Sleep Architecture Alterations Following High-Dose Steroid Pulse Therapy: A Pilot Study Using a Portable Electroencephalogram-Based Device

Abstract

Background: Sleep disturbance is a common side effect of high-dose steroid pulse therapy (SPT). However, in clinical settings, the impact of this therapy on sleep architecture has not been objectively studied. Objective: This study aimed to investigate changes in sleep architecture associated with high-dose SPT administration in patients with neuroimmunological disorders. Methods: A prospective cohort study was conducted involving six hospitalized patients with neuroimmunological disorders who were administered intravenous methylprednisolone (1000 mg/day for 3 days). Objective sleep parameters were assessed on days 0, 1, and 3 using a SleepGraph, a validated portable electroencephalography (EEG) device. Subjective sleep was evaluated using the Insomnia Severity Index (ISI), Pittsburgh Sleep Quality Index (PSQI), sleep diary, and Likert scale. Results: Rapid eye movement (REM) sleep significantly decreased from 71.2 ± 36.6 min on day 0 to 9.4 ± 8.3 min on day 1 and remained low on day 3 (16.5 ± 16.0 min). Total sleep time was also reduced, while non-REM (NREM) sleep remained relatively stable. Two patients who received lemborexant showed partial improvement in their sleep parameters. ISI and PSQI scores did not change significantly, possibly owing to the short observation period. Conclusion: These findings suggest that high-dose SPT can markedly reduce REM sleep. Moreover, portable EEG devices could be a practical approach for monitoring steroid-induced sleep alterations. Our findings provide clinical evidence that may help to deepen the objective understanding of sleep during SPT.