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Sleep disorders in amyotrophic lateral sclerosis: by the way of a case
Sleep disorders are a common and can be an early manifestation of amyotrophic lateral sclerosis (ALS), but can be undetected until the later stages of disease. Abnormal breathing during sleep is frequently present and may occur even in patients with normal respiratory function and no signs of diaphragmatic denervation. Various studies have reported obstructive and central apneas as well as non-obstructive hypoventilation in patients with ALS.
Describe sleep disorders caught on polysomnography in a patient with amyotrophic lateral sclerosis and a literature review about sleep disorders in ALS.
The study was conducted from the examination analysis of a patient who underwent polysomnography in the sleep laboratory of a school hospital
RFL, 76 years old, three months after diagnosis of ALS, presented alterations of the sleep-wake cycle. Polysomnography findings were: extremely short total sleep time, normal sleep latency and slightly decreased for REM sleep. Alteration of sleep architecture was also found at the expense of increased N1 and N2 phase content, decreased REM sleep and absence of N3 phase. There was also an increase in the rate of respiratory disorders, all of obstructive pattern, being exacerbated during REM sleep.
Amyotrophic lateral sclerosis represents a multi-faceted disorder of multiple genetic preponderance, with disturbance of respiratory function and sleep a key component and early indicator of respiratory compromise. Not only is REM sleep the period of greatest vulnerability for developing nocturnal hypoventilation, a marked reduction of REM sleep duration has been shown to be associated with reduced survival in ALS.
amyotrophic lateral sclerosis, sleep disorders, REM sleep
Relato de Caso
Clélia Maria Ribeiro Franco, Thaís Lins Gemir, Hercília Xavier, Carolina Cunha Correia