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Drug-Induced Sleep Endoscopy (DISE) with Target Controlled Infusion (TCI) and Bispectral Analysis in Obstructive Sleep Apnea

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[Nocturnal stridor in multiple system atrophy].

Maartje Louter¹, Roel H Pelleboer, Guido B van den Broek

¹UMC St Radboud, Afd. Neurologie, Nijmegen, the Netherlands.

Nederlands Tijdschrift Voor Geneeskunde

|November 24, 2011

Summary

Nocturnal stridor in multiple system atrophy (MSA) patients significantly impacts life expectancy. While tracheotomy offers a solution, non-invasive treatments like CPAP are increasingly effective when indicated.

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Area of Science:

Neurology
Sleep Medicine
Otolaryngology

Background:

Multiple system atrophy (MSA) is a progressive neurodegenerative disease characterized by parkinsonism, ataxia, and autonomic dysfunction.
Nocturnal stridor in MSA patients is linked to reduced survival, necessitating effective management strategies.
Stridor in MSA is often overlooked, leading to uncertainty regarding optimal therapeutic interventions.

Observation:

A case study involved a 58-year-old female with MSA experiencing nocturnal stridor.
Diagnostic evaluations, including direct laryngoscopy, revealed bilateral vocal cord paresis and glottic stenosis.
Continuous positive airway pressure (CPAP) treatment provided unsatisfactory results for this patient.

Findings:

Tracheotomy successfully resolved the stridor in the presented MSA case.
Polysomnography and laryngoscopy are crucial diagnostic tools for stridor in MSA, following clinical assessment.
Non-invasive treatments, such as CPAP, demonstrate comparable effectiveness to tracheotomy when appropriate indications are met.

Implications:

Accurate diagnosis through polysomnography and laryngoscopy is vital for managing stridor in MSA.
Therapeutic decisions for stridor in MSA require a multidisciplinary approach involving neurologists, sleep specialists, otolaryngologists, and patients.
While tracheotomy remains an option, the efficacy of CPAP offers a less invasive alternative for selected MSA patients with stridor.