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Daytime hypoxemia, sleep-disordered breathing, and laryngopharyngeal findings in multiple system atrophy.
Arch Neurol. 2007 Jun; 64(6):856-61.AN

Abstract

BACKGROUND

The mechanism underlying nocturnal sudden death in patients with MSA remains unclear. It may be explained by upper airway obstruction, such as vocal cord abductor paralysis; an impairment of the respiratory center, such as Cheyne-Stokes respiration; or an impaired hypoxemic ventilatory response.

OBJECTIVE

To investigate the mechanism of sleep-disordered breathing in multiple system atrophy (MSA).

DESIGN

We recruited 21 patients with probable MSA who were admitted sequentially to our hospital, and performed daytime blood gas analysis, pulmonary function tests, polysomnography, and fiberoptic laryngoscopy during wakefulness and with the patient under anesthesia.

RESULTS

A decrease in arterial oxygen pressure and an increase in alveolar-arterial oxygen gradient significantly correlated with disease duration (P = .045 and .046, respectively). Polysomnography demonstrated Cheyne-Stokes respiration in 3 (15%) of 20 patients. Fiberoptic laryngoscopy during wakefulness showed that 3 (14%) of the 21 patients exhibited vocal cord abductor paralysis, and laryngoscopy under anesthesia showed that 9 (45%) of 20 patients exhibited vocal cord abductor paralysis. Laryngoscopy under anesthesia also revealed that 11 (55%) of 20 patients showed upper airway obstruction in places other than the vocal cords, including obstruction at the base of the tongue or soft palate. In addition, it demonstrated novel laryngopharyngeal findings, such as floppy epiglottis and airway obstruction at the arytenoid.

CONCLUSIONS

We observed daytime hypoxemia with an increased alveolar-arterial oxygen gradient, Cheyne-Stokes respiration, and novel abnormal laryngopharyngeal movements in patients with MSA. We also found that laryngoscopy under anesthesia might be useful for evaluating upper airway obstruction. The significance of these findings to the mechanism of sudden death in those with MSA needs to be examined.

Authors+Show Affiliations

Department of Neurology, Brain Research Institute, Niigata University, 1-757 Asahi-machi-dori Niigata, Niigata 951-8585, Japan.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

17562934

Citation

Shimohata, Takayoshi, et al. "Daytime Hypoxemia, Sleep-disordered Breathing, and Laryngopharyngeal Findings in Multiple System Atrophy." Archives of Neurology, vol. 64, no. 6, 2007, pp. 856-61.
Shimohata T, Shinoda H, Nakayama H, et al. Daytime hypoxemia, sleep-disordered breathing, and laryngopharyngeal findings in multiple system atrophy. Arch Neurol. 2007;64(6):856-61.
Shimohata, T., Shinoda, H., Nakayama, H., Ozawa, T., Terajima, K., Yoshizawa, H., Matsuzawa, Y., Onodera, O., Naruse, S., Tanaka, K., Takahashi, S., Gejyo, F., & Nishizawa, M. (2007). Daytime hypoxemia, sleep-disordered breathing, and laryngopharyngeal findings in multiple system atrophy. Archives of Neurology, 64(6), 856-61.
Shimohata T, et al. Daytime Hypoxemia, Sleep-disordered Breathing, and Laryngopharyngeal Findings in Multiple System Atrophy. Arch Neurol. 2007;64(6):856-61. PubMed PMID: 17562934.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Daytime hypoxemia, sleep-disordered breathing, and laryngopharyngeal findings in multiple system atrophy. AU - Shimohata,Takayoshi, AU - Shinoda,Hideo, AU - Nakayama,Hideaki, AU - Ozawa,Tetsutaro, AU - Terajima,Kenshi, AU - Yoshizawa,Hirohisa, AU - Matsuzawa,Yoko, AU - Onodera,Osamu, AU - Naruse,Satoshi, AU - Tanaka,Keiko, AU - Takahashi,Sugata, AU - Gejyo,Fumitake, AU - Nishizawa,Masatoyo, PY - 2007/6/15/pubmed PY - 2007/7/18/medline PY - 2007/6/15/entrez SP - 856 EP - 61 JF - Archives of neurology JO - Arch. Neurol. VL - 64 IS - 6 N2 - BACKGROUND: The mechanism underlying nocturnal sudden death in patients with MSA remains unclear. It may be explained by upper airway obstruction, such as vocal cord abductor paralysis; an impairment of the respiratory center, such as Cheyne-Stokes respiration; or an impaired hypoxemic ventilatory response. OBJECTIVE: To investigate the mechanism of sleep-disordered breathing in multiple system atrophy (MSA). DESIGN: We recruited 21 patients with probable MSA who were admitted sequentially to our hospital, and performed daytime blood gas analysis, pulmonary function tests, polysomnography, and fiberoptic laryngoscopy during wakefulness and with the patient under anesthesia. RESULTS: A decrease in arterial oxygen pressure and an increase in alveolar-arterial oxygen gradient significantly correlated with disease duration (P = .045 and .046, respectively). Polysomnography demonstrated Cheyne-Stokes respiration in 3 (15%) of 20 patients. Fiberoptic laryngoscopy during wakefulness showed that 3 (14%) of the 21 patients exhibited vocal cord abductor paralysis, and laryngoscopy under anesthesia showed that 9 (45%) of 20 patients exhibited vocal cord abductor paralysis. Laryngoscopy under anesthesia also revealed that 11 (55%) of 20 patients showed upper airway obstruction in places other than the vocal cords, including obstruction at the base of the tongue or soft palate. In addition, it demonstrated novel laryngopharyngeal findings, such as floppy epiglottis and airway obstruction at the arytenoid. CONCLUSIONS: We observed daytime hypoxemia with an increased alveolar-arterial oxygen gradient, Cheyne-Stokes respiration, and novel abnormal laryngopharyngeal movements in patients with MSA. We also found that laryngoscopy under anesthesia might be useful for evaluating upper airway obstruction. The significance of these findings to the mechanism of sudden death in those with MSA needs to be examined. SN - 0003-9942 UR - https://www.unboundmedicine.com/medline/citation/17562934/Daytime_hypoxemia_sleep_disordered_breathing_and_laryngopharyngeal_findings_in_multiple_system_atrophy_ L2 - https://jamanetwork.com/journals/jamaneurology/fullarticle/10.1001/archneur.64.6.856 DB - PRIME DP - Unbound Medicine ER -