title: Noninvasive ventilation improves sleep in amyotrophic lateral sclerosis: a prospective polysomnographic study.
abstract: OBJECTIVE
  To evaluate the effects of noninvasive ventilation (NIV) on sleep in patients with amyotrophic lateral sclerosis (ALS) after meticulous titration with polysomnography (PSG).
  
  
  METHODS
  In this prospective observational study, 24 ALS patients were admitted to the sleep laboratory during 4 nights for in-hospital NIV titration with PSG and nocturnal capnography. Questionnaires were used to assess subjective sleep quality and quality of life (QoL). Patients were readmitted after one month.
  
  
  RESULTS
  In the total group, slow wave sleep and REM sleep increased and the arousal-awakening index improved. The group without bulbar involvement (non-bulbar) showed the same improvements, together with an increase in sleep efficiency. Nocturnal oxygen and carbon dioxide levels improved in the total and non-bulbar group. Except for oxygen saturation during REM sleep, no improvement in respiratory function or sleep structure was found in bulbar patients. However, these patients showed less room for improvement. Patient-reported outcomes showed improvement in sleep quality and QoL for the total and non-bulbar group, while bulbar patients only reported improvements in very few subscores.
  
  
  CONCLUSIONS
  This study shows an improvement of sleep architecture, carbon dioxide, and nocturnal oxygen saturation at the end of NIV titration and after one month of NIV in ALS patients. More studies are needed to identify the appropriate time to start NIV in bulbar patients. Our results suggest that accurate titration of NIV by PSG improves sleep quality.
  
  
  CONCLUSIONS
  A commentary on this article appears in this issue on page 511.
authors.affiliation: Leuven University Centre for Sleep/Wake Disorders, Department of Pulmonology, University Hospitals Leuven, Belgium.|Department of Pulmonology, University of Leuven, Belgium.
authors.forename: Bart
authors.initials: B
authors.lastname: Vrijsen
authors.affiliation: Leuven University Centre for Sleep/Wake Disorders, Department of Pulmonology, University Hospitals Leuven, Belgium.|Department of Pulmonology, University of Leuven, Belgium.
authors.forename: Bertien
authors.initials: B
authors.lastname: Buyse
authors.affiliation: Leuven University Centre for Sleep/Wake Disorders, Department of Pulmonology, University Hospitals Leuven, Belgium.|Department of Pulmonology, University of Leuven, Belgium.
authors.forename: Catharina
authors.initials: C
authors.lastname: Belge
authors.affiliation: Department of Neurology, University of Leuven, Belgium.|Experimental Neurology (Department of Neurosciences) and Leuven Research Institute for Neuroscience and Disease (LIND), University of Leuven (KU Leuven), Belgium.
authors.forename: Wim
authors.initials: W
authors.lastname: Robberecht
authors.affiliation: Department of Neurology, University of Leuven, Belgium.|Experimental Neurology (Department of Neurosciences) and Leuven Research Institute for Neuroscience and Disease (LIND), University of Leuven (KU Leuven), Belgium.|Laboratory of Neurobiology, Vesalius Research Center, VIB, Leuven, Belgium.
authors.forename: Philip
authors.initials: P
authors.lastname: Van Damme
authors.affiliation: Department of Pulmonology, University of Leuven, Belgium.
authors.forename: Marc
authors.initials: M
authors.lastname: Decramer
authors.affiliation: Leuven University Centre for Sleep/Wake Disorders, Department of Pulmonology, University Hospitals Leuven, Belgium.|Department of Pulmonology, University of Leuven, Belgiumd.
authors.forename: Dries
authors.initials: D
authors.lastname: Testelmans
mesh_terms: D000690:Amyotrophic Lateral Sclerosis / Q000150:complications*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D063087:Noninvasive Ventilation / Q000379:methods*; D017286:Polysomnography; D011446:Prospective Studies; D011788:Quality of Life; D012890:Sleep; D012893:Sleep Wake Disorders / Q000150:complications* / Q000628:therapy*; D011795:Surveys and Questionnaires; D016896:Treatment Outcome
keywords: amyotrophic lateral sclerosis; noninvasive ventilation; polysomnography; sleep architecture