Sleep quality in the early stages of amyotrophic lateral sclerosis may be associated with disease progression

Gan Zhang Yong Chen Lu Tang Linna Bai Hui Zhang Hong Liu Dongsheng Fan ^*

• Peking University Third Hospital, Haidian, China

Nonmotor symptoms are clinical manifestations of amyotrophic lateral sclerosis (ALS). However, few studies have examined nonmotor symptoms in patients with early-stage ALS. We conducted a cross-sectional investigation in which we explored nonmotor symptoms in 69 patients with ALS within 18 months of disease onset. The Pittsburgh Sleep Quality Index (PSQI), the Epworth Sleepiness Scale (ESS) and the Hospital Anxiety and Depression Scale (HADS) were used to evaluate sleep quality, daytime sleepiness, and anxiety and depression, respectively. Differences in the abovementioned nonmotor symptoms between ALS patients and age-/sex-matched caregivers were examined, and correlations between these symptoms and the clinical features of ALS were analyzed. Compared with caregivers, ALS patients were more likely to report poor sleep [odds ratio (OR) and 95% confidence interval (95% CI)=2.664, 1.276–5.560; p=0.009] and excessive daytime sleepiness [OR and 95% CI=5.135, 1.640–16.072; p=0.005]. PSQI scores in ALS patients correlated significantly with disease progression rate [ΔFS=(48-score on the Amyotrophic Lateral Sclerosis Functional Rating Scale-Revised)/disease duration)] [β(95% CI)=2.867 (0.397, 5.336), p=0.024] and plasma neurofilament light chain levels [β (95% CI)=0.041 (0.012, 0.070), p=0.008). Our results revealed that patients with early-stage ALS experience poor sleep quality and daytime sleepiness and suggest that low sleep quality may be related to more rapid disease progression. Confounders are not obvious in the early stage of ALS, and our results suggest that these symptoms may be related to more severe and extensive pathological changes in the central nervous system.