The close relationship between life-threatening breathing disorders and urine storage dysfunction in multiple system atrophy

Abstract

Survival of multiple system atrophy (MSA) depends on whether a variety of sleep-related breathing problems as well as autonomic failure (AF) occur. Since the brainstem lesions that cause respiratory and autonomic dysfunction overlap with each other, these critical manifestations might get worse in parallel. If so, the detection of AF, which is comparatively easy, might be predictive of a latent life-threatening breathing disorder. In 15 patients with MSA, we performed autonomic function tests composed of postural challenges and administered a questionnaire on bladder condition, as well as polysomnography and laryngoscopy during wakefulness and under anesthesia. Polysomnographic variables such as the apnea-hypopnea index (AHI) and oxygen saturation (SpO(2)) and the findings of laryngoscopy were compared with the degree of cardiac and urinary autonomic dysfunction. AHI, mean SpO(2) and the lowest SpO(2) showed significant correlations with urine storage dysfunction. In addition, patients with vocal cord abductor paralysis (VCAP) or central sleep apnea (CSA) contributing to nocturnal sudden death had more severe storage disorders than those without. On the other hand, no significant relationship between polysomnographic variables and orthostatic hypotension was observed except in the case of mean SpO(2). These results indicate that life-threatening breathing disorders have a close relationship with AF, and especially urine storage dysfunction. Therefore, longitudinal assessment of deterioration of the storage function might be useful for predicting the latent progress of VCAP and CSA.

Sleep-related hypoventilation and hypercapnia in multiple system atrophy detected by polysomnography with transcutaneous carbon dioxide monitoring

“…We found that 85% of patients with MSA had SRBD, defined as an AHI of ≥ 5/h, which is comparable with previous studies using the same definition of SRBD that reported a prevalence of SRBD ranging from 48.6 to 88.9% in patients with MSA [ 22 – 27 ]. We also found that 62% of patients with MSA had moderate to severe SRBD, defined as an AHI of ≥ 15/h, which is consistent with previous studies reporting the prevalence of moderate to severe SRBD, defined as an AHI of ≥ 15/h, ranging from 37.5 to 66.7% in patients with MSA [ 23 , 26 , 27 ].…”

Multiple system atrophy: Prognostic indicators of survival

“…Among patients with MSA, urinary retention caused by detrusor underactivity tends to follow development of urinary incontinence caused by detrusor overactivity . An association between urinary incontinence caused by detrusor overactivity, loss of medullary serotonergic neurons, and nocturnal hypoxia has been reported in MSA . Detrusor overactivity might have preceded the early development of detrusor underactivity in our patients, and the loss of medullary serotonergic neurons and development of nocturnal hypoxia, both associated with increased risk of sudden death, might have already occurred by the time they needed early bladder catheterization.…”

Vocal fold motion impairment in multiple system atrophy

“…Deguchi et al have suggested that because the brainstem lesions that cause respiratory and autonomic dysfunction overlap with each other, these critical manifestations may get worse in parallel . Therefore, assessing autonomic function via postural challenges and bladder questionnaires might be predictive of vocal fold impairment and breathing disorders.…”