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Sleep dysfunction in multiple system atrophy
Luigi Ferini-Strambi1, Sara Marelli
1Department of Clinical Neurosciences, Sleep Disorders Center, Università Vita-Salute San Raffaele, Via Stamira d' Ancona 20, 20127, Milan, Italy, ferinistrambi.luigi@hsr.it.
Current Treatment Options in Neurology
|August 14, 2012
Summary
Sleep disorders, especially REM sleep behaviour disorder (RBD), are common in multiple system atrophy (MSA). Effective treatments for sleep issues and sleep-disordered breathing in MSA patients are available, improving survival and quality of life.
Area of Science:
- Neurology
- Sleep Medicine
Background:
- Sleep disorders are prevalent in multiple system atrophy (MSA), manifesting as fragmented sleep, daytime sleepiness, REM sleep behaviour disorder (RBD), and sleep-disordered breathing.
- RBD is nearly universal in MSA (90-100%) and can precede motor and autonomic symptoms by years, serving as an early indicator.
- Sleep disturbances affect both MSA with parkinsonism (MSA-P) and MSA with cerebellar ataxia (MSA-C) subtypes.
Purpose of the Study:
- To review the common sleep disorders in multiple system atrophy (MSA).
- To discuss current treatment strategies for sleep disturbances and sleep-disordered breathing in MSA patients.
- To highlight the prognostic significance of certain sleep disorders in MSA.
Main Methods:
- Literature review of sleep disorders in multiple system atrophy.
- Analysis of treatment options for REM sleep behaviour disorder (RBD) and sleep-disordered breathing (SDB) in MSA.
- Discussion of the clinical implications and diagnostic value of sleep disorders in MSA.
Main Results:
- REM sleep behaviour disorder (RBD) is the most common sleep disorder in MSA, often appearing years before other symptoms.
- Obstructive sleep apnea (OSA) affects 15-37% of MSA patients, while central sleep apnea is less frequent.
- Clonazepam is effective for RBD; zopiclone or melatonin may help with insomnia; CPAP is recommended for OSA and stridor, with tracheostomy reserved for severe cases or wakeful stridor.
Conclusions:
- Sleep disorders are a critical and often early feature of multiple system atrophy (MSA).
- Individualized treatment approaches are essential for managing sleep disturbances and improving outcomes in MSA.
- Early recognition and management of sleep disorders, particularly RBD and sleep-disordered breathing, can impact MSA patient survival and quality of life.
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