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Strained face during sleep in multiple system atrophy: not just a bad dream
Lecca Rosamaria1,2, Figorilli Michela2, Bouniol Emma1
1Sleep and EEG, Neurophysiology Unit, Neurology Department, CHU University Hospital and UMR 6602-Université Clermont Auvergne, CNRS, Institute Pascal, Clermont-Ferrand, France.
Sleep
|July 18, 2023
Summary
Facial movements during sleep, particularly a "strained face," are more common in multiple system atrophy (MSA) than Parkinson's disease (PD). This may indicate sleep state dissociation due to neurodegeneration in MSA patients.
Area of Science:
- Neurology
- Sleep Medicine
- Neuroscience
Background:
- Parkinson's disease (PD) and multiple system atrophy (MSA) can cause sleep disturbances.
- Sleep state dissociation is a potential issue in these neurodegenerative conditions.
- Prominent facial movements during sleep were noted in MSA patients.
Purpose of the Study:
- To compare facial motor activity and chin muscle tone during sleep in MSA patients versus PD patients and controls.
- To investigate if specific facial movements or muscle tone changes characterize MSA during sleep.
Main Methods:
- Video-polysomnography and chin electromyography were used to analyze sleep in 62 participants (11 MSA, 38 PD, 13 controls).
- Facial movements were categorized, and chin muscle atonia index was calculated during REM and NREM sleep.
- Analysis was performed by a sleep expert blinded to patient pathology and sleep stage.
Main Results:
- MSA patients exhibited more facial movements during NREM sleep compared to controls.
- "Strained face" was significantly more frequent in MSA than PD, even after accounting for REM sleep behavior disorder (RBD).
- MSA patients showed a lower atonia index during REM and NREM sleep compared to controls and PD, with significant differences persisting in NREM stages N1 and N2 compared to PD after adjusting for RBD.
Conclusions:
- Increased facial movements, especially "strained face," are characteristic of MSA during sleep.
- Elevated muscle tone and facial activity in MSA may signify sleep state dissociation.
- These findings suggest more severe neurodegeneration in MSA patients presenting with these sleep-related motor phenomena.
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