title: Early stridor onset and stridor treatment predict survival in 136 patients with MSA.
abstract: OBJECTIVE
  To evaluate the predictive value of stridor and its latency of onset and to investigate the role of stridor treatment in a cohort of patients with multiple system atrophy (MSA) referred to a tertiary center.
  
  
  METHODS
  We retrospectively identified patients diagnosed with MSA referred to our department beginning in 1991 and evaluated at least yearly during the disease course. Stridor was defined as present when confirmed by a whole night video-polysomnography and as early if presenting within 3 years of disease onset. Survival data, from disease onset to time of death, were calculated with Kaplan-Meier curves. Predictors were identified in univariate and multivariable Cox regression analyses.
  
  
  RESULTS
  We included 136 patients with MSA; 113 were deceased at the time of study. Stridor was diagnosed in 42 patients, and 22 presented early stridor onset. Twelve of the 31 patients treated for stridor received tracheostomy, and 19 received continuous positive airway pressure. Overall survival did not differ between patients with and without stridor, while patients with early stridor onset had a worse prognosis than those developing this symptom later. In the stridor subgroup, early stridor onset was an unfavorable survival predictor. Stridor treatment was significantly associated with survival in our population. The Kaplan-Meier curve did not reveal significant differences in survival between the 2 treatments even though there was a trend toward longer disease duration in patients receiving tracheostomy.
  
  
  CONCLUSIONS
  Our results demonstrated that early stridor onset is an independent predictor for shorter survival and that tracheostomy could control stridor, influencing disease duration.
authors: From the IRCCS Institute of Neurological Sciences of Bologna (G.G., G.C.-B., A.C., G.B., F.P., P.C.); Departments of Biomedical and Neuromotor Sciences (G.G., G.C.-B., M.R., G.B., F.P., P.C.) and Experimental, Diagnostic and Specialty Medicine (M.L.B.-R.), Alma Mater Studiorum-University of Bologna, Italy; Department of Neurology (F.M.), Lewisham and Greenwich NHS Trust, Queen Elizabeth Hospital, London, UK; and Neurology Outpatient Clinic, Department of Primary Care (P.G.), Local Health Authority of Modena, Italy.
authors: Giulia
authors: G
authors: Giannini
authors: From the IRCCS Institute of Neurological Sciences of Bologna (G.G., G.C.-B., A.C., G.B., F.P., P.C.); Departments of Biomedical and Neuromotor Sciences (G.G., G.C.-B., M.R., G.B., F.P., P.C.) and Experimental, Diagnostic and Specialty Medicine (M.L.B.-R.), Alma Mater Studiorum-University of Bologna, Italy; Department of Neurology (F.M.), Lewisham and Greenwich NHS Trust, Queen Elizabeth Hospital, London, UK; and Neurology Outpatient Clinic, Department of Primary Care (P.G.), Local Health Authority of Modena, Italy.
authors: Giovanna
authors: G
authors: Calandra-Buonaura
authors: From the IRCCS Institute of Neurological Sciences of Bologna (G.G., G.C.-B., A.C., G.B., F.P., P.C.); Departments of Biomedical and Neuromotor Sciences (G.G., G.C.-B., M.R., G.B., F.P., P.C.) and Experimental, Diagnostic and Specialty Medicine (M.L.B.-R.), Alma Mater Studiorum-University of Bologna, Italy; Department of Neurology (F.M.), Lewisham and Greenwich NHS Trust, Queen Elizabeth Hospital, London, UK; and Neurology Outpatient Clinic, Department of Primary Care (P.G.), Local Health Authority of Modena, Italy.
authors: Francesca
authors: F
authors: Mastrolilli
authors: From the IRCCS Institute of Neurological Sciences of Bologna (G.G., G.C.-B., A.C., G.B., F.P., P.C.); Departments of Biomedical and Neuromotor Sciences (G.G., G.C.-B., M.R., G.B., F.P., P.C.) and Experimental, Diagnostic and Specialty Medicine (M.L.B.-R.), Alma Mater Studiorum-University of Bologna, Italy; Department of Neurology (F.M.), Lewisham and Greenwich NHS Trust, Queen Elizabeth Hospital, London, UK; and Neurology Outpatient Clinic, Department of Primary Care (P.G.), Local Health Authority of Modena, Italy.
authors: Matteo
authors: M
authors: Righini
authors: From the IRCCS Institute of Neurological Sciences of Bologna (G.G., G.C.-B., A.C., G.B., F.P., P.C.); Departments of Biomedical and Neuromotor Sciences (G.G., G.C.-B., M.R., G.B., F.P., P.C.) and Experimental, Diagnostic and Specialty Medicine (M.L.B.-R.), Alma Mater Studiorum-University of Bologna, Italy; Department of Neurology (F.M.), Lewisham and Greenwich NHS Trust, Queen Elizabeth Hospital, London, UK; and Neurology Outpatient Clinic, Department of Primary Care (P.G.), Local Health Authority of Modena, Italy.
authors: Maria Letizia
authors: ML
authors: Bacchi-Reggiani
authors: From the IRCCS Institute of Neurological Sciences of Bologna (G.G., G.C.-B., A.C., G.B., F.P., P.C.); Departments of Biomedical and Neuromotor Sciences (G.G., G.C.-B., M.R., G.B., F.P., P.C.) and Experimental, Diagnostic and Specialty Medicine (M.L.B.-R.), Alma Mater Studiorum-University of Bologna, Italy; Department of Neurology (F.M.), Lewisham and Greenwich NHS Trust, Queen Elizabeth Hospital, London, UK; and Neurology Outpatient Clinic, Department of Primary Care (P.G.), Local Health Authority of Modena, Italy.
authors: Annagrazia
authors: A
authors: Cecere
authors: From the IRCCS Institute of Neurological Sciences of Bologna (G.G., G.C.-B., A.C., G.B., F.P., P.C.); Departments of Biomedical and Neuromotor Sciences (G.G., G.C.-B., M.R., G.B., F.P., P.C.) and Experimental, Diagnostic and Specialty Medicine (M.L.B.-R.), Alma Mater Studiorum-University of Bologna, Italy; Department of Neurology (F.M.), Lewisham and Greenwich NHS Trust, Queen Elizabeth Hospital, London, UK; and Neurology Outpatient Clinic, Department of Primary Care (P.G.), Local Health Authority of Modena, Italy.
authors: Giorgio
authors: G
authors: Barletta
authors: From the IRCCS Institute of Neurological Sciences of Bologna (G.G., G.C.-B., A.C., G.B., F.P., P.C.); Departments of Biomedical and Neuromotor Sciences (G.G., G.C.-B., M.R., G.B., F.P., P.C.) and Experimental, Diagnostic and Specialty Medicine (M.L.B.-R.), Alma Mater Studiorum-University of Bologna, Italy; Department of Neurology (F.M.), Lewisham and Greenwich NHS Trust, Queen Elizabeth Hospital, London, UK; and Neurology Outpatient Clinic, Department of Primary Care (P.G.), Local Health Authority of Modena, Italy.
authors: Pietro
authors: P
authors: Guaraldi
authors: From the IRCCS Institute of Neurological Sciences of Bologna (G.G., G.C.-B., A.C., G.B., F.P., P.C.); Departments of Biomedical and Neuromotor Sciences (G.G., G.C.-B., M.R., G.B., F.P., P.C.) and Experimental, Diagnostic and Specialty Medicine (M.L.B.-R.), Alma Mater Studiorum-University of Bologna, Italy; Department of Neurology (F.M.), Lewisham and Greenwich NHS Trust, Queen Elizabeth Hospital, London, UK; and Neurology Outpatient Clinic, Department of Primary Care (P.G.), Local Health Authority of Modena, Italy.
authors: Federica
authors: F
authors: Provini
authors: From the IRCCS Institute of Neurological Sciences of Bologna (G.G., G.C.-B., A.C., G.B., F.P., P.C.); Departments of Biomedical and Neuromotor Sciences (G.G., G.C.-B., M.R., G.B., F.P., P.C.) and Experimental, Diagnostic and Specialty Medicine (M.L.B.-R.), Alma Mater Studiorum-University of Bologna, Italy; Department of Neurology (F.M.), Lewisham and Greenwich NHS Trust, Queen Elizabeth Hospital, London, UK; and Neurology Outpatient Clinic, Department of Primary Care (P.G.), Local Health Authority of Modena, Italy. pietro.cortelli@unibo.it.
authors: Pietro
authors: P
authors: Cortelli
mesh_terms: D045422:Continuous Positive Airway Pressure; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D019578:Multiple System Atrophy / Q000175:diagnosis* / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D015999:Multivariate Analysis; D017286:Polysomnography; D011379:Prognosis; D016016:Proportional Hazards Models; D012135:Respiratory Sounds / Q000175:diagnosis*; D012189:Retrospective Studies; D062606:Tertiary Care Centers; D014139:Tracheostomy; D014741:Video Recording