Sleep Disorders Center, Department of Medical Science and Public Health, University of Cagliari, Monserrato, Cagliari, Italy.
Division of Sleep and Circadian Disorders, Brigham and Women's Hospital and Division of Sleep Medicine, Harvard Medical School, Boston, MA 02115, USA.
Sleep. 2019 Oct 21;42(11). doi: 10.1093/sleep/zsz164.
Amyotrophic lateral sclerosis (ALS) is a progressive neurodegenerative disease due to loss of motor neurons. However, the autonomic nervous system (ANS) can also be involved. The aim of this research was to assess the sleep macro- and microstructure, the cardiac ANS during sleep, and the relationships between sleep, autonomic features, and clinical parameters in a cohort of ALS patients.
Forty-two consecutive ALS patients underwent clinical evaluation and full-night video-polysomnography. Only 31 patients met inclusion criteria (absence of comorbidities, intake of cardioactive drugs, or recording artifacts) and were selected for assessment of sleep parameters, including cyclic alternating pattern (CAP) and heart rate variability (HRV). Subjective sleep quality and daytime vigilance were also assessed using specific questionnaires.
Although sleep was subjectively perceived as satisfactory, compared with age- and sex-matched healthy controls, ALS patients showed significant sleep alteration: decreased total sleep time and sleep efficiency, increased nocturnal awakenings, inverted stage 1 (N1)/stage 3 (N3) ratio, reduced REM sleep, and decreased CAP rate, the latter supported by lower amounts of A phases with an inverted A1/A3 ratio. Moreover, a significant reduction in HRV parameters was observed during all sleep stages, indicative of impaired autonomic oscillations.
Our results indicate that sleep is significantly disrupted in ALS patients despite its subjective perception. Moreover, electroencephalogram activity and autonomic functions are less reactive, as shown by a decreased CAP rate and a reduction in HRV features, reflecting an unbalanced autonomic modulation.
肌萎缩侧索硬化症（ALS）是一种由于运动神经元丧失导致的进行性神经退行性疾病。然而，自主神经系统（ANS）也可能受到影响。本研究旨在评估一组 ALS 患者的睡眠宏观和微观结构、睡眠期间心脏自主神经系统（ANS）以及睡眠、自主特征和临床参数之间的关系。
42 例连续 ALS 患者接受了临床评估和整夜视频多导睡眠图检查。只有 31 例符合纳入标准（无合并症、服用影响心脏的药物或记录伪迹）的患者被选择用于评估睡眠参数，包括周期性交替模式（CAP）和心率变异性（HRV）。还使用特定问卷评估了主观睡眠质量和白天警觉性。
尽管与年龄和性别匹配的健康对照组相比，ALS 患者的睡眠被主观认为是满意的，但他们表现出明显的睡眠改变：总睡眠时间和睡眠效率降低，夜间觉醒次数增加，1 期（N1）/3 期（N3）比值倒置，快速眼动（REM）睡眠减少，CAP 率降低，后者支持 A 期数量减少，A1/A3 比值倒置。此外，在所有睡眠阶段均观察到 HRV 参数显著降低，表明自主神经振荡受损。
尽管患者的主观感知是满意的，但我们的研究结果表明 ALS 患者的睡眠受到明显干扰。此外，脑电图活动和自主功能反应性降低，表现为 CAP 率降低和 HRV 特征减少，反映出自主调节失衡。
