Diaphragm pacing improves sleep in patients with amyotrophic lateral sclerosis.
In amyotrophic lateral sclerosis (ALS) patients, respiratory insufficiency is a major burden. Diaphragm conditioning by electrical stimulation could interfere with lung function decline by promoting the development of type 1 muscle fibres. We describe an ancillary study to a prospective, non-randomized trial (NCT00420719) assessing the effects of diaphragm pacing on forced vital capacity (FVC). Sleep-related disturbances being early clues to diaphragmatic dysfunction, we postulated that they would provide a sensitive marker. Stimulators were implanted laparoscopically in the diaphragm close to the phrenic motor point in 18 ALS patients for daily conditioning. ALS functioning score (ALSFRS), FVC, sniff nasal inspiratory pressure (SNIP), and polysomnographic recordings (PSG, performed with the stimulator turned off) were assessed before implantation and after four months of conditioning (n = 14). Sleep efficiency improved (69 ± 15% to 75 ± 11%, p = 0.0394) with fewer arousals and micro-arousals. This occurred against a background of deterioration as ALSFRS-R, FVC, and SNIP declined. There was, however, no change in NIV status or the ALSFRS respiratory subscore, and the FVC decline was mostly due to impaired expiration. Supporting a better diaphragm function, apnoeas and hypopnoeas during REM sleep decreased. In conclusion, in these severe patients not expected to experience spontaneous improvements, diaphragm conditioning improved sleep and there were hints at diaphragm function changes.
Service de Pneumologie et Réanimation, Groupe Hospitalier Pitié-Salpêtrière, 47-83 Bd. de l’Hôpital, Paris, France.
Jesus
J
Gonzalez-Bermejo
Capucine
C
Morélot-Panzini
François
F
Salachas
Stefania
S
Redolfi
Christian
C
Straus
Marie-Hélène
MH
Becquemin
Isabelle
I
Arnulf
Pierre-François
PF
Pradat
Gaëlle
G
Bruneteau
Anthony R
AR
Ignagni
Moustapha
M
Diop
Raymond
R
Onders
Teresa
T
Nelson
Fabrice
F
Menegaux
Vincent
V
Meininger
Thomas
T
Similowski
D000368:Aged; D000690:Amyotrophic Lateral Sclerosis / Q000150:complications / Q000503:physiopathology*; D002986:Clinical Trials as Topic; D003964:Diaphragm / Q000502:physiology*; D004558:Electric Stimulation / Q000295:instrumentation / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015337:Multicenter Studies as Topic; D017286:Polysomnography; D011446:Prospective Studies; D012131:Respiratory Insufficiency / Q000209:etiology / Q000503:physiopathology*; D012890:Sleep / Q000502:physiology*; D016896:Treatment Outcome; D014797:Vital Capacity / Q000502:physiology