Preview

Neurology, Neuropsychiatry, Psychosomatics

Advanced search

The severity of respiratory disorders in different forms of amyotrophic lateral sclerosis

https://doi.org/10.14412/2074-2711-2017-3-54-58

Full Text:

Abstract

Sleep-disordered breathing (SDB) substantially impairs quality of life in a patient with amyotrophic lateral sclerosis (ALS) and promote the addition of serious respiratory and cardiovascular complications.
Objective: to identify the early signs of SDB in patients with various onset ALS using a comprehensive sleep assessment.
Patients and methods. A questionnaire survey using a comprehensive test for sleep disorders was conducted in 65 patients: 39 of them had ALS (male:female ratio, 25:14; age, 59 [51; 66] years) and 26 patients made up a control group (male:female ratio, 13:13; age, 54 [43; 59] years).
The questionnaire consists of 50 questions; the results were expressed as scores.
Screening portable polysomnographic study was conducted in patients with newly diagnosed ALS at the relatively early stages of the disease.
A total of 61 patients (32 women and 29 men; median (Me and the 25th and 75th percentile) age was 62 [55; 67] years) were examined. The disease duration was 12 [8.9, 27.1] months after the onset of the first symptoms. The body mass index was 25.7 [23.3, 28.7] kg/m2 . In the study
group, ALSFRSR [9] scores at study inclusion were 34.32 [32; 38]. Cervicothoracic onset ALS was present in 23 patients; 26 and 12 patients had bulbar and lumbosacral onsets, respectively.
Screening diagnosis of sleep was carried out using a Polymate YH-1000C portable polysomnograph (BMC, China) that registered nasopharyngeal flow (airflow through the nasal and oral cavities); thoracoabdominal movements (movements of the thoracic and abdominal walls); hemoglobin oxygen saturation of arterial blood ( SpO2); a snore sound through the microphone; and sleeping position (actography).
Results. The comprehensive screening study of breathing during sleep shows the underestimation of the complaints and symptoms of subclinical respiratory disorders in patients with ALS. Portable pulse oximetry at the early stages of the disease revealed changes in the nocturnal respiratory parameters that indicated a predisposition to the development of hypoventilation syndrome. Bulbar-onset ALS patients who had significantly higher apnea/hypopnea index (AHI) and oxygen desaturation (ODI) and lower mean SpO2 with the development of hypoventilation syndrome and, to a lesser extent, obstructive sleep apnea syndrome were most vulnerable to the development of SDB.
A correlation analysis revealed the impact of minimal SpO2, ODI, and apnea duration on cardiorespiratory parameters in ALS patients and the possibility of their use as markers to analyze of SDB and cardiac arrhythmias during screening studies in these patients.
Conclusion. The early detection and correction of respiratory failure symptoms can prolong patients' life and improve its quality. The screening study of nocturnal sleep and SDB in patients with ALS is a simple and informative method to evaluate a range of respiratory disorders, especially at the early stages of the disease.

About the Authors

Yu. N. Rushkevich
Republican Research and Clinical Center of Neurology and Neurosurgery, Ministry of Health of the Republic of Belarus
Belarus
24, F. Skorina St., Minsk 220114, Republic of Belarus


N. M. Chechik
Republican Research and Clinical Center of Neurology and Neurosurgery, Ministry of Health of the Republic of Belarus
Belarus
24, F. Skorina St., Minsk 220114, Republic of Belarus


S. A. Likhachev
Republican Research and Clinical Center of Neurology and Neurosurgery, Ministry of Health of the Republic of Belarus
Belarus
24, F. Skorina St., Minsk 220114, Republic of Belarus


O. V. Merkul
Republican Research and Clinical Center of Neurology and Neurosurgery, Ministry of Health of the Republic of Belarus
Belarus
24, F. Skorina St., Minsk 220114, Republic of Belarus


T. V. Korbut
Republican Research and Clinical Center of Neurology and Neurosurgery, Ministry of Health of the Republic of Belarus
Belarus
24, F. Skorina St., Minsk 220114, Republic of Belarus


References

1. Ambrosino N, Carpene N, Gherardi M. Chronic respiratory care for neuromuscular diseases in adults. Eur Respir J. 2009; 34(2): 444–451.

2. Bourke S, Gibson G. Sleep and breathing in neuromuscular disease. Eur Respir J. 2002 Jun; 19(6):1194-201. doi:10.1183/09031936.02.01302001a.

3. Hutchinson D, Whyte K. Neurosmuscular disease and respiratory failure. Pract Neurol. 2008 Aug;8(4):229-37. doi: 10.1136/pn.2008.152611.

4. Lofaso F, Fauroux B, Orlikowski D, Prigent H. Daytime predictors of sleep disordered breathing in neuromuscular patients to better schedule polysomnography. Eur Respir J. 011 Feb;37(2):231-2. doi: 10.1183/09031936.00122610.

5. Gordon P. Amyotrophic Lateral Sclerosis: An update for 2013 Clinical Features, Pathophysiology, Management and Therapeutic Trials. Aging and Disease. 2013;4(5):295-310. doi: org/10.14336/ad.2013.0400295.

6. Strong MJ. Amyotrophic Lateral Sclerosis and the Frontotemporal Dementias. Oxford University Press; 2012.

7. Logroscino G, Traynor B, Hardiman O, et al. Incidence of amyotrophic lateral sclerosis in Europe. J Neurol Neurosurg Psychiatry. 2010 Apr; 81(4):385-90. doi:10.1136/jnnp.2009.183525.

8. Полуэктов MГ, Левин ЯИ, Левицкий ГН и др. Расстройства дыхания во сне при болезни двигательного нейрона. Журнал неврологии и психиатрии им. С.С. Корсакова. 2005;(10):4-9. [Poluektov MG, Levin YaI, Levitskii GN, et al. Disorders of breathing during sleep in motor neuron disease. Zhurnal nevrologii i psikhiatrii im. S.S. Korsakova. 2005; (10):4-9. (In Russ.)].

9. Cedarbaum J, Stambler N. Performance of the Amyotrophic Lateral Sclerosis Functional Rating Scale(ALSFRS) in multicenter clinical trials. J Neurol Sci. 1997 Nov 6;152(1):85-92. doi:10.1016/s0022-510x(97)00237-2.

10. Brooks BR. El Escorial World Federation of Neurology criteria for the diagnosis of amyotrophic lateral sclerosis. Subcommittee on Motor Neuron Diseases/Amyotrophic Lateral Sclerosis of the World Federation of Neurology Research Group on Neuromuscular Diseases and the El Escorial «Clinical limits of amyotrophic lateral sclerosis» workshop contributors. J Neurol Sci. 1994 Jul;124 Suppl:96-107.

11. Okita T, Nodera H, Shibuta Y, et al. Can Awaji ALS criteria provide earlier diagnosis than the revised El Escorialcriteria? J Neurol Sci. 2011 Mar 15;302(1-2):29-32. doi: 10.1016/j.jns.2010.12.007. Epub 2011 Jan 6.

12. Kryger M, Roth T, Dement W. Principles and practice of sleep medicine. Philadelphia: WB Saunders; 2000. P. 693-742.

13. International Classification of Sleep Disorders: Diagnostic & Coding Manual 2nd Edition. American Academy of Sleep Medicine; 2005.

14. Hardiman O. Management of respiratory symptoms in ALS. J Neurol. 2011 Mar;258(3): 359-65. doi: 10.1007/s00415-010-5830-y. Epub 2010 Nov 17.

15. Lechtzin N, Rothstein J, Clawson L, et al. Amyotrophic lateral sclerosis: evaluation and treatment of respiratory impairment. Amyotroph Lateral Scler Other Motor Neuron Disord. 2002 Mar;3(1):5-13.

16. Mangera Z, Panesar K, Makker H. Practical approach to management of respiratory complications in neurological disorders. Int J Gen Med. 2012;5:255-63. doi: 10.2147/IJGM.S26333. Epub 2012 Mar 21.

17. Barthlen GM. Nocturnal respiratory failure as an indication of noninvasive ventilation in the patient with neuromuscular disease. Respiration. 1997;(64) Suppl 1:35-8.

18. Ferguson KA, Strong MJ, Ahmad D, George CF. Sleep-Disordered Breathing in Amyotrophic Lateral Sclerosis. Chest. 1996 Sep;110(3):664-9. doi:10.1378/chest.110.3.664.


For citation:


Rushkevich Y.N., Chechik N.M., Likhachev S.A., Merkul O.V., Korbut T.V. The severity of respiratory disorders in different forms of amyotrophic lateral sclerosis. Neurology, Neuropsychiatry, Psychosomatics. 2017;9(3):54-58. (In Russ.) https://doi.org/10.14412/2074-2711-2017-3-54-58

Views: 343


Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 License.


ISSN 2074-2711 (Print)
ISSN 2310-1342 (Online)