Tonic Electromyogram Density in Multiple System Atrophy with Predominant Parkinsonism and Parkinson's Disease

Abstract

Background:Both Parkinson's disease (PD) and multiple system atrophy (MSA) have associated sleep disorders related to the underlying neurodegenerative pathology. Clinically, MSA with predominant parkinsonism (MSA-P) resembles PD in the manifestation of prominent parkinsonism. Whether the amount of rapid eye movement (REM) sleep without atonia could be a potential marker for differentiating MSA-P from PD has not been thoroughly investigated. This study aimed to examine whether sleep parameters could provide a method for differentiating MSA-P from PD.Methods:This study comprised 24 MSA-P patients and 30 PD patients, and they were of similar age, gender, and REM sleep behavior disorder (RBD) prevalence. All patients underwent clinical evaluation and one night of video-polysomnography recording. The tonic and phasic chin electromyogram (EMG) activity was manually quantified during REM sleep of each patient. We divided both groups in terms of whether they had RBD to make subgroup analysis.Results:No significant difference between MSA-P group and PD group had been found in clinical characteristics and sleep architecture. However, MSA-P patients had higher apnea-hypopnea index (AHI; 1.15 [0.00, 8.73]/h vs. 0.00 [0.00, 0.55]/h, P = 0.024) and higher tonic chin EMG density (34.02 [18.48, 57.18]% vs. 8.40 [3.11, 13.06]%, P < 0.001) as compared to PD patients. Subgroup analysis found that tonic EMG density in MSA + RBD subgroup was higher than that in PD + RBD subgroup (55.04 [26.81, 69.62]% vs. 11.40 [8.51, 20.41]%, P < 0.001). Furthermore, no evidence of any difference in tonic EMG density emerged between PD + RBD and MSA - RBD subgroups (P > 0.05). Both disease duration (P = 0.056) and AHI (P = 0.051) showed no significant differences during subgroup analysis although there was a trend toward longer disease duration in PD + RBD subgroup and higher AHI in MSA - RBD subgroup. Stepwise multiple linear regression analysis identified the presence of MSA-P (β = 0.552, P < 0.001) and RBD (β = 0.433, P < 0.001) as predictors of higher tonic EMG density.Conclusion:Tonic chin EMG density could be a potential marker for differentiating MSA-P from PD.

Increased Serum Cystatin C in Early Parkinson's Disease with Objective Sleep Disturbances

“…The objective sleep parameters of this early PD cohort were similar to our studies before[ 21 22 ] as TST was 352.6 ± 108.3 min, SE was 60.9% ± 18.3%, SL was 30.6 ± 52.0 min, awakenings (n) was 20.5 ± 9.4, NREM1 was 29.6% ± 18.5%, NREM2 was 42.9% ± 16.0%, NREM3 was 13.1% ± 11.6%, REM was 14.4% ± 9.1%, PLMSI was 31.5 ± 50.1/h, AHI was 9.2 ± 13.5/h, AI was 6.2 ± 11.1/h, HI was 3.0 ± 5.4/h, ODI was 8.6 ± 12.5/h, minimal SaO 2 (%) was 89.3% ± 3.9%, the percentage of time spent at SaO 2 <90% (%) was 1.7% ± 4.2%, and arousal with respiratory events during sleep was 2.5 ± 6.3/h.…”

Management Recommendations on Sleep Disturbance of Patients with Parkinson's Disease

“…[3106263] In China, this prevalence is 22.2–60.0%. [4917436465666768697071] The conversion rate from RBD to neurodegenerative diseases is 35.0–98.8%. The conversion rate from RBD to PD is 18.6–65.0%.…”

Pervasive and diffuse muscle activity during REM sleep and non‐REM sleep characterises multiple system atrophy in comparison with Parkinson's disease

“…We found that with respect to Parkinson's disease, multiple system atrophy within 5 years from disease onset was characterised by (Ferri et al, 2008), also with respect to Parkinson's disease (Iranzo et al, 2005;Wang et al, 2017).…”