Sleep disorders in aging polio survivors: a systematic review

Abstract Background. Sleep disturbances, especially sleep disordered breathing and sleep movement disorders, seem to be highly prevalent among aging polio survivors. They could contribute to late functional deterioration, fatigue, poor quality of life and negative health outcomes, thereby increasing cardiovascular risk. Objectives. This review focused on current knowledge of the prevalence of sleep disorders in polio survivors, their features, predictive factors and management. Data sources. Articles were searched in PubMed and the Cochrane Library up to March 2018. Study eligibility criteria, participants and interventions. Articles needed to 1) be written in English; 2) include only participants with previous poliomyelitis or post-polio syndrome diagnosis; and 3) involve any form of sleep disorders. Articles about isolated fatigue or nonspecific sleep complaints as well as non-polio specific articles (neuromuscular disorders) were not included in the qualitative analysis. Results. Among 166 studies identified, 41 were included in this review. The prevalence of sleep apnea syndrome, nocturnal alveolar hypoventilation and restless legs syndrome seemed higher than in the general population (from 7.3% to 65%, 15% to 20% and 28% to 63%, respectively). This study highlights the lack of randomized studies assessing sleep disorder management in this specific population. Limitations. Because of the small number of eligible publications, none was excluded for methodological limitations, and only a qualitative analysis was provided. Conclusions and implications. Follow-up of polio survivors should include systematic screening for sleep disorders because they are associated with adverse consequences. Sleep disorder evaluation and management should improve the long-term survival and quality of life of polio survivors. Methodologically robust clinical trials are needed, but the decreasing prevalence and large clinical spectrum of the disease may complicate the creation of comparable groups.