Disturbances in night-time sleep and daytime sleepiness in patients with amyotrophic lateral sclerosis

The main manifestations of amyotrophic lateral sclerosis (ALS) are traditionally associated with progressive motor impairments; however, nonmotor symptoms – in particular, sleep disturbances and daytime sleepiness – play a significant role in the clinical picture of the disease.

Objective: to analyse the prevalence and clinical characteristics of sleep disturbances and daytime sleepiness in patients with ALS.

Material and methods. A total of 53 patients with a confirmed diagnosis of ALS were examined; 64% were men, with a median age of 62 [54; 70.5] years. The quality of night-time sleep was assessed using the Pittsburgh Sleep Quality Index (PSQI), and daytime sleepiness using the Epworth Sleepiness Scale (ESS). Disease characteristics were recorded, as well as the severity of symptoms of autonomic dysfunction and urodynamic disorders, psycho-emotional disorders, pain syndromes and hypersalivation.

Results. Impaired night-time sleep quality was observed in 31 patients (58.5%), and excessive daytime sleepiness in 23 (41.1%). The most common causes of night-time awakenings were nocturia (79.2%), thermal discomfort (41.5%) and unpleasant dreams (41.5%). Independent predictors of reduced sleep quality in ALS were the severity of urinary disorders as measured by the UDI-6 (β=0.326; p=0.011) and symptoms of autonomic dysfunction (β=0.275; p=0.036). An independent predictor of daytime sleepiness was the severity of functional deficit as measured by the ALSFRS-R (β=-0.357; p=0.009).

Conslusion. In patients with ALS, sleep disturbances and daytime sleepiness are common and are associated with functional deficits, as well as urodynamic, autonomic and affective disorders. The findings suggest that these conditions should be actively identified as part of a comprehensive clinical assessment of patients with ALS.

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