title: REM sleep behavior disorder and periodic leg movements during sleep in ALS.
abstract: OBJECTIVE
  To assess sleep characteristics and the occurrence of abnormal muscle activity during sleep, such as REM sleep without atonia (RSWA), REM sleep behavior disorder (RBD), and periodic leg movements during sleep (PLMS), in patients with amyotrophic lateral sclerosis (ALS).
  
  
  METHODS
  A total of 41 patients with ALS and 26 healthy subjects were submitted to clinical interview and overnight video-polysomnography.
  
  
  RESULTS
  A total of 22 patients with ALS (53.6%) reported poor sleep quality. Polysomnographic studies showed that patients with ALS had reduced total sleep time, increased wakefulness after sleep onset, shortened REM and slow-wave sleep, and decreased sleep efficiency, compared to controls. Polysomnographic abnormalities were not different in patients reporting good or poor sleep and were not correlated to clinical and demographic variables. The PLMS index was significantly higher in patients with ALS than in healthy subjects, and 22 patients (53.6%) showed a PLMS index > 15/h, vs 4 (15.4%) controls (P < 0.001). Finally, two patients with ALS (4.9%) had RBD, and two more patients presented RSWA (4.9%), whereas no controls showed abnormalities of REM sleep.
  
  
  CONCLUSIONS
  Patients with ALS frequently present abnormalities of sleep that can be documented both at the clinical interview and at the polysomnographic evaluation, including insomnia, fragmented sleep, and increased PLMS. Moreover, abnormalities of REM sleep can be found in some of these patients.
authors.affiliation: ALS Clinical Research Center, Department of Biomedicine and Clinical Neurosciences, University of Palermo, Palermo, Italy.
authors.forename: D
authors.initials: D
authors.lastname: Lo Coco
authors.affiliation: Sleep Disorder Center - Neurophysiology Unit, University of Cagliari, Monserrato, Cagliari, Italy.
authors.forename: M
authors.initials: M
authors.lastname: Puligheddu
authors.affiliation: ALS Clinical Research Center, Department of Biomedicine and Clinical Neurosciences, University of Palermo, Palermo, Italy.
authors.forename: P
authors.initials: P
authors.lastname: Mattaliano
authors.affiliation: Sleep Disorder Center - Neurophysiology Unit, University of Cagliari, Monserrato, Cagliari, Italy.
authors.forename: P
authors.initials: P
authors.lastname: Congiu
authors.affiliation: Neurology Unit, Azienda Ospedaliero-Universitaria di Cagliari and University of Cagliari, Monserrato, Cagliari, Italy.
authors.forename: G
authors.initials: G
authors.lastname: Borghero
authors.affiliation: Neurology Service, CHU Clermont-Ferrand, UFR Medicine, Clermont-Ferrand, France.
authors.forename: M L
authors.initials: ML
authors.lastname: Fantini
authors.affiliation: ALS Clinical Research Center, Department of Biomedicine and Clinical Neurosciences, University of Palermo, Palermo, Italy.
authors.forename: V
authors.initials: V
authors.lastname: La Bella
authors.affiliation: Department of Neurology, Oasi Institute for Research on Mental Retardation and Brain Aging (IRCCS), Troina, Italy.
authors.forename: R
authors.initials: R
authors.lastname: Ferri
mesh_terms: D000368:Aged; D000690:Amyotrophic Lateral Sclerosis / Q000175:diagnosis* / Q000453:epidemiology*; D005260:Female; D006801:Humans; D007558:Italy / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D020189:Nocturnal Myoclonus Syndrome / Q000175:diagnosis* / Q000453:epidemiology*; D017286:Polysomnography / Q000379:methods; D020187:REM Sleep Behavior Disorder / Q000175:diagnosis* / Q000453:epidemiology*; D012894:Sleep Stages / Q000502:physiology*
keywords: amyotrophic lateral sclerosis; periodic leg movements; polysomnography; rapid eye movement sleep behavior disorder; rapid eye movement sleep without atonia; sleep