Study On Sleep Disorders In Patients With Amyotrophic Lateral Sclerosis

Part 1.Restless Legs Syndrome in Chinese Patients with Sporadic Amyotrophic Lateral SclerosisObjective:To evaluate the frequency and clinical features of restless legs syndrome(RLS)in a group of Chinese patients with amyotrophic lateral sclerosis(ALS).Methods:109 Patients included in this study fulfilled the revised El Escorial diagnostic criteria for clinically definite,probable and lab-supported probable ALS,and a group of 109 control subjects was matched for age and sex to the ALS group.Disease severity was assessed by the revised ALS functional rating scale(ALSFRS-R).The diagnosis of RLS was made according to the criteria of the Intermational RLS Study Group.Other characteristics including sleep quality,excessive daytime sleepiness(EDS),REM sleep behaviour disorder(RBD),depression and anxiety were also evaluated in ALS patients.Results:RLS was significantly more frequent in ALS patients than in control subjects(14.6%vs.0.9%;P<0.05).Compared to those without RLS,ALS patients with RLS reported a higher frequency of anxiety and EDS.ALS patients with RLS showed more severe legs dysfunction.EDS and legs function scores of the ALSFRS-R were independent factors significantly associated with RLS in ALS patients.Conclusions:Our findings suggest that Chinese ALS patients exhibit a high frequency of RLS symptoms and that these patients may benefit from recognition of the condition and optimized management of its symptoms.Moreover,ALS patients might cause circadian rhythms disturbance and our study further supports that ALS is a heterogeneous disorder involving multiple systems;further studies are needed to confirm these preliminary findings.Part 2.Excessive Daytime Sleepiness in Chinese Patients with Sporadic Amyotrophic Lateral Sclerosis and its Association with Cognitive and Behavioural ImpairmentsObjective:To examine the frequency and clinical features of excessive daytime sleepiness(EDS)and its association with cognitive and behavioural impairments in patients with amyotrophic lateral sclerosis(ALS).Methods:We conducted a cross-sectional investigation to explore the frequency and clinical features of EDS in a group of 121 Chinese ALS patients compared with 121 age-and sex-matched healthy subjects.EDS was diagnosed using the Epworth Sleepiness Scale(ESS).Other characteristics of ALS patients including sleep quality,REM sleep behaviour disorder(RBD),restless legs syndrome(RLS),cognition,behaviour,depression and anxiety were also evaluated.Results:EDS was significantly more frequent in ALS patients than in conttols(26.4%vs.8.3%;p<0.05).ALS patients with EDS scored lower scores on the revised ALS Functional Rating Scale(ALSFRS-R),Mini-Mental State Examination(MMSE),Montreal Cognitive Assessment(MoCA)and MMSE and MoCA delayed memory sub-items and higher on the Frontal Behavioural Inventoiy(FBI)than ALS patients without EDS.ESS scores correlated with global ALSFRS-R,FBI,MMSE and MoCA scores and MMSE and MoCA delayed memory scores.RLS and global ALSFRS-R scores were independently associated with EDS in ALS patients.Conclusions:We identified a high frequency of EDS symptoms in Chinese ALS patients,and these patients might have more serious physical,cognitive and frontal behaviour impairment.ALS patients might improve quality of life from the timely recognition and optimised management of EDS symptoms.Our results further suggest that ALS is a heterogeneous disease that might exhibit abnormal sleep-wake patterns.Part 3.Self?assessed sleep disturbance is associated with cognitive impairment in patients with amyotrophic lateral sclerosisObjective:To examine the clinical features of poor sleepers and the relationship between sleep quality and cognitive impairments in a Chinese amyotrophic lateral sclerosis(ALS)population.Methods:In this case-control study,206 ALS patients and 206 age-,sex-,and education-matched healthy controls were included.We evaluated sleep quality using the Pittsburgh Sleep Quality Index.Excessive daytime sleepiness was diagnosed according to the Epworth Sleepiness Scale.Restless legs syndrome was diagnosed using the criteria defined by the Intermational Restless Leg Syndrome Study Group.REM sleep behavior disorder was diagnosed according to the REM sleep behavior disorder screening questionnaire.Other characteristics including cognition,depression,and anxiety were also evaluated.Results:Poor sleepers were significantly more frequent in ALS patients than in controls(57.2%vs.22.8%,respectively;p<0.05).In ALS patients,poor sleepers scored lower scores on the revised ALS Functional Rating Scale,Mini-Mental State Examination,Montreal Cognitive Assessment,and Frontal Assessment Battery than good sleepers.Pittsburgh Sleep Quality Index scores correlated with the global revised ALS Functional Rating Scale,Mini-Mental State Examination,Montreal Cognitive Assessment,and Frontal Assessment Batteiy scores.In healthy controls,cognitive function was similar between poor sleepers and good sleepers.Conclusions:We identified a high frequency of poor sleepers in Chinese ALS patients,and these patients may have more serious physical and cognitive impairments.Further studies on sleep problems in ALS may help elucidate the etiology and pathology of ALS.Moreover,ALS patients may benefit from the timely recognition and optimized management of sleep problems.