A strategic approach of the management of sleep-disordered breathing in multiple system atrophy
Dr. Anaïs Laga
First-year ENT resident from Ghent University with a special interest in sleep medicine.
Sleep-disordered breathing in multiple system atrophy
Multiple System Atrophy (MSA) is a rare and progressive neurodegenerative disorder characterised by autonomic dysfunction, often combined with Parkinsonian, cerebellar, or pyramidal signs. Sleep-disordered breathing (SDB) is common in MSA and can significantly affect quality of life and survival. Patients frequently present with stridor, obstructive sleep apnea (OSA), and central sleep apnea (CSA), making diagnosis and treatment particularly challenging.
This review summarises current evidence on the treatment of SDB in patients with MSA. A total of 29 studies, including 681 patients, were analysed. A broad range of therapeutic options has been explored in the literature, including continuous positive airway pressure (CPAP), tracheostomy, tracheostomy with invasive ventilation (TIV), non-invasive positive pressure ventilation(NPPV), adaptive servoventilation (ASV), vocal cord surgery, botulinum toxin injections, oral appliances, cervical spinal cord stimulation, and selective serotonin reuptake inhibitors (SSRIs).
Among these treatments, tracheostomy and particularly TIV are associated with improved survival. CPAP and other forms of positive airway pressure can be effective for managing symptoms of OSA, but CPAP may worsen CSA in some patients. Data on ASV and NPPV are limited and inconclusive. An important anatomical consideration in some MSA patients is a floppy epiglottis, which may necessitate a different therapeutic approach.
Given the variability and complexity of SDB manifestations in MSA, an individualised and multidisciplinary treatment plan is essential. Early recognition of breathing disturbances during sleep and careful selection of therapy can help improve outcomes in this vulnerable patient population.
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