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| NI FEATURE: THE EDITORIAL DEBATE II-- PROS AND CONS |
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| Year : 2018 | Volume
: 66
| Issue : 3 | Page : 666 |
Sleep in amyotrophic lateral sclerosis
Prahlad K Sethi1, Nitin K Sethi2
1 Department of Neurology, Sir Ganga Ram Hospital, Rajinder Nagar, New Delhi, India
2 Department of Neurology, New York-Presbyterian Hospital, Weill Cornell Medical Center, New York, NY, United States of America
| Date of Web Publication | 15-May-2018 |
Correspondence Address:
Dr. Prahlad K Sethi
Department of Neurology, Sir Ganga Ram Hospital, Rajinder Nagar, New Delhi- 110060
India
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/0028-3886.232305
How to cite this article:
Sethi PK, Sethi NK. Sleep in amyotrophic lateral sclerosis. Neurol India 2018;66:666 |
Amyotrophic lateral sclerosis (ALS) is a common disease with an annual incidence rate of 0.4 to 1.76 per 100,000 population occurring in a random pattern throughout the world with men more frequently being affected than women. ALS is a progressive degenerative disorder of motor neurons in the spinal cord, brainstem and motor cortex, leading to progressive muscular weakness, atrophy and bulbar dysfunction when brainstem motor neurons are affected.[1] There is a paucity of studies highlighting sleep disorders in patients with amyotrophic lateral sclerosis (ALS). Hetta et al., reported sleep disorders such as restless leg syndrome (RLS), increased myoclonic activity, sleep disordered breathing (hypoventilation) causing sleep onset and sleep maintenance insomnia, possibly contributing to daytime fatigue and poor quality of life in these patients.[2] Takekawa et al., reported a patient who was diagnosed with ALS when he was evaluated for complaints of insomnia and nocturnal dyspnea. Polysomnography revealed severe REM sleep hypoxia, shortened REM sleep stages and disorganized sleep architecture. Daytime and nocturnal hypoxia responded to non-invasive bi-level positive airway pressure therapy.[3] Likhachev et al., studied 29 patients with an established diagnosis of ALS (mean illness duration was 12 months) and found increased level of awake time, decrease in deep sleep and REM sleep. Presence of sleep disordered breathing (alveolar hypoventilation syndrome and obstructive sleep apnea) was also increased as compared to controls.[4] Panda et al., are to be lauded for their questionnaire based study which provides valuable insights into the presence of sleep disorders in Indian patients with ALS.[5] Poor sleep was the most common complaint and excessive daytime sleepiness emerged as an independent predictor for the presence of sleep disorders in ALS patients. Further studies preferably with polysomnographic correlation are needed to identify the true presence of sleep disorders in ALS patients. In the interim period, we physicians should proactively enquire about sleep disorders in our ALS patients, as treatment of these disorders can improve the quality of life of these patients.
| » References | |  |
| 1. | Victor M, Ropper AH. Adams and Victor's Principles of Neurology. 7 th Edition. McGraw-Hill publishing house.  |
| 2. | Hetta J, Jansson I. Sleep in patients with amyotrophic lateral sclerosis. J Neurol. 1997;244(4 Suppl 1):S7-9. |
| 3. | Takekawa H, Kubo J, Miyamoto T, Miyamoto M, Hirata K. Amyotrophic lateral sclerosis associated with insomnia and the aggravation of sleep-disordered breathing. Psychiatry Clin Neurosci. 2001;55:263-4. |
| 4. | Likhachev SA, Rushkevich YN, Abelskaia IS, Chechik NM, Merkul OV. Polysomnography in patients with amyotrophic lateral sclerosis. Zh Nevrol Psikhiatr Im S S Korsakova. 2016;116:37-41. |
| 5. | Panda S, Gourie-Devi M, Sharma A. Sleep disorders in amyotrophic lateral sclerosis: A questionnaire-based study from India. Neurol India 2018;66:700-8. [Full text] |
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