Potential Survival Benefits from REM Sleep Inhibition in ALS Patients

Recent research presented at the American Thoracic Society 2025 International Conference indicates a potential link between the inhibition of rapid eye movement (REM) sleep through antidepressant medication and improved survival rates in patients diagnosed with amyotrophic lateral sclerosis (ALS). This study, conducted by a team from Emory University School of Medicine, sheds light on the impact of REM sleep pharmacological suppression on the health of ALS patients.

The research focused on a substantial dataset comprising 17,444 ALS patients who had been prescribed riluzole, a medication commonly used in ALS treatment. Of this group, 14.3% were identified as the REM-inhibited cohort, meaning they were treated with certain antidepressants known to suppress REM sleep within the three years prior to the study. Conversely, 2.1% of the participants were categorized as the non-REM-inhibited group, receiving antidepressants that do not affect REM sleep. Participants who received both types of antidepressant treatments were excluded from the analysis.

Prior to matching for demographic variables such as age, race, and gender, the researchers observed that the REM-inhibited group exhibited a significantly higher two-year survival rate, measuring at 47.18% compared to 41.06% in the non-REM-inhibited group. The calculated hazard ratio for this difference was 1.21, suggesting a notable survival advantage. However, after propensity-score matching, while the trend toward improved survival remained evident, the results did not reach statistical significance (48.13% versus 41.06%; hazard ratio of 1.23). This indicates that although there is a consistent trend, the findings require further validation.

Despite the limitations associated with the retrospective nature of the study and potential confounding factors arising from the reliance on electronic health record data, the authors emphasize the potential clinical significance of their findings. They suggest that pharmacologically targeting periods of known vulnerability in ALS could lead to meaningful improvements in patient outcomes.

The study highlights an innovative approach to ALS management that warrants further exploration, particularly in understanding the role of sleep disturbances and their treatment in conjunction with existing therapies.