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Multiple system atrophy manifesting as complex sleep-disordered breathing.

Masaaki Suzuki1, Hanako Saigusa, Kana Shibasaki

  • 1Department of Otolaryngology, Teikyo University School of Medicine, 2-11-1 Kaga, Itabashi-ku, Tokyo 173-8605, Japan. suzukima@med.teikyo-u.ac.jp

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Multiple system atrophy (MSA) patients may have obstructive sleep-disordered breathing (SDB) that masks central sleep apnea. Central sleep apnea in MSA is only identifiable after upper airway obstruction is resolved.

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Area of Science:

  • Neurology
  • Sleep Medicine
  • Respiratory Medicine

Background:

  • Multiple system atrophy (MSA) is a neurodegenerative disorder affecting autonomic, motor, and respiratory functions.
  • Sleep-disordered breathing (SDB) is a common comorbidity in MSA, presenting diagnostic challenges.

Observation:

  • A patient with MSA and obstructive SDB (AHI 29.6/h) initially showed no central apneas.
  • Upon positive airway pressure titration to eliminate obstruction, central apneas emerged (CAI 45.3/h).

Findings:

  • Adaptive servoventilation reduced central apnea index (CAI) but did not eliminate it (14.2/h).
  • MSA-related SDB can stem from upper airway obstruction and/or degeneration of respiratory control centers.
  • Diagnostic polysomnography may underestimate central sleep apnea in MSA if upper airway obstruction is not addressed.

Implications:

  • Accurate diagnosis of central sleep apnea in MSA requires addressing upper airway obstruction first.
  • Understanding the dual etiology of SDB in MSA is crucial for effective management.
  • Clinicians must consider the potential for masked central sleep apnea in MSA patients with obstructive SDB.