ALS is a fatal neurodegenerative disease characterised by skeletal muscles wasting and weakness. 30% present a bulbar onset, while 70% a spinal one. Extra-motor systems involved in ALS include circuits regulating sleep; the early identification of sleep impairment and his better definition could improve ALS patient’s QoL.

One of the most important prognostic factors in ALS is respiratory impairment. It’s early recognition and an early starting of non-invasive ventilation (NIV) allow a prolongation of survival.

To evaluate early impairment of sleep and breath in patients affected by amyotrophic lateral sclerosis (ALS) in order to do early treatments, for a longer survival and a better quality of life (QoL).

Between August 2021 and January 2022 we enrolled, until 2 months from diagnosis, 37 ALS patients and 37 healthy controls (HC). At baseline and at month six, patients underwent neurological examination, polysomnography (PSG), arterial blood gases (ABG), spirometry and filled sleep and respiratory questionnaire (RLSRS, STOP-BANG, ISI, ESS, PSQI, PIRS, MEQ, STAI, BDI).

Mann-Whitney U test, Friedman test, and Cox regression analysis were applied.

At baseline, ALS patients without respiratory symptoms showed an increase of AHI index and of ODI index, contrary to HC (respectively, p=0.001 and p=0.04). Contrarily, spirometry and ABG resulted normal in this sub-group of patients.

Longitudinally we observed a significant worsening of PSG parameters (p<0.05). Patients who started nocturnal-NIV (10 out of 37) showed a significant improvement of PSG parameters.

At baseline we also observed an excess of periodic limb movement in ALS vs HC (p=0.01).

Direct correlation between progression rate of disease and both AHI and ODI (r=0.546 and r=0.442 p<0.05).

This preliminary study showed the presence of respiratory impairment and of sleep disorders in ALS patients since the beginning of the disease. Their identification is fundamental for an early treatment, and for an improvement of QoL.