title: Sleep disorders in multiple system atrophy: a correlative video-polysomnographic study.
abstract: 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.
authors.affiliation: Department of Neurological Sciences, University of Bologna, Via Ugo Foscolo 7, 40123 Bologna, Italy. vetrugno@neuro.unibo.it
authors.forename: Roberto
authors.initials: R
authors.lastname: Vetrugno
authors.forename: Federica
authors.initials: F
authors.lastname: Provini
authors.forename: Pietro
authors.initials: P
authors.lastname: Cortelli
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Plazzi
authors.forename: Enrico M
authors.initials: EM
authors.lastname: Lotti
authors.forename: Giulia
authors.initials: G
authors.lastname: Pierangeli
authors.forename: Carlotta
authors.initials: C
authors.lastname: Canali
authors.forename: Pasquale
authors.initials: P
authors.lastname: Montagna
mesh_terms: 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