Sleep disorders in multiple system atrophy: a correlative video-polysomnographic study.
OBJECTIVE
The reciprocal relation between breathing, heart and motor system abnormalities during sleep was studied in multiple system atrophy (MSA) by means of video-polysomnographic recordings (VPSG).


METHODS
Nineteen consecutive MSA patients underwent VPSG with scoring for sleep, respiratory abnormalities, heart (HR) and breathing (BR) rates, and abnormal motor activities. A comparative analysis was performed versus 10 patients with obstructive sleep apnoea syndrome (OSAS).


RESULTS
All MSA patients displayed snoring, 42% stridor, and 37% OSAS. Mean sleep SaO(2) was 92.7%, and lowest SaO(2) 86%. Patients with stridor had a significant increase in BR from Wake to NREM and REM sleep, and higher HR during sleep. Respiratory muscles and tibialis anterior EMG tonic activity was frequently found, more often in patients with stridor. All patients had REM sleep behaviour disorders (RBD) and 88% periodic limb movements during sleep (PLMS). No OSAS patient had RBD or respiratory muscles and tibialis anterior tonic activity.


CONCLUSIONS
MSA patients, especially those with associated stridor, commonly display impaired breathing and abnormal control of respiratory and limb muscles during sleep. Breathing and motor abnormalities are often concomitant in the same patient, indicating a diffuse impairment of sleep homeostatic integration that should be included within the diagnostic features of MSA.
Vetrugno
Roberto
R
Department of Neurological Sciences, University of Bologna, Via Ugo Foscolo 7, 40123 Bologna, Italy. vetrugno@neuro.unibo.it
Provini
Federica
F
Cortelli
Pietro
P
Plazzi
Giuseppe
G
Lotti
Enrico M
EM
Pierangeli
Giulia
G
Canali
Carlotta
C
Montagna
Pasquale
P
D000328:Adult; D000368:Aged; D004562:Electrocardiography; D004576:Electromyography / Q000295:instrumentation; D005260:Female; D006339:Heart Rate / Q000502:physiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D019578:Multiple System Atrophy / Q000453:epidemiology*; D017286:Polysomnography / Q000295:instrumentation*; D012119:Respiration; D012120:Respiration Disorders / Q000175:diagnosis; D012135:Respiratory Sounds; D012148:Restless Legs Syndrome / Q000175:diagnosis / Q000453:epidemiology; D020181:Sleep Apnea, Obstructive / Q000175:diagnosis / Q000453:epidemiology; D012893:Sleep Wake Disorders / Q000453:epidemiology* / Q000209:etiology*; D012895:Sleep, REM / Q000502:physiology; D012913:Snoring / Q000175:diagnosis / Q000453:epidemiology; D014743:Videotape Recording; D014851:Wakefulness / Q000502:physiology