title: Effects of noninvasive ventilation on sleep outcomes in amyotrophic lateral sclerosis.
abstract: OBJECTIVE
  The objective was to study the effects on noninvasive ventilation on sleep outcomes in patient with ALS, specifically oxygenation and overall sleep quality.
  
  
  METHODS
  Patients with ALS who met criteria for initiation of NIV were studied with a series of 2 home PSG studies, one without NIV and a follow-up study while using NIV. Primary outcome was a change in the maximum overnight oxygen saturation; secondary outcomes included change in mean overnight oxygen saturation, apnea and hypopnea indexes, sleep latency, sleep efficiency, sleep arousals, and sleep architecture.
  
  
  RESULTS
  A total of 94 patients with ALS were screened for eligibility; 15 were enrolled; and 12 completed study procedures. Maximum overnight oxygen saturation improved by 7.0% (p = 0.01) and by 6.7% during REM sleep (p = 0.02) with NIV. Time spent below 90% oxygen saturation was also significant-ly better with NIV (30% vs 19%, p < 0.01), and there was trend for improvement in mean overnight saturation (1.5%, p = 0.06). Apnea index (3.7 to 0.7), hypopnea index (6.2 to 5.7), and apnea hypopnea index (9.8 to 6.3) did not significantly improve after introducing NIV. NIV had no effect on sleep efficiency (mean change 10%), arousal index (7 to 12), or sleep stage distribution (Friedman chi-squared = 0.40).
  
  
  CONCLUSIONS
  NIV improved oxygenation but showed no significant effects on sleep efficiency, sleep arousals, restful sleep, or sleep architecture. The net impact of these changes for patients deserves further study in a larger group of ALS patients.
authors.affiliation: Division of Neurology, University Health Network, Toronto, Ontario, Canada. hans.katzberg@utoronto.com
authors.forename: Hans D
authors.initials: HD
authors.lastname: Katzberg
authors.forename: Adam
authors.initials: A
authors.lastname: Selegiman
authors.forename: Lee
authors.initials: L
authors.lastname: Guion
authors.forename: Nancy
authors.initials: N
authors.lastname: Yuan
authors.forename: Sungho C
authors.initials: SC
authors.lastname: Cho
authors.forename: Jonathan S
authors.initials: JS
authors.lastname: Katz
authors.forename: Robert G
authors.initials: RG
authors.lastname: Miller
authors.forename: Yuen T
authors.initials: YT
authors.lastname: So
mesh_terms: D000368:Aged; D000690:Amyotrophic Lateral Sclerosis / Q000150:complications*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D063087:Noninvasive Ventilation / Q000379:methods*; D010865:Pilot Projects; D017286:Polysomnography / Q000379:methods; D012893:Sleep Wake Disorders / Q000150:complications* / Q000628:therapy*; D016896:Treatment Outcome
keywords: ALS; bilevel PAP; motor neuron disease; noninvasive ventilation; sleep