Objective: The purpose of this study is to elucidate whether sleep-discorded breathing (SDB) impact motor and non-motor symptoms in multiple system atrophy (MSA), and to explore the association between SDB and other sleep disorders in MSA. SDB was diagnosed in the presence of an AHI>5/h.

Background: Although increasing studies suggested that the SDB is common in MSA, the impact of SDB on clinical features was unknown.

Methods: Forty patients with MSA were examined by video-polysomnography (PSG). Forty age- and sex- matched healthy volunteers were performed PSG as a health control (HC) group. All of the patients were evaluated by Epworth Sleepiness Scale (ESS), Unified Multiple-System Atrophy Rating Scale (UMSARS), Non-Motor Symptoms Scale (NMSS), Hamilton Depression Scale (HAMD), Hamilton Anxiety Scale (HAMA), PD Questionnaire-39 (PDQ-39), Frontal assessment battery (FAB), and Montreal Cognitive Assessment (MoCA).

Results: Comparing with HCs, MSA patients had higher apnea-hypopnea index (AHI) recorded by PSG. Additionally, SDB (AHI>5/h) was diagnosed in 26 MSA patients (26/40, 65%), which was significantly higher than that in HCs (8/40, 20%). MSA patients also presented significantly longer latency to sleep onset, decreased total sleep time, higher arousal index and decreased sleep efficiency when compared with HCs. UMSARS score was positively associated with AHI (r=0.40, p=0.011). Compared to patients without SDB, MSA patients with SDB had significantly higher total UMSARS score (p=0.048), higher UMSARS-II score (p=0.030), increased number of ESS score≥10 (p=0.026), higher FAB score (p=0.038), higher HAMD score (p=0.032), increased number of low ventilation (p=0.029) and longer mean low ventilation time (p=0.039) than those without SDB. No significant differences were found in periodic limb movements, sleep time and sleep efficiency between MSA patients with and without SDB.

Conclusions: SDB is a relatively common symptom in Chinese MSA patients. The excessive daytime sleepiness had significant association with SDB in MSA. Moreover, MSA patients who had SDB are more likely to present increased disease severity, depression and frontal lobe dysfunction.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/clinical-and-polysomnographic-features-correlates-to-sleep-disordered-breathing-in-multiple-system-atrophy/