title: The close relationship between life-threatening breathing disorders and urine storage dysfunction in multiple system atrophy.
abstract: Survival of multiple system atrophy (MSA) depends on whether a variety of sleep-related breathing problems as well as autonomic failure (AF) occur. Since the brainstem lesions that cause respiratory and autonomic dysfunction overlap with each other, these critical manifestations might get worse in parallel. If so, the detection of AF, which is comparatively easy, might be predictive of a latent life-threatening breathing disorder. In 15 patients with MSA, we performed autonomic function tests composed of postural challenges and administered a questionnaire on bladder condition, as well as polysomnography and laryngoscopy during wakefulness and under anesthesia. Polysomnographic variables such as the apnea-hypopnea index (AHI) and oxygen saturation (SpO(2)) and the findings of laryngoscopy were compared with the degree of cardiac and urinary autonomic dysfunction. AHI, mean SpO(2) and the lowest SpO(2) showed significant correlations with urine storage dysfunction. In addition, patients with vocal cord abductor paralysis (VCAP) or central sleep apnea (CSA) contributing to nocturnal sudden death had more severe storage disorders than those without. On the other hand, no significant relationship between polysomnographic variables and orthostatic hypotension was observed except in the case of mean SpO(2). These results indicate that life-threatening breathing disorders have a close relationship with AF, and especially urine storage dysfunction. Therefore, longitudinal assessment of deterioration of the storage function might be useful for predicting the latent progress of VCAP and CSA.
authors.affiliation: Department of Gastroenterology and Neurology, Faculty of Medicine, Kagawa University, 1750-1 Ikenobe, Miki-cho, Kita-gun, Kagawa 761-0793, Japan. kdeguchi@med.kagawa-u.ac.jp
authors.forename: Kazushi
authors.initials: K
authors.lastname: Deguchi
authors.forename: Kazuyo
authors.initials: K
authors.lastname: Ikeda
authors.forename: Rieko
authors.initials: R
authors.lastname: Goto
authors.forename: Masago
authors.initials: M
authors.lastname: Tsukaguchi
authors.forename: Yoshiteru
authors.initials: Y
authors.lastname: Urai
authors.forename: Kazutaka
authors.initials: K
authors.lastname: Kurokohchi
authors.forename: Tetsuo
authors.initials: T
authors.lastname: Touge
authors.forename: Nozomu
authors.initials: N
authors.lastname: Mori
authors.forename: Tsutomu
authors.initials: T
authors.lastname: Masaki
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D007828:Laryngoscopy; D008297:Male; D008875:Middle Aged; D019578:Multiple System Atrophy / Q000150:complications*; D009460:Neurologic Examination; D017286:Polysomnography; D011187:Posture / Q000502:physiology; D012131:Respiratory Insufficiency / Q000175:diagnosis* / Q000209:etiology; D012791:Shy-Drager Syndrome / Q000175:diagnosis* / Q000209:etiology / Q000503:physiopathology*; D001750:Urinary Bladder, Neurogenic / Q000209:etiology / Q000503:physiopathology*