Grazia Crescimanno1,2, Francesca Greco3, Salvatore Arrisicato4, Oreste Marrone5. 1. Institute of Biomedicine and Molecular Immunology, Italian National Research Council, Via Ugo La Malfa, 153 90146, Palermo, Italy. grazia.crescimanno@ibim.cnr.it. 2. Regional Center for Prevention and Treatment of Respiratory Complications of Rare Genetic Neuromuscular Diseases, Villa Sofia-Cervello Hospital, Palermo, Italy. grazia.crescimanno@ibim.cnr.it. 3. Italian Union Against Muscular Dystrophy (UILDM), Section of Palermo, Palermo, Italy. 4. Regional Center for Prevention and Treatment of Respiratory Complications of Rare Genetic Neuromuscular Diseases, Villa Sofia-Cervello Hospital, Palermo, Italy. 5. Institute of Biomedicine and Molecular Immunology, Italian National Research Council, Via Ugo La Malfa, 153 90146, Palermo, Italy.
Abstract
PURPOSE: The study aims to evaluate the performance of autonomic activations as a tool to assess sleep fragmentation and to recognize hypopneas in patients with amyotrophic lateral sclerosis (ALS) under non-invasive mechanical ventilation and secondarily, to evaluate, in patients with the same disease, the relationship between disruption of autonomic nervous system (ANS) activity and the usefulness of the autonomic activations as surrogates of cortical arousals. METHODS: Sixteen ALS patients underwent simultaneous polysomnography and portable cardiorespiratory monitoring (PM). On the polysomnography, standard rules were used for scoring arousals and respiratory events. On the PM, autonomic arousals were scored as ≥ 15% heart rate (HR) increase with a ≥ 35% pulse wave amplitude (PWA) reduction, HR increase ≥ 20%, or PWA decrease ≥ 40%. Nocturnal HR variability was analyzed in the ALS patients and in 11 control subjects as an index of ANS activity. RESULTS: Synchronized epoch by epoch analysis of the polysomnography and PM recordings showed that only 31.0 (22.5-58.7)% cortical and 36.1 (20.5-47.2)% autonomic arousals were associated with one another. Among hypopneas scored at polysomnography, 71.7% were associated with a cortical arousal but not with a desaturation. On average, HR variability in ALS showed signs of depressed ANS activity that was particularly evident in the patients where the cortical arousals exceeded the autonomic ones. CONCLUSIONS: In ventilated ALS patients, autonomic activations may hardly have a role as surrogates of cortical arousals for assessment of sleep fragmentation and for respiratory scoring. Depression of ANS activity may be related to their poor performance.
PURPOSE: The study aims to evaluate the performance of autonomic activations as a tool to assess sleep fragmentation and to recognize hypopneas in patients with amyotrophic lateral sclerosis (ALS) under non-invasive mechanical ventilation and secondarily, to evaluate, in patients with the same disease, the relationship between disruption of autonomic nervous system (ANS) activity and the usefulness of the autonomic activations as surrogates of cortical arousals. METHODS: Sixteen ALSpatients underwent simultaneous polysomnography and portable cardiorespiratory monitoring (PM). On the polysomnography, standard rules were used for scoring arousals and respiratory events. On the PM, autonomic arousals were scored as ≥ 15% heart rate (HR) increase with a ≥ 35% pulse wave amplitude (PWA) reduction, HR increase ≥ 20%, or PWA decrease ≥ 40%. Nocturnal HR variability was analyzed in the ALSpatients and in 11 control subjects as an index of ANS activity. RESULTS: Synchronized epoch by epoch analysis of the polysomnography and PM recordings showed that only 31.0 (22.5-58.7)% cortical and 36.1 (20.5-47.2)% autonomic arousals were associated with one another. Among hypopneas scored at polysomnography, 71.7% were associated with a cortical arousal but not with a desaturation. On average, HR variability in ALS showed signs of depressed ANS activity that was particularly evident in the patients where the cortical arousals exceeded the autonomic ones. CONCLUSIONS: In ventilated ALSpatients, autonomic activations may hardly have a role as surrogates of cortical arousals for assessment of sleep fragmentation and for respiratory scoring. Depression of ANS activity may be related to their poor performance.
Authors: Richard B Berry; Alejandro Chediak; Lee K Brown; Jonathan Finder; David Gozal; Conrad Iber; Clete A Kushida; Timothy Morgenthaler; James A Rowley; Sally L Davidson-Ward Journal: J Clin Sleep Med Date: 2010-10-15 Impact factor: 4.062
Authors: José Haba-Rubio; Georges Darbellay; François R Herrmann; Jean G Frey; Alda Fernandes; Jean M Vesin; Jean P Thiran; Jean M Tschopp Journal: Sleep Breath Date: 2005-06 Impact factor: 2.816
Authors: M Toepfer; C Folwaczny; A Klauser; R L Riepl; W Müller-Felber; D Pongratz Journal: Amyotroph Lateral Scler Other Motor Neuron Disord Date: 1999-12