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Awareness of the importance of sleep-related disorders in patients with cardiovascular diseases is growing. In particular, sleep-disordered breathing, short sleep time, and low sleep quality are frequently reported by patients with heart failure (HF). Sleep-disordered breathing, which includes obstructive sleep apnoea (OSA) and central sleep apnoea (CSA), is common in patients with HF and has been suggested to increase the morbidity and mortality in these patients. Both OSA and CSA are associated with increased sympathetic activation, vagal withdrawal, altered haemodynamic loading conditions, and hypoxaemia. Moreover, OSA is strongly associated with arterial hypertension, the most common risk factor for cardiac hypertrophy and failure. Intrathoracic pressure changes are also associated with OSA, contributing to haemodynamic alterations and potentially affecting overexpression of genes involved in ventricular remodelling. HF treatment can decrease the severity of both OSA and CSA. Indeed, furosemide and spironolactone administration, exercise training, cardiac resynchronization therapy, and eventually heart transplantation have shown a positive effect on OSA and CSA in patients with HF. At present, whether CSA should be treated and, if so, which is the optimal therapy is still debated. By contrast, more evidence is available on the beneficial effects of OSA treatment in patients with HF.

Objective To evaluate the frequency, severity and determinants of sleep disturbances in patients with amyotrophic lateral sclerosis (ALS). Methods Information about night-time complaints was collected using a standardised questionnaire, the Pittsburgh Sleep Quality Index (PSQI), and the Epworth Sleepiness Scale (ESS) in a group of 100 patients with ALS and in 100 control subjects matched for age and sex. Functional disability was assessed using the ALS Functional Rating Scale-Revised (ALSFRS-R). Sleep was studied by overnight polysomnography in 12 patients. Results Fifty-nine patients with ALS and 36 controls reported sleep disturbances. The mean global PSQI score of patients with ALS was significantly higher than the control participants (6.82±4.0 vs 4.86±3.2), and three of the seven components of PSQI in patients with ALS were significantly different from controls: ‘sleep latency,’ ‘habitual sleep efficiency’ and ‘sleep disturbances.’ The most commonly reported night-time complaints by patients with ALS were nocturia (54%), sleep fragmentation (48%) and nocturnal cramps (45%). Poor sleep was associated with decreased ALSFRS-R score, highest depression and ESS score. After a multivariate analysis, patients9 disability and daytime somnolence remained significantly associated with sleep quality. Polysomnographic studies showed decreased sleep efficiency and fragmented sleep architecture. Conclusion This study demonstrated that patients with ALS have a significant poor quality of sleep, and this correlated with the severity of ALS and daytime somnolence. Increased awareness for sleep–wake problems in patients with ALS is important, as effective intervention could lead to a better management of these patients.

E vidence is available that the frequency and severity of arterial hypertension, and, in general, of cardiovascular diseases, bear a relationship with sleep disorders and, more specifically, with sleep duration [1,2]. Indeed, on the one side patients with cardiovascular diseases often complain of a number of sleep disturbances, including sleep fragmentation, insomnia, and breathing disorders during sleep. On the other side, patients with sleep complaints seem to be more frequently affected by cardiovascular problems. Given such a complex bidirectional relationship between these phenomena, it is therefore often difficult to determine which is the cause and which is the effect between cardiovascular problems and sleep disorders. Sleep-related breathing disorders, and, in particular, obstructive sleep apnea (OSA) syndrome, formerly named Pickwickian syndrome [3], are among the most common problems occurring during sleep in the general population, with at least 4% of middle-aged men and 2% of middle-aged women being affected in the developed world, its prevalence is increasing in parallel with the increasing prevalence of obesity [4–6]. A number of studies have shown OSA to be strictly related to the presence of hypertension and to represent an independent risk factor for the development of a high blood pressure (BP) condition [5,6]. Evidence of a relationship between arterial hypertension and excessive daytime somnolence has also been provided [7,8], whereas sleep fragmentation and a reduction in nocturnal sleep duration have been identified as factors majorly responsible for the increased sympathetic activity and the occurrence of elevated BP levels extending during daytime [9,10]. Given the large number of papers demonstrating the complex and multiple links relating sleep disorders and sleep duration with the occurrence of high BP levels, it is somehow surprising that only limited evidence has been up