Sleep and psychiatric abnormalities in Gullian Barré Syndrome

Abstract

BackgroundThe sensori-motor manifestations of Guillain Barré Syndrome (GBS) are usually severe enough to mask the psychiatric and sleep problems which are in need for more attention for better functional outcome.MethodsThis study was performed on 20 GBS patients and 10 healthy controls. Patients were evaluated initially before immunotherapy using the Overall Disability Sum Score (ODSS), Neuropathy Pain Scale (NPS), Hamilton Anxiety Scale (HAS), Montgomery–Åsberg Depression Rating Scale (MADRS) and one-night polysomnography (PSG) followed by the multiple sleep latency test (MSLT) to evaluate the mean sleep latencies. Reevaluation was done using the same parameters 1 month after completing immunotherapy.ResultsThe study showed significant increase in HAS in GBS patients which were positively correlated with the degree of motor disability. The mean sleep latencies of MSLT were significantly shortened and PSG showed shortening of the total sleep time, sleep efficiency, lowest O2 saturation and pulse transit time with increased wake after sleep onset, sleep stage transition index, apnea hypopnea index, desaturation index, arousal index, snore index and periodic limb movement index. One month after immunotherapy, the anxiety symptoms and sleep abnormalities showed non-significant improvements which were not correlated with the improvements in the sensori-motor manifestations.ConclusionsGBS patients usually have sleep and psychiatric abnormalities which may take longer time to improve than the sensori-motor manifestations. So, they need more attention in the management protocol for early patients’ independence and return to usual daily activities.

Psychiatric Sequelae of Guillain-Barré Syndrome: Towards a Multidisciplinary Team Approach

“…A recent study by Bahnasy et al reported that sleep quality was significantly reduced in 20 GBS patients compared to healthy controls [10]. Severity of physical disability and initial anxiety were positively correlated with waking after sleep onset.…”

“…GBS patients have 4.8-fold increased risk for depression [11]. A study by Bahnasy et al found significantly higher depression scores in GBS patients compared to controls (2.6-fold increased) [10]. The prevalence of depression among the most severely disabled GBS patients is high (67%) [20].…”

“…The prevalence of depression among the most severely disabled GBS patients is high (67%) [20]. Although the severity of depression is not significantly correlated with rate of initial progression of physical effects of GBS, the severity of depression is positively correlated with the severity of anxiety, which positively correlates with the severity of muscle weakness [10]. Therefore, more severely disabled GBS patients may be more likely to develop psychological symptoms, with residual depression negatively affecting rehabilitation and quality of life [26,42].…”

“…Fear and anxiety associated with the suddenness in onset and severity of physical disability during the acute phase of GBS may impact on the psychological status of the patient and, although most patients experience improvement in physical symptoms, many experience longterm severe residual anxiety, depression, and fatigue [10,28]. The prevalence of anxiety and depression in GBS patients is higher in comparison to other patients admitted to ICU for other conditions [12].…”

“…After the acute phase, patients enter a rehabilitation phase with most returning to usual daily activities within three years, with greater improvements amongst younger patients. However, at least 20% of GBS patients experience some long-term disability [1,[8][9][10].…”