Sleep
in the Completely Locked-in State (CLIS) in Amyotrophic Lateral
Sclerosis. Azim Malekshahi, Ujwal Chaudhary, Andres Jaramillo-Gonzalez,
Alberto Lucas Luna, Aygul Rana, Alessandro Tonin, Niels Birbaumer,
Steffen Gais. Sleep, zsz185, August 2 2019,
https://doi.org/10.1093/sleep/zsz185
Abstract: Persons in the
completely locked in state (CLIS) suffering from amyotrophic lateral
sclerosis (ALS) are deprived of many zeitgebers of the circadian rhythm:
While cognitively intact, they are completely paralyzed, eyes mostly
closed, with artificial ventilation and artificial nutrition, and social
communication extremely restricted or absent. Polysomnographic
recordings in 8 patients in CLIS however revealed the presence of
regular episodes of deep sleep during night time in all patients. It was
also possible to distinguish an alpha-like state and a wake-like state.
Classification of REM sleep is difficult because of absent eye
movements and absent muscular activity. 4 out of 8 patients did not show
any sleep spindles. Those who have spindles also show K-complexes and
thus regular phases of sleep stage 2. Thus, despite some irregularities
we found a surprisingly healthy sleep pattern in these patients.
Keywords:
movement disorders, neurological disorders, sleep/wake physiology,
circadian rhythms, completely locked in state, polysomnography
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