Objective: The goal of this preliminary study is to introduce the technique of CardioPulmonary Coupling (CPC) to visualize and quantify the sleep spectrograms of Amyotrophic Lateral Sclerosis (ALS) patients with different ages and pathology severity and estimate the percentage of stable sleep and unstable sleep during the night.

Background: ALS is a progressive neurodegenerative disease. Sleep quality and fragmentation in ALS patients have not yet been extensively studied. Electrocardiogram (ECG)-based (CPC) provides a graphical and computational method to represent the behavior of dynamical interactions between the cardio-autonomics and respiration during sleep. Introduced by Thomas, Goldberger and colleagues [1], CPC combines spectral information derived from inter-beat interval (RR) time series and an ECG-derived respiratory signal (EDR). The method reveals two distinct modes of cardiopulmonary interaction during non-REM sleep: one in the low frequency band [0.01 Hz-0.1 Hz] and the other in the high frequency band [0.1 Hz-0.4 Hz]. Prior studies have shown that former reflects unstable (more arousable) sleep, while the latter reflects stable (deeper) sleep.

Methods: We applied this method to ECG data from a cohort of 13 ALS patients (4 F, 9 M, age 46-79, mean 62.3 yrs) recorded at the Sleep Disorders Center of Cagliari. The patients underwent a full PSG exam, including a continuous ECG. The patient’s level of self-sufficiency was measured by means of the ALS functional rating scale (ALS-FRS), where 0=worst and 48=best.

Results: Subjects with the most advanced pathology had the most unstable sleep patterns, with %HFC<4%. Mean reported values for healthy controls of similar age range are 56% [2], 50% and 48%.

Conclusions: Further studies are warranted to see if CPC provides a useful way to analyze sleep stability in ALS and if this method provides insights into autonomic dysfunction and overall prognosis. References: [1] Thomas, R. J., …, & Goldberger, A. L., (2005). An electrocardiogram-based technique to assess cardiopulmonary coupling during sleep. Sleep, 28(9), 1151-1161. [2] Thomas, R. J., …, & Goldberger, A. L. (2014). Relationship between delta power and the electrocardiogram-derived cardiopulmonary spectrogram: possible implications for assessing the effectiveness of sleep. Sleep Med, 15(1), 125-131.

Presented at the XXV AIMS Meeting, Pula (CA), 1-3/10/2015.

« Back to 2016 International Congress

MDS Abstracts - https://www.mdsabstracts.org/abstract/ecg-based-cardiopulmonary-coupling-for-sleep-stability-assessment-in-patients-with-amyotrophic-lateral-sclerosis/