Amyotrophic Lateral Sclerosis is a neurodegenerative disease, mostly due to progressive loss of motor neurons, with poor prognosis. Although motor involvement is predominant, other systems may be altered, and, among these, also sleep. The aim of this study is to evaluate sleep in a cohort of patients affected by ALS. We consecutively enrolled 48 patients, whom underwent to clinical and instrumental evaluation, including a full night video-PSG. They were compared to 15 control subjects. Respect to controls, patients had fragmented sleep, with poor sleep efficiency, higher amount of WASO and N1 sleep stage, and lower percentage of N2 and REM sleep stages, despite they perceived a sleep of good quality. Moreover, 33% of patients underwent video-PSG was diagnosed with OSAS, and 14, 28% with nocturnal respiratory insufficiency. Start NIV early is known to raise QOL, prolong life expectancy, and improve compliance to subsequent 24h NIV and tracheal ventilation. Furthermore, sleep of bad quality is a cardiovascular risk factor. In conclusion, in patients with ALS, instrumental assessment of sleep in early stages of the disease should be mandatory
