0.01) and by 6.7% during REM sleep (p = 0.02) with NIV. Time spent below 90% oxygen saturation was also signifi cantly better with NIV (30% vs 19%, p < 0.01), and there was trend for improvement in mean overnight saturation (1.5%, p = 0.06). Apnea index (3.7 to 0.7), hypopnea index (6.2 to 5.7), and apnea hypopnea index (9.8 to 6.3) did not signifi cantly improve after introducing NIV. NIV had no effect on sleep effi ciency (mean change 10%), arousal index (7 to 12), or sleep stage distribution (Friedman chi-squared = 0.40). Conclusions: NIV improved oxygenation but showed no signifi cant effects on sleep effi ciency, sleep arousals, restful sleep, or sleep architecture. The net impact of these changes for patients deserves further study in a larger group of ALS patients. S C I E N T I F I C I N V E S T I G A T I O N SS leep dysfunction is commonly seen in patients with amyotrophic lateral sclerosis (ALS) through a number of nonrespiratory (psychological stress, pain, cramps) and respiratory (sleep apnea, hypoventilation) mechanisms.1 Most sleep dysfunction occurs later in the course of the illness, particularly when diaphragmatic dysfunction occurs and respiratory compromise becomes evident.2 The mechanisms underlying respiratory dysfunction during sleep in ALS depend on multiple factors, including the disease stage and whether or not the diaphragm is involved.The most effective interventions for respiratory and sleep dysfunction in ALS include noninvasive ventilation (NIV), which has been shown to improve respiratory parameters, survival and quality of life.3-6 The 2009 American Academy of Neurology Practice Parameter on ALS treatment recommended the use of NIV for patients ...

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“…with bulbar involvement [3], diaphragmatic involvement [1] or in the presence [2] or absence [50] of respiratory and/or sleep-related symptoms. In the largest unselected cross-sectional study, GAY et al [4] reported a mean AHI of 11.3 events?h -1 in 21 subjects, of whom seven had an AHI w10.…”

Section: Amyotrophic Lateral Sclerosismentioning

confidence: 99%

“…However, the principal cause of nocturnal desaturation was hypoventilation. Comparing the PSG results of the various studies, the frequency of sleepdisordered breathing is very variable (16.7-76.5%), and appears to reflect the prevalence of respiratory and sleep-related symptoms, and to a lesser extent, the impairment of daytime respiratory function in the populations studied [2][3][4][5]50]. A similar variation is seen with the degree of disruption of sleep architecture [1,[3][4][5].…”

Section: Amyotrophic Lateral Sclerosismentioning

confidence: 99%

Sleep and breathing in neuromuscular disease

Bourke¹,

Gibson²

2002

European Respiratory Journal

150

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Respiratory muscle weakness in neuromuscular disease causes significant morbidity and mortality. The published data on respiratory muscle activity and breathing during sleep in normal subjects, the impact of respiratory muscle weakness on sleep and breathing and the relations to daytime respiratory function in neuromuscular disease are reviewed here. In normal subjects during sleep upper airway resistance increases, chemosensitivity is reduced and the wakefulness drive to breathe is lost, resulting in a fall in ventilation. During rapid eye movement (REM) sleep, ribcage and accessory breathing muscles are suppressed, particularly during bursts of eye movements, and breathing is more irregular, rapid and shallow, with a further fall in ventilation.In subjects with respiratory muscle weakness sleep is fragmented, with shorter total sleep time, frequent arousals, an increase in stage 1 sleep and a reduction in, or complete suppression of, REM sleep. Sleep-disordered breathing and nocturnal desaturation are common and most severe during REM sleep. Correlations between daytime respiratory function and nocturnal desaturation are moderate or weak, but daytime respiratory function has greater prognostic value than nocturnal measurements.Noninvasive ventilation improves sleep quality and breathing in subjects with respiratory muscle weakness. However, the optimal criteria for initiation of ventilation and its role in rapidly progressive neuromuscular diseases are unclear.

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Sleep-disordered breathing at an early stage of amyotrophic lateral sclerosis

Cited by 95 publications

References 18 publications

Noninvasive Ventilation Improves Sleep in Amyotrophic Lateral Sclerosis: A Prospective Polysomnographic Study

Noninvasive Ventilation Improves Sleep in Amyotrophic Lateral Sclerosis: A Prospective Polysomnographic Study

Effects of Noninvasive Ventilation on Sleep Outcomes in Amyotrophic Lateral Sclerosis

Sleep and breathing in neuromuscular disease

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