Sleep Disorders and Diaphragmatic Function in Patients with Amyotrophic Lateral Sclerosis

Arnulf, Isabelle; Similowski, Thomas; Salachas, François; Garma, L; Mehiri, S.; Attali, Valérie; Behin-Bellhesen, Valerie; Meininger, Vincent; Derenne, Jean‐Philippe

doi:10.1164/ajrccm.161.3.9805008

Cited by 226 publications

(137 citation statements)

References 36 publications

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“…23,24 One explanation for this may be accessory muscle atonia, which occurs during REM sleep when the already weak diaphragm is the only functional respiratory muscle and when NIV can best support breathing and improve oxygenation. 25,26 We found that half of our patients were not able to achieve REM sleep. In those who were, NIV had greatest effects on oxygenation in this stage of sleep.…”

mentioning

confidence: 76%

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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mentioning

confidence: 76%

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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“…[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. 9 Although NIV is predominantly used at night, few studies have examined the effect on sleep in ALS.…”

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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“…Out of a wide range of tests of respiratory muscle strength, the nonvolitional CMS Pdi,tw had the strongest correlations with indices of sleep-disordered breathing, including significant negative relationships with AHI, hypopnoeas during rapid eye movement (REM) sleep and hypopnoeas during non-REM sleep. ARNULF et al [84] have shown that ALS patients with diaphragmatic dysfunction have reduced time spent in REM sleep, and dramatically shorter median survival times compared with patients without diaphragm dysfunction (217 days versus 619 days). The same group also demonstrated that ALS patients with dyspnoea had significantly lower Pmo,tw following phrenic nerve stimulation than those without dyspnoea (3.71 versus 7.26 cmH 2 O; p=0.001) [85].…”

Section: Neuromuscular Diseasementioning

confidence: 99%

Magnetic stimulation for the measurement of respiratory and skeletal muscle function

Man¹

2004

European Respiratory Journal

117

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Respiratory and skeletal muscle function is of interest in many areas of pulmonary and critical care medicine. The capacity of the respiratory muscle pump to respond to the load imposed by disease is the basis of an understanding of ventilatory failure. Over the last four decades, considerable progress has been made in quantifying the capacity of the respiratory muscles, in terms of strength, endurance and fatigue. With the development of magnetic stimulation, it has recently become possible to nonvolitionally assess the respiratory muscles in a clinically acceptable way. This is of particular interest in the investigation of patients receiving critical care, those with neuromuscular disease, and in children where volitional efforts are either not possible or likely to be sub-maximal. Furthermore, the adaptation of these techniques to quantify the strength of peripheral muscles, such as the quadriceps, has allowed the effects of muscle training or rehabilitation, uninfluenced by learning effect, to be assessed. This article focuses on the physiological basis of magnetic nerve stimulation, and reviews how the technique has been applied to measure muscle strength and fatigue, with particular emphasis upon the diaphragm. The translation of magnetic stimulation into a clinical tool is described, and how it may be of diagnostic, prognostic and therapeutic value in several areas of pulmonary medicine. In particular, the use of magnetic stimulation in neuromuscular disease, the intensive care setting, chronic obstructive pulmonary disease and paediatrics will be discussed. The nonvolitional assessment of skeletal musclesFor routine muscle strength measurements, the force generated from a maximum voluntary contraction (MVC) is often used. However volitional, effort-dependent manoeuvres for measuring strength are not always suitable for patients as the ability to perform a true MVC relies upon subject motivation and cooperation. This is particularly so in patients on intensive care units (ICU), children, patients with cognitive difficulties, and those patients prevented from performing a true MVC by pain (for example, following surgery). However, even in well-motivated subjects, sub-maximal muscle activation is common in routine clinical practice [1]. As volitional manoeuvres are influenced by a learning effect, the value of MVC is also limited in studies of training or rehabilitation. Consequently, there has been a need for nonvolitional methods to assess muscle strength. Skeletal muscle physiologySkeletal muscle is controlled by electrical impulses conducted by motor neurones that lead to the release of acetylcholine from the motor end plate, thus depolarising the muscle cell membrane. The force generated by muscle contraction is dependent upon a number of factors, including the number of muscle fibres stimulated, muscle length at the time of stimulation and the frequency of stimulation. The force-frequency curve of a muscle is of particular relevance in the understanding of nonvolitional techniques to asse...

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Sleep Disorders and Diaphragmatic Function in Patients with Amyotrophic Lateral Sclerosis

Cited by 226 publications

References 36 publications

Effects of Noninvasive Ventilation on Sleep Outcomes in Amyotrophic Lateral Sclerosis

Effects of Noninvasive Ventilation on Sleep Outcomes in Amyotrophic Lateral Sclerosis

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

Magnetic stimulation for the measurement of respiratory and skeletal muscle function

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