Patients locked in state suffering from amyotrophic lateral sclerosis: Cognitively intact, are completely paralyzed, eyes mostly closed, artificial ventilation & artificial nutrition, but we found a surprisingly healthy sleep pattern

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