Laryngo-pharyngeal findings and sleep-related breathing disorders in patients with multiple system atrophy

Abstract

Patients with multiple system atrophy (MSA) manifest a variety of sleep-related breathing disorders (SRBD). Vocal cord abductor paralysis (VCAP) is associated with respiratory failure and sudden death during sleep. To evaluate the relation between SRBD and clinical symptoms in patients with MSA, 11 patients with MSA admitted to our hospital were recruited for this study. All patients underwent detailed neurological examinations and brain imaging studies. Laryngoscopic examination and polysomnography were performed to detect SRBD and abnormal movements of the vocal cords and larynx. Ten patients (91%) showed SRBD, defined as five or more episodes of apnea and/or hypopnea per hour, with hypopnea predominant. Among the nine patients who underwent laryngoscopic examination, six (67%) showed VCAP, of whom two exhibited it only during sleep. Four patients had abnormal laryngeal movements, of whom two (33%) showed floppy arytenoid, one showed omega type, according to the classification of sleep-induced laryngomalacia in MSA, and the fourth one showed an unclassified pattern. Patients with VCAP tended to be older and have more frequent dysphagia, neurogenic bladder and severe SRBD, compared with those without VCAP. Physicians should be aware that SRBD is frequently observed in patients with MSA, and that VCAP and laryngo-pharyngeal abnormalities may be the initial or early signs of MSA.