Noninvasive ventilation improves sleep in amyotrophic lateral sclerosis: a prospective polysomnographic study.
STUDY OBJECTIVE
To evaluate the effects of noninvasive ventilation (NIV) on sleep in patients with amyotrophic lateral sclerosis (ALS) after meticulous titration with polysomnography (PSG).


METHODS
In this prospective observational study, 24 ALS patients were admitted to the sleep laboratory during 4 nights for in-hospital NIV titration with PSG and nocturnal capnography. Questionnaires were used to assess subjective sleep quality and quality of life (QoL). Patients were readmitted after one month.


RESULTS
In the total group, slow wave sleep and REM sleep increased and the arousal-awakening index improved. The group without bulbar involvement (non-bulbar) showed the same improvements, together with an increase in sleep efficiency. Nocturnal oxygen and carbon dioxide levels improved in the total and non-bulbar group. Except for oxygen saturation during REM sleep, no improvement in respiratory function or sleep structure was found in bulbar patients. However, these patients showed less room for improvement. Patient-reported outcomes showed improvement in sleep quality and QoL for the total and non-bulbar group, while bulbar patients only reported improvements in very few subscores.


CONCLUSIONS
This study shows an improvement of sleep architecture, carbon dioxide, and nocturnal oxygen saturation at the end of NIV titration and after one month of NIV in ALS patients. More studies are needed to identify the appropriate time to start NIV in bulbar patients. Our results suggest that accurate titration of NIV by PSG improves sleep quality.


COMMENTARY
A commentary on this article appears in this issue on page 511.
['Vrijsen|Bart|B|', 'Buyse|Bertien|B|', 'Belge|Catharina|C|', 'Robberecht|Wim|W|', 'Van Damme|Philip|P|', 'Decramer|Marc|M|', 'Testelmans|Dries|D|']
D000690:Amyotrophic Lateral Sclerosis D005260:Female D006801:Humans D008297:Male D008875:Middle Aged D063087:Noninvasive Ventilation D017286:Polysomnography D011446:Prospective Studies D011788:Quality of Life D012890:Sleep D012893:Sleep Wake Disorders D011795:Surveys and Questionnaires D016896:Treatment Outcome
noninvasive ventilation amyotrophic lateral sclerosis polysomnography sleep architecture