Stridor combined with other sleep breathing disorders in multiple system atrophy: a tailored treatment?

Rekik, S.; Fortin, Martin; Dodet, Pauline; Redolfi, Stefania; Leu‐Semenescu, Smaranda; Corvol, Jean‐Christophe; Grabli, David; Arnulf, Isabelle

doi:10.1016/j.sleep.2017.12.008

Cited by 26 publications

(20 citation statements)

References 26 publications

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“…Respiratory dysfunction, including sleep-related breathing disorders and stridor, are included as the additional or supportive features of the current consensus diagnostic criteria for MSA [2]. Previous studies found that 15-70% of MSA patients had sleep apnea [25,26], which is more frequent than in PD [27]. In our study, snoring and sleep apnea were reported with a frequency of 70.5% and 34.4%, respectively.…”

Section: Discussionsupporting

confidence: 49%

Various Motor and Non-Motor Symptoms in Early Multiple System Atrophy

et al. 2019

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Background: Multiple system atrophy (MSA) patients present a variety of symptoms other than autonomic dysfunctions, parkinsonism, and cerebellar ataxia. The aim of this study was to evaluate the frequency of various motor and non-motor symptoms including so-called "red flags" in patients with early MSA and to determine whether the frequency of these symptoms was different between the parkinsonian (MSA-P) and cerebellar (MSA-C) subtypes. Methods: Sixty-one probable or possible MSA patients with disease duration of 3 years or less were included. Patients were classified into MSA-P, MSA-C, and MSA-PC. The frequency of 13 features including various motor and non-motor symptoms that commonly occur in MSA was assessed. Results: Dysarthria was the most prevalent feature (98.4%) followed by sexual dysfunction (95.1%). Probable REM sleep behavior disorder was present in 90.2%. The frequency of constipation (82.0%), dysphagia (68.9%), and snoring (70.5%) was also high. Stridor was present in 42.6% and more common in MSA-C than in MSA-P. Conclusions: Increasing awareness of various motor and non-motor symptoms may assist clinicians to make an early, accurate diagnosis and to improve management of patients with MSA. We suggest that the diagnostic accuracy can be improved if these features are appropriately reflected in the new diagnostic criteria for MSA.

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Section: Discussionsupporting

confidence: 49%

Various Motor and Non-Motor Symptoms in Early Multiple System Atrophy

et al. 2019

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“…The prevalence of MSA is 4-5/100,000 [1]. Common sleep disorders in MSA patients include rapid eye movement (REM) sleep behavior disorder (RBD), sleep-disordered breathing, reduced and fragmented sleep, and daytime excessive sleepiness [2]. Sleep disturbance is one of the common nonmotor symptoms in patients with Parkinson's disease (PD) as well as in those with Parkinson plus disorders [3,4].…”

Section: Introductionmentioning

confidence: 99%

A Questionnaire-Based Study on Clinical REM Sleep Behavior Disorder and Subtypes in Multiple System Atrophy

et al. 2021

Eur Neurol

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Objectives: Studies documenting the association between rapid eye movement sleep behavior disorder (RBD) and subtypes of multiple system atrophy (MSA) are rare. In this study, we investigated the presence of clinical RBD in MSA patients and compared the prevalence and severity of RBD in patients with MSA-P and MSA-C subtypes. Methods: We evaluated 54 consecutive patients presenting with MSA and hospitalized in the neurology ward of Beijing Hospital from February 2012 to June 2020. The healthy control (HC) group consisted of 100 healthy individuals who came to our hospital for physical examination. The clinical diagnosis of RBD was based on the minimal diagnostic criteria of International Classification of Sleep Disorders, revised. The severity of clinical RBD was rated on a digital scale from 0 to 3. The patients were divided into 2 subgroups: MSA-P and MSA-C. The MSA and HC groups were compared in terms of frequency of clinical RBD. The MSA-P and MSA-C subgroups were compared with each other for age, sex, onset age, disease duration, and features of clinical RBD. The correlation between severity of clinical RBD and clinical characteristics of MSA was analyzed in the patient groups. Results: The frequency of clinical RBD in MSA and HC groups was 70.4% (38/54) and 5% (5/100), respectively. The difference between 2 groups was significant (χ2 = 74.453, p = 0.000). Among the patients, 57.4% (31/54) had the MSA-P subtype. There were no significant differences between MSA-P and MSA-C subtypes in the prevalence (χ2 = 1.734, p = 0.188) and severity (χ2 = 1.776, p = 0.412) of clinical RBD. The onset of clinical RBD during the premotor period was not different between the subtypes of MSA, either in patients’ number of preceding the onset of motor symptoms (χ2 = 0.581, p = 0.446) or the preceding time (Z = −0.550, p = 0.582). For the MSA-C patients, there was a negative correlation between the score of severity of the RBD scale and RBD preceding motor symptoms (r = −0.482, p = 0.020). Conclusion: In our study, the prevalence of clinical RBD is unrelated to the subtypes of MSA. The onset of clinical RBD during the premotor period was not different between subtypes of MSA. However, we found that the severity of RBD occurring before the motor symptoms was more than that occurring after the motor symptoms in MSA-C patients. Our results showed that MSA-P and MSA-C patients may have a probable indicator for the similar pathologic mechanism of the disease and its sleep problems.

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“…Case-control studies have identified increased rates of OSA and AHI levels >5, compared to controls with continuous positive airways pressure (CPAP) improving stridor and sleep apnea. 50 Disruption to subcortical serotonergic neurotransmission is considered to be a key pathophysiological contributor, with depletion of the serotonergic innervation of the raphe nuclei and neurodegeneration of regions involved in respiratory regulation -the brainstem ventral arcuate nucleus and pre-Bötzinger complex cellsconsidered central in pathogenesis.…”

Section: Sleep Disorders In Multiple System Atrophy (Msa)mentioning

confidence: 99%

Sleep disturbance in movement disorders: insights, treatments and challenges

Bailey

Hubbard

Fasano

et al. 2021

J Neurol Neurosurg Psychiatry

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Sleep and circadian rhythm disturbances are central features of many movement disorders, exacerbating motor and non-motor symptoms and impairing quality of life. Understanding these disturbances to sleep is clinically important and may further our understanding of the underlying movement disorder. This review evaluates the current anatomical and neurochemical understanding of normal sleep and the recognised primary sleep disorders. In addition, we undertook a systematic review of the evidence for disruption to sleep across multiple movement disorders. Rapid eye movement sleep behaviour disorder has emerged as the most reliable prodromal biomarker for the alpha synucleinopathies, including Parkinson’s disease and multiple system atrophy, often preceding motor symptom onset by several years. Abnormal sleep has also been described for many other movement disorders, but further evidence is needed to determine whether this is a primary or secondary phenotypic component of the underlying condition. Medication used in the treatment of motor symptoms also affects sleep and can aggravate or cause certain sleep disorders. Within the context of movement disorders, there is also some suggestion of a shared underlying mechanism for motor and sleep pathophysiology, with evidence implicating thalamic and brainstem structures and monoaminergic neurotransmission. This review highlights the need for an understanding of normal and abnormal sleep within the movement disorder clinic, an ability to screen for specific causes of poor sleep and to treat sleep disturbance to improve quality of life. Key sleep disorders also act as important biomarkers and have implications in diagnosis, prognosis and the development of future therapies.

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Stridor combined with other sleep breathing disorders in multiple system atrophy: a tailored treatment?

Cited by 26 publications

References 26 publications

Various Motor and Non-Motor Symptoms in Early Multiple System Atrophy

Various Motor and Non-Motor Symptoms in Early Multiple System Atrophy

A Questionnaire-Based Study on Clinical REM Sleep Behavior Disorder and Subtypes in Multiple System Atrophy

Sleep disturbance in movement disorders: insights, treatments and challenges

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