{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,7]],"date-time":"2026-07-07T14:16:06Z","timestamp":1783433766378,"version":"3.54.6"},"reference-count":43,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2026,6,23]],"date-time":"2026-06-23T00:00:00Z","timestamp":1782172800000},"content-version":"vor","delay-in-days":22,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"},{"start":{"date-parts":[[2026,6,1]],"date-time":"2026-06-01T00:00:00Z","timestamp":1780272000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Euro J of Neurology"],"published-print":{"date-parts":[[2026,6]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Respiratory failure is the main cause of death in Amyotrophic lateral sclerosis (ALS), in which the physiological sigh reflex is impaired due to inspiratory muscle weakness. Aim of this study is to assess the tolerability, safety, and effectiveness of adding a sigh cycle to non\u2010invasive mechanical ventilation (NIMV) settings in ALS patients.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>In this randomized, blind\u2010controlled proof\u2010of concept study, 44 consecutive ALS patients with indication for NIMV were randomized to: Group I: NIMV with Sigh cycles; Group II: NIMV without Sigh. The primary outcome was the reduction in the Oxygen Desaturation Index (ODI); secondary outcomes included: Overnight Oximetry (OvOx), Arterial blood gas (ABG), and Visual Analog Scale (VAS; 0\u201310) scores to assess sleep quality, symptom intensity, mask interface, and NIMV tolerance. Assessments were conducted at baseline, after NIMV adaptation (T1) and at 1\u2010month follow\u2010up (T2).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      The Sigh cycle was safe and well tolerated. No significant group differences were observed at T1 or T2 in the primary outcome ODI (median \u0394ODI: Group A:\u20134.2; Group B:\u20134.6:\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.54), as well as in the OvOx parameters and pO\n                      <jats:sub>2<\/jats:sub>\n                      and pCO\n                      <jats:sub>2<\/jats:sub>\n                      ABG values. At T2, secondary analysis showed a significant difference in HCO\u2083\n                      <jats:sup>\u2212<\/jats:sup>\n                      in favor of the Sigh arm (\u0394HCO\n                      <jats:sub>3<\/jats:sub>\n                      <jats:sup>\u2212<\/jats:sup>\n                      : \u22121.60 vs. 1.35\u2009mmol\/L,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.042). Exploratory Cox\u2010regression models suggested a potential independent effect of SIGH on survival.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Sigh is safe, well tolerated in ALS patients. Although this study did not reach the primary outcome, we also cannot rule out that sigh doesn't benefit the patient.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/ene.70660","type":"journal-article","created":{"date-parts":[[2026,6,23]],"date-time":"2026-06-23T12:44:57Z","timestamp":1782218697000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Tolerability, Safety and Effectiveness of Sigh Introduction During Non\u2010Invasive Mechanical Ventilation Cycles in Patients With Amyotrophic Lateral Sclerosis"],"prefix":"10.1111","volume":"33","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0513-9517","authenticated-orcid":false,"given":"Nilo","family":"Riva","sequence":"first","affiliation":[{"name":"Division of Neuroscience, Neurology and Neuro\u2010Rehabilitation Unit IRCCS San Raffaele  Milan Italy"},{"name":"Division of Neuroscience, Experimental Neuropathology Unit Institute of Experimental 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Eleonora","family":"Ferraro","sequence":"additional","affiliation":[{"name":"Department of Public Health, Experimental and Forensic Medicine, Unit of Biostatistics and Clinical Epidemiology University of Pavia  Pavia Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gianluca","family":"Durante","sequence":"additional","affiliation":[{"name":"Department of Rehabilitation and Functional Recovery IRCCS San Raffaele Scientific Institute  Milan Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrea","family":"Tettamanti","sequence":"additional","affiliation":[{"name":"Department of Rehabilitation and Functional Recovery IRCCS San Raffaele Scientific Institute  Milan Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elisa","family":"Riboldi","sequence":"additional","affiliation":[{"name":"Department of Rehabilitation and Functional Recovery IRCCS San Raffaele Scientific Institute  Milan 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