Institute of Biomedicine and Molecular Immunology, Italian National Research Council, Via Ugo La Malfa, 153 90146, Palermo, Italy.
Regional Center for Prevention and Treatment of Respiratory Complications of Rare Genetic Neuromuscular Diseases, Villa Sofia-Cervello Hospital, Palermo, Italy.
Sleep Breath. 2019 Jun;23(2):433-438. doi: 10.1007/s11325-018-1699-2. Epub 2018 Jul 24.
The study aims to evaluate the performance of autonomic activations as a tool to assess sleep fragmentation and to recognize hypopneas in patients with amyotrophic lateral sclerosis (ALS) under non-invasive mechanical ventilation and secondarily, to evaluate, in patients with the same disease, the relationship between disruption of autonomic nervous system (ANS) activity and the usefulness of the autonomic activations as surrogates of cortical arousals.
Sixteen ALS patients underwent simultaneous polysomnography and portable cardiorespiratory monitoring (PM). On the polysomnography, standard rules were used for scoring arousals and respiratory events. On the PM, autonomic arousals were scored as ≥ 15% heart rate (HR) increase with a ≥ 35% pulse wave amplitude (PWA) reduction, HR increase ≥ 20%, or PWA decrease ≥ 40%. Nocturnal HR variability was analyzed in the ALS patients and in 11 control subjects as an index of ANS activity.
Synchronized epoch by epoch analysis of the polysomnography and PM recordings showed that only 31.0 (22.5-58.7)% cortical and 36.1 (20.5-47.2)% autonomic arousals were associated with one another. Among hypopneas scored at polysomnography, 71.7% were associated with a cortical arousal but not with a desaturation. On average, HR variability in ALS showed signs of depressed ANS activity that was particularly evident in the patients where the cortical arousals exceeded the autonomic ones.
In ventilated ALS patients, autonomic activations may hardly have a role as surrogates of cortical arousals for assessment of sleep fragmentation and for respiratory scoring. Depression of ANS activity may be related to their poor performance.
本研究旨在评估自主激活作为评估睡眠碎片化和识别肌萎缩侧索硬化（ALS）患者无创机械通气下呼吸暂停的工具的性能，其次，评估同一疾病患者中，自主神经系统（ANS）活动中断与自主激活作为皮质唤醒替代物的有用性之间的关系。
16 名 ALS 患者同时进行多导睡眠图和便携式心肺监测（PM）。在多导睡眠图上，使用标准规则对唤醒和呼吸事件进行评分。在 PM 上，自主唤醒被定义为心率（HR）增加≥15%，脉搏波幅度（PWA）降低≥35%，HR 增加≥20%或 PWA 降低≥40%。分析 ALS 患者和 11 名对照受试者的夜间 HR 变异性作为 ANS 活动的指标。
多导睡眠图和 PM 记录的逐时同步分析表明，只有 31.0%（22.5-58.7%）皮质唤醒和 36.1%（20.5-47.2%）自主唤醒相互关联。在多导睡眠图上评分的呼吸暂停中，71.7%与皮质唤醒相关，但与饱和度降低无关。平均而言，ALS 中的 HR 变异性显示出自主神经活动抑制的迹象，在皮质唤醒超过自主唤醒的患者中尤其明显。
在接受通气治疗的 ALS 患者中，自主激活可能难以作为皮质唤醒的替代物，用于评估睡眠碎片化和呼吸评分。ANS 活动的抑制可能与其性能不佳有关。
