Saleheddine Rekik1, Francis Martin2, Pauline Dodet3, Stefania Redolfi3, Smaranda Leu-Semenescu4, Jean-Christophe Corvol5, David Grabli5, Isabelle Arnulf6. 1. Sleep Disorder Unit, Pitie-Salpetriere Hospital, AP-HP, Paris, France(1); Sorbonne University, Paris, France; Faculty of Medicine of Sfax, Sfax University, Sfax, Tunisia. 2. Sleep Disorder Unit, Pitie-Salpetriere Hospital, AP-HP, Paris, France(1); Chest Department, Compiegne General Hospital, Compiegne, France. 3. Sleep Disorder Unit, Pitie-Salpetriere Hospital, AP-HP, Paris, France(1); Sorbonne University, Paris, France. 4. Sleep Disorder Unit, Pitie-Salpetriere Hospital, AP-HP, Paris, France(1). 5. Sorbonne University, Paris, France; Neurology Department, Pitie-Salpetriere Hospital, AP-HP, Paris, France; National Reference Center for Multiple Systemic Atrophy, France. 6. Sleep Disorder Unit, Pitie-Salpetriere Hospital, AP-HP, Paris, France(1); Sorbonne University, Paris, France. Electronic address: isabelle.arnulf@aphp.fr.
Abstract
OBJECTIVES: To determine the frequency of sleep breathing disorders in multiple systemic atrophy (MSA, combining Parkinsonism, cerebellar syndrome, and dysautonomia) and evaluate the benefit/tolerance of various modes of ventilation. METHODS: We retrospectively analyzed 45 patients with MSA having undergone a videopolysomnography. Their sleep characteristics were compared to those of 45 patients with Parkinson's disease and 45 healthy controls, matched for age and sex. Patients with MSA received fixed continuous positive airway pressure (CPAP) when stridor was isolated, auto-adjusting CPAP when it was combined with obstructive sleep apnea, and adaptive servo-ventilation (ASV) when combined with central sleep apnea. RESULTS: Higher periodic leg movements index and more frequent REM sleep behavior disorder were observed in MSA patients, compared to patients with Parkinson's disease and healthy controls. In MSA, 28/45 (62.2%) patients had sleep breathing disorders, including (overlapping samples) stridor (n = 17, 38%), obstructive sleep apnea (n = 14, 31%), central sleep apnea (n = 4, 9%), and ataxic breathing (n = 1). Except for three initial refusals and two yet untreated patients, fixed CPAP (n = 9), auto-adjusting CPAP (n = 8) and ASV (n = 2) were well-tolerated (limited leaks and good compliance) and successfully controlled stridor plus sleep apnea. Treated patients had survival times similar to those of patients without any sleep breathing disorder. CONCLUSION: In this small group, tailored management of stridor in MSA as an independent issue or combined with obstructive and central sleep apnea, yields a survival similar to survival in patients without sleep breathing disorders.
OBJECTIVES: To determine the frequency of sleep breathing disorders in multiple systemic atrophy (MSA, combining Parkinsonism, cerebellar syndrome, and dysautonomia) and evaluate the benefit/tolerance of various modes of ventilation. METHODS: We retrospectively analyzed 45 patients with MSA having undergone a videopolysomnography. Their sleep characteristics were compared to those of 45 patients with Parkinson's disease and 45 healthy controls, matched for age and sex. Patients with MSA received fixed continuous positive airway pressure (CPAP) when stridor was isolated, auto-adjusting CPAP when it was combined with obstructive sleep apnea, and adaptive servo-ventilation (ASV) when combined with central sleep apnea. RESULTS: Higher periodic leg movements index and more frequent REM sleep behavior disorder were observed in MSA patients, compared to patients with Parkinson's disease and healthy controls. In MSA, 28/45 (62.2%) patients had sleep breathing disorders, including (overlapping samples) stridor (n = 17, 38%), obstructive sleep apnea (n = 14, 31%), central sleep apnea (n = 4, 9%), and ataxic breathing (n = 1). Except for three initial refusals and two yet untreated patients, fixed CPAP (n = 9), auto-adjusting CPAP (n = 8) and ASV (n = 2) were well-tolerated (limited leaks and good compliance) and successfully controlled stridor plus sleep apnea. Treated patients had survival times similar to those of patients without any sleep breathing disorder. CONCLUSION: In this small group, tailored management of stridor in MSA as an independent issue or combined with obstructive and central sleep apnea, yields a survival similar to survival in patients without sleep breathing disorders.