Sleep-disordered breathing at an early stage of amyotrophic lateral sclerosis
Introduction
Neuromuscular diseases of various etiologies are often accompanied by respiratory disturbance due to weakness of the respiratory muscles [21]. Patients mildly affected by these diseases may show respiratory disturbance only during sleep or sleep-disordered breathing (SDB) while they still manifest no clinical signs of respiratory dysfunction in the daytime [16], [18]. SDB was observed also in patients with amyotrophic lateral sclerosis (ALS) who presented with advanced bulbar symptoms or respiratory muscle weakness [7], [8]. These previous studies, however, dealt with ALS patients at different clinical stages or at various lengths of time after the clinical onset, and furthermore those patients lacked detailed neurological information. In patients with ALS at an early clinical stage in particular, monitoring of respiratory function during sleep has not been reported to our knowledge.
In ALS, not only the muscles subserving inspiration and/or expiration itself but also those involved in bulbar function may cause SDB when affected. For example, bulbar involvement with brainstem infarction influences the incidence and severity of SDB [1]. In this study, therefore, in order to evaluate the respiratory function during sleep in patients at an early stage of ALS presenting no daytime respiratory symptoms, we investigated the occurrence and degree of SDB by using a multi-parameter EdenTrace II recorder. The data were analyzed with special emphasis being placed on the presence or absence of bulbar symptoms.
Section snippets
Subjects and methods
We studied 18 patients with ALS (seven women and 11 men) who were at an early clinical stage and had no respiratory complaints or subjective symptoms of sleep disturbance. Their age ranged from 45 to 75 years (mean±SD, 57.6±8.1 years). All of them were admitted to our hospital for neurological evaluation between January 1996 and July 1997. Inclusion criteria were: firstly, they suffered from definite or probable ALS according to the diagnostic criteria (see below) and, secondly, they were
Results
The patients consisted of 11 bulbar and seven non-bulbar patients according to the above criteria. None of the patients had respiratory complaints or subjective symptoms of sleep disturbance. All were normotensive with a normal electrocardiogram, and had no history of cardiovascular diseases. The age of the bulbar and non-bulbar group ranged from 46 to 68 years (mean±SD, 58.2±7.3) and from 45 to 75 years (56.6±9.8), respectively. The duration of illness from the onset of clinical symptoms to
Discussion
The advantage of using ambulatory equipment like that used in the present study is that it enables us to study a substantial number of neurological patients, especially in circumstances where a full polysomnographic (PSG) study is unable to be performed routinely due to lack of laboratory technicians. Although the ambulatory equipment precludes us from monitoring EEG, electrooculogram and chin electoromyogram, all of which are essential for sleep staging, a high level of agreement was
Acknowledgements
The authors are grateful to Dr Motoharu Ohi and Dr Kazuo Chin of the Chest Disease Research Institute of Kyoto University for their advice on pulmonary function tests. This study was partly supported by Grants-in-Aid for Scientific Research (A) 09308031 and (A) 08558083, and for Scientific Research on Priority Areas 08279106 from the Japan Ministry of Education, Science, Sports and Culture, Research for the Future Program from the Japan Society for the Promotion of Science JSPS-RFTF97L00201,
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