Sleep-Induced Glottis Closure in Multiple System Atrophy Evaluated by Four-Dimensional Computed Tomography

Area of Science:

• Neurology
• Respiratory Medicine
• Radiology

Background:

• Multiple system atrophy (MSA) is a progressive neurodegenerative disease.
• Patients with MSA frequently exhibit sleep-related respiratory disorders, including upper airway obstruction and central sleep disturbances.
• Accurate assessment of the upper airway during sleep is crucial for managing MSA patients.

Observation:

• A 46-year-old male with MSA experienced respiratory failure during sleep, diagnosed with obstructive sleep apnea (OSA) and bilateral vocal abduction impairment (BVAI).
• Standard fiberoptic laryngoscopy was not tolerated by the patient.
• Four-dimensional computed tomography (4D-CT) was employed to evaluate upper airway dynamics during sleep.

Findings:

• 4D-CT imaging revealed glottis and velopharyngeal closure during the terminal phase of inspiration in the MSA patient.
• These findings, distinct from typical OSA in obesity, indicated MSA-related sleep-induced airway obstruction.
• The patient's respiratory failure was attributed to these specific upper airway abnormalities during sleep.

Implications:

• 4D-CT provides a non-intolerable method for assessing sleep-induced upper airway obstruction in MSA patients.
• This technique aids in identifying the specific causes of respiratory failure in MSA.
• The findings support the continued use of tracheostomy in certain MSA patients to manage progressive airway compromise.