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Clinical determinants of sleep quality in patients with amyotrophic lateral sclerosis

  • Epidemiology • Original Article
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Abstract

Objectives

Poor sleep quality is more prevalent in patients with amyotrophic lateral sclerosis (ALS) than in healthy populations. The purpose of this study was to examine whether or not motor dysfunction at various distinct levels correlates with subjective sleep quality.

Methods

Patients with ALS and controls were assessed using the Pittsburgh Sleep Quality Index (PSQI), ALS Functional Rating Scale Revised (ALSFRS-R), Beck Depression Inventory-II (BDI-II), and the Epworth Sleepiness Scale (ESS). The ALSFRS-R was used to obtain information on 12 different aspects of motor function in patients with ALS. We compared these data between the groups with poor and good sleep quality.

Results

A total of 92 patients with ALS and 92 age- and sex-matched controls entered the study. The global PSQI score was significantly higher in patients with ALS than in healthy subjects (5.5 ± 4.2 vs. 4.0 ± 2.8) and 44% of the patients with ALS had poor sleep quality (PSQI score > 5). The sleep duration, sleep efficiency, and sleep disturbances components were significantly worse in patients with ALS. Sleep quality (PSQI) score correlated with ALSFRS-R score, BDI-II score, and ESS score. Of the 12 ALSFRS-R functions, swallowing significantly affected sleep quality. Orthopnea, speech, salivation, dyspnea, and walking had a medium effect. In addition, turning in bed, climbing stairs, and dressing and hygiene were found to have a small effect on sleep quality among patients with ALS.

Conclusions

Nearly half of our patients had poor sleep quality related to disease severity, depression, and daytime sleepiness. Bulbar muscle dysfunction may be associated with sleep disturbances in individuals with ALS, particularly when swallowing is impaired. In addition, patients suffering from axial or lower limb muscle disruptions are likely to have trouble sleeping.

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Data availability

The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.

References

  1. Hardiman O, Al-Chalabi A, Chio A, Corr EM, Logroscino G, Robberecht W et al (2017) Amyotrophic lateral sclerosis. Nat Rev Dis Primers 3:17071. https://doi.org/10.1038/nrdp.2017.71

    Article  PubMed  Google Scholar 

  2. Masrori P, Van Damme P (2020) Amyotrophic lateral sclerosis: a clinical review. Eur J Neurol. 27(10):1918–1929. https://doi.org/10.1111/ene.14393

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  3. Arnulf I, Similowski T, Salachas F, Garma L, Mehiri S, Attali V et al (2000) Sleep disorders and diaphragmatic function in patients with amyotrophic lateral sclerosis. Am J Respir Crit Care Med 161(3):849–856

    Article  CAS  PubMed  Google Scholar 

  4. Atalaia A, De Carvalho M, Evangelista T, Pinto A (2007) Sleep characteristics of amyotrophic lateral sclerosis in patients with preserved diaphragmatic function. Amyotroph Lateral Scler 8(2):101–105. https://doi.org/10.1080/17482960601029883

    Article  PubMed  Google Scholar 

  5. Boentert M (2019) Sleep disturbances in patients with amyotrophic lateral sclerosis: current perspectives. Nature and science of sleep. 11:97–111. https://doi.org/10.2147/nss.S183504

    Article  PubMed  PubMed Central  Google Scholar 

  6. Coco DL, Mattaliano P, Spataro R, Mattaliano A, La Bella V (2011) Sleep–wake disturbances in patients with amyotrophic lateral sclerosis. J Neurol Neurosurg Psychiatry 82(8):839–842

    Article  PubMed  Google Scholar 

  7. Hetta J, Jansson I (1997) Sleep in patients with amyotrophic lateral sclerosis. J Neurol 244(1):S7–S9

    Article  CAS  PubMed  Google Scholar 

  8. Minz M, Autret A, Laffont F, Beillevaire T, Cathala HP, Castaigne P (1979) A study on sleep in amyotrophic lateral sclerosis. Biomedicine 30(1):40–46

    CAS  PubMed  Google Scholar 

  9. Liu S, Shen D, Tai H, Su N, Ding Q, Fu H et al (2018) Restless legs syndrome in Chinese patients with sporadic amyotrophic lateral sclerosis. Front Neurol 9:735. https://doi.org/10.3389/fneur.2018.00735

    Article  PubMed  PubMed Central  Google Scholar 

  10. Lo Coco D, Puligheddu M, Mattaliano P, Congiu P, Borghero G, Fantini ML et al (2017) REM sleep behavior disorder and periodic leg movements during sleep in ALS. Acta Neurol Scand 135(2):219–224. https://doi.org/10.1111/ane.12593

    Article  CAS  PubMed  Google Scholar 

  11. Diaz-Abad M, Buczyner JR, Venza BR, Scharf SM, Kwan JY, Lubinski B et al (2018) Poor sleep quality in patients with amyotrophic lateral sclerosis at the time of diagnosis. J Clin Neuromuscul Dis 20(2):60–68

    Article  PubMed  Google Scholar 

  12. Lou JS, Reeves A, Benice T, Sexton G (2003) Fatigue and depression are associated with poor quality of life in ALS. Neurology. 60(1):122–123. https://doi.org/10.1212/01.wnl.0000042781.22278.0a

    Article  PubMed  Google Scholar 

  13. Panda S, Gourie-Devi M, Sharma A (2018) Sleep disorders in amyotrophic lateral sclerosis: a questionnaire-based study from India. Neurol India 66(3):700

    Article  PubMed  Google Scholar 

  14. Brooks BR, Miller RG, Swash M, Munsat TL (2000) El Escorial revisited: revised criteria for the diagnosis of amyotrophic lateral sclerosis. Amyotroph Lateral Scler and other motor neuron disorders: official publication of the World Federation of Neurology, Research Group on Motor Neuron Diseases 1(5):293–299. https://doi.org/10.1080/146608200300079536

    Article  CAS  Google Scholar 

  15. Cedarbaum JM, Stambler N, Malta E, Fuller C, Hilt D, Thurmond B et al (1999) The ALSFRS-R: a revised ALS functional rating scale that incorporates assessments of respiratory function. BDNF ALS Study Group (Phase III). J Neurol Sci 169(1-2):13–21. https://doi.org/10.1016/s0022-510x(99)00210-5

    Article  CAS  PubMed  Google Scholar 

  16. Buysse DJ, Reynolds CF, Monk TH, Berman SR, Kupfer DJ (1989) The Pittsburgh sleep quality index: a new instrument for psychiatric practice and research. Psychiatry Res 28(2):193–213. https://doi.org/10.1016/0165-1781(89)90047-4

    Article  CAS  PubMed  Google Scholar 

  17. Johns MW (1991) A new method for measuring daytime sleepiness: the Epworth sleepiness scale. Sleep. 14(6):540–545. https://doi.org/10.1093/sleep/14.6.540

    Article  CAS  PubMed  Google Scholar 

  18. García-Batista ZE, Guerra-Peña K, Cano-Vindel A, Herrera-Martínez SX, Medrano LA (2018) Validity and reliability of the Beck Depression Inventory (BDI-II) in general and hospital population of Dominican Republic. PloS one 13(6):e0199750. https://doi.org/10.1371/journal.pone.0199750

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  19. Sullivan GM, Feinn R (2012) Using effect size-or why the P value is not enough. J Grad Med Educ 4(3):279–282. https://doi.org/10.4300/jgme-d-12-00156.1

    Article  PubMed  PubMed Central  Google Scholar 

  20. Liu S, Huang Y, Tai H, Zhang K, Wang Z, Shen D et al (2018) Excessive daytime sleepiness in Chinese patients with sporadic amyotrophic lateral sclerosis and its association with cognitive and behavioural impairments. J Neurol Neurosurg Psychiatry 89(10):1038–1043. https://doi.org/10.1136/jnnp-2018-318810

    Article  PubMed  Google Scholar 

  21. D’Cruz RF, Murphy PB, GJJoTD K (2018) Sleep disordered breathing in motor neurone disease. 2018:S86–S93

  22. Santos C, Braghiroli A, Mazzini L, Pratesi R, Oliveira LV, Mora G (2003) Sleep-related breathing disorders in amyotrophic lateral sclerosis. Monaldi Arch Chest Dis= Arch Monaldi Mal Torace 59(2):160–165

    CAS  Google Scholar 

  23. Boentert M, Glatz C, Helmle C, Okegwo A, Young P (2018) Prevalence of sleep apnoea and capnographic detection of nocturnal hypoventilation in amyotrophic lateral sclerosis. J Neurol Neurosurg Psychiatry 89(4):418–424. https://doi.org/10.1136/jnnp-2017-316515

    Article  PubMed  Google Scholar 

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Acknowledgements

We would like to thank the clinic staff for their efforts and our dear patients for their collaboration and tolerance.

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Authors and Affiliations

  1. Iranian Center of Neurological Research, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran

    Ali Goudarzi, Elmira Agah, Mahsa Ghajarzadeh, Maryam Rashidi Jazani & Payam Sarraf

  2. Department of Neuromuscular Disorders, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran

    Maryam Rashidi Jazani & Payam Sarraf

Authors
  1. Ali Goudarzi
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  2. Elmira Agah
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  3. Mahsa Ghajarzadeh
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  4. Maryam Rashidi Jazani
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  5. Payam Sarraf
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Corresponding authors

Correspondence to Ali Goudarzi or Payam Sarraf.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the research ethics committee of Tehran University of Medical Sciences (TUMS) and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Informed consent was obtained from all individual participants included in the study.

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The authors declare no competing interests.

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Goudarzi, A., Agah, E., Ghajarzadeh, M. et al. Clinical determinants of sleep quality in patients with amyotrophic lateral sclerosis. Sleep Breath 27, 2517–2522 (2023). https://doi.org/10.1007/s11325-023-02853-w

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  • DOI: https://doi.org/10.1007/s11325-023-02853-w

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