title: Discontinuation of continuous positive airway pressure treatment in multiple system atrophy.
abstract: OBJECTIVE
  Continuous positive airway pressure (CPAP) is used for the management of sleep-disordered breathing in patients with multiple system atrophy (MSA). However, the long-term outcome after CPAP treatment is yet to be ascertained.
  
  
  METHODS
  A retrospective study was performed to investigate the frequency and causes of CPAP treatment discontinuation, and to ascertain the determinations of CPAP treatment duration in Japanese patients diagnosed with probable MSA based upon the consensus diagnostic criteria, who were admitted to our hospital from 2001 to 2012.
  
  
  RESULTS
  Twenty-nine consecutive patients treated with CPAP were analyzed. During the observation period, 19 patients (66%) discontinued CPAP treatment. The median CPAP treatment duration was 13.0 months (range, 1-53 months). The major causes for discontinuation were pulmonary infection, respiratory insufficiency of undetermined origin, and CPAP intolerance. On comparing the clinical characteristics of the groups subjected to short- and long-term CPAP treatment, floppy epiglottis was more frequently observed in the short-term group than in the long-term group (64% vs. 15%; P = 0.015).
  
  
  CONCLUSIONS
  The CPAP treatment duration in MSA patients was not long, and floppy epiglottis may be a determinant of the duration of CPAP treatment.
authors.affiliation: Department of Neurology, Brain Research Institute, Niigata University, Niigata, Japan. Electronic address: t-shimo@bri.niigata-u.ac.jp.
authors.forename: Takayoshi
authors.initials: T
authors.lastname: Shimohata
authors.affiliation: Department of Respiratory Medicine, Tokyo Medical University, Tokyo, Japan.
authors.forename: Hideaki
authors.initials: H
authors.lastname: Nakayama
authors.affiliation: Department of Otolaryngology, Head and Neck Surgery, Faculty of Medicine, Niigata University, Niigata, Japan.
authors.forename: Naotaka
authors.initials: N
authors.lastname: Aizawa
authors.affiliation: Department of Neurology, Brain Research Institute, Niigata University, Niigata, Japan.
authors.forename: Masatoyo
authors.initials: M
authors.lastname: Nishizawa
mesh_terms: D000328:Adult; D045422:Continuous Positive Airway Pressure; D004825:Epiglottis / Q000503:physiopathology; D005260:Female; D006801:Humans; D007564:Japan; D008134:Long-Term Care; D008297:Male; D019578:Multiple System Atrophy / Q000453:epidemiology / Q000503:physiopathology / Q000628:therapy*; D017286:Polysomnography; D020181:Sleep Apnea, Obstructive / Q000453:epidemiology / Q000503:physiopathology / Q000628:therapy*; D013997:Time Factors; D017211:Treatment Failure
keywords: Continuous positive airway pressure; Discontinuation; Floppy epiglottis; Multiple system atrophy; Sleep-disordered breathing; Tracheostomy