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Specific patterns of laryngeal electromyography during wakefulness are associated to sleep disordered breathing and nocturnal stridor in multiple system atrophy.
Parkinsonism Relat Disord. 2016 10; 31:104-109.PR

Abstract

BACKGROUND

Nocturnal stridor and respiratory abnormalities are important features of multiple system atrophy (MSA) with relevance to patient survival, and they are detected and evaluated mainly through video-polysomnography (video-PSG). Diurnal laryngoscopy seems to yield abnormal findings only in the presence of significant vocal cord (VC) dysfunction.

AIM

To assess whether specific electrophysiological patterns of diurnal EMG of VC muscles may indicate nocturnal stridor or respiratory dysfunctions in MSA patients.

MATERIALS AND METHODS

Seventeen patients with probable MSA were examined. A full-night video-PSG to collect standard breathing parameters (apnea/hypopnea index, mean HbSAO2, oxygen desaturation index, total sleep time with HbSaO2 below 90%) was performed in all the patients. Laryngoscopy and EMG investigation of adductor (thyroarytenoid-TA) and abductor (posterior cricoarytenoid-PCA) muscles of the VCs were also performed.

RESULTS

Both the laryngeal EMG abnormalities (based on MUAP analysis and kinesiologic EMG investigation of VC muscles) and the laryngoscopic alterations correlated with video-PSG respiratory abnormalities. Specific patterns of EMG findings were consistently found in MSA subjects with nocturnal stridor detected at PSG. In particular, the following EMG findings were related to the severity of breathing abnormalities and the presence of stridor on video-PSG: neurogenic pattern on MUAP analysis of the PCA, paradoxical activation of the TA during inspiration and tonic EMG activity of the TA during quiet breathing.

CONCLUSIONS

Electromyographic/kinesiologic investigation of VC muscles during wakefulness provides additional information on the pathophysiology of the respiratory abnormalities in MSA patients that could be useful for guiding the choice of the best appropriate treatment and care.

Authors+Show Affiliations

Spinal and Brainstem Reflexes Laboratory, C. Mondino National Neurological Institute, University of Pavia, Pavia, Italy. Electronic address: enrico.alfonsi@mondino.it.Sleep Disorders Center, C. Mondino National Neurological Institute, University of Pavia, Pavia, Italy.Department of Experimental Biomedicine and Clinical Neurosciences (BioNec), University of Palermo, Palermo, Italy.Spinal and Brainstem Reflexes Laboratory, C. Mondino National Neurological Institute, University of Pavia, Pavia, Italy.Sleep Disorders Center, C. Mondino National Neurological Institute, University of Pavia, Pavia, Italy.Parkinson's Disease Center, C. Mondino National Neurological Institute, University of Pavia, Pavia, Italy.Spinal and Brainstem Reflexes Laboratory, C. Mondino National Neurological Institute, University of Pavia, Pavia, Italy.Department of Otorhinolaryngology, IRCCS Policlinico San Matteo Foundation, University of Pavia, Pavia, Italy.Spinal and Brainstem Reflexes Laboratory, C. Mondino National Neurological Institute, University of Pavia, Pavia, Italy.Spinal and Brainstem Reflexes Laboratory, C. Mondino National Neurological Institute, University of Pavia, Pavia, Italy.Spinal and Brainstem Reflexes Laboratory, C. Mondino National Neurological Institute, University of Pavia, Pavia, Italy.Parkinson's Disease Center, C. Mondino National Neurological Institute, University of Pavia, Pavia, Italy.Parkinson's Disease Center, C. Mondino National Neurological Institute, University of Pavia, Pavia, Italy.Spinal and Brainstem Reflexes Laboratory, C. Mondino National Neurological Institute, University of Pavia, Pavia, Italy.Spinal and Brainstem Reflexes Laboratory, C. Mondino National Neurological Institute, University of Pavia, Pavia, Italy.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

27510647

Citation

Alfonsi, E, et al. "Specific Patterns of Laryngeal Electromyography During Wakefulness Are Associated to Sleep Disordered Breathing and Nocturnal Stridor in Multiple System Atrophy." Parkinsonism & Related Disorders, vol. 31, 2016, pp. 104-109.
Alfonsi E, Terzaghi M, Cosentino G, et al. Specific patterns of laryngeal electromyography during wakefulness are associated to sleep disordered breathing and nocturnal stridor in multiple system atrophy. Parkinsonism Relat Disord. 2016;31:104-109.
Alfonsi, E., Terzaghi, M., Cosentino, G., Tassorelli, C., Manni, R., Pozzi, N., De Icco, R., Bertino, G., Todisco, M., Alvisi, E., Fresia, M., Pacchetti, C., Zangaglia, R., Prunetti, P., & Moglia, A. (2016). Specific patterns of laryngeal electromyography during wakefulness are associated to sleep disordered breathing and nocturnal stridor in multiple system atrophy. Parkinsonism & Related Disorders, 31, 104-109. https://doi.org/10.1016/j.parkreldis.2016.07.017
Alfonsi E, et al. Specific Patterns of Laryngeal Electromyography During Wakefulness Are Associated to Sleep Disordered Breathing and Nocturnal Stridor in Multiple System Atrophy. Parkinsonism Relat Disord. 2016;31:104-109. PubMed PMID: 27510647.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Specific patterns of laryngeal electromyography during wakefulness are associated to sleep disordered breathing and nocturnal stridor in multiple system atrophy. AU - Alfonsi,E, AU - Terzaghi,M, AU - Cosentino,G, AU - Tassorelli,C, AU - Manni,R, AU - Pozzi,N, AU - De Icco,R, AU - Bertino,G, AU - Todisco,M, AU - Alvisi,E, AU - Fresia,M, AU - Pacchetti,C, AU - Zangaglia,R, AU - Prunetti,P, AU - Moglia,A, Y1 - 2016/08/02/ PY - 2016/05/10/received PY - 2016/07/05/revised PY - 2016/07/28/accepted PY - 2016/8/12/pubmed PY - 2018/2/7/medline PY - 2016/8/12/entrez KW - Laryngeal electromyography KW - Laryngoscopy KW - Multiple system atrophy KW - Nocturnal stridor KW - Sleep disordered breathing SP - 104 EP - 109 JF - Parkinsonism & related disorders JO - Parkinsonism Relat. Disord. VL - 31 N2 - BACKGROUND: Nocturnal stridor and respiratory abnormalities are important features of multiple system atrophy (MSA) with relevance to patient survival, and they are detected and evaluated mainly through video-polysomnography (video-PSG). Diurnal laryngoscopy seems to yield abnormal findings only in the presence of significant vocal cord (VC) dysfunction. AIM: To assess whether specific electrophysiological patterns of diurnal EMG of VC muscles may indicate nocturnal stridor or respiratory dysfunctions in MSA patients. MATERIALS AND METHODS: Seventeen patients with probable MSA were examined. A full-night video-PSG to collect standard breathing parameters (apnea/hypopnea index, mean HbSAO2, oxygen desaturation index, total sleep time with HbSaO2 below 90%) was performed in all the patients. Laryngoscopy and EMG investigation of adductor (thyroarytenoid-TA) and abductor (posterior cricoarytenoid-PCA) muscles of the VCs were also performed. RESULTS: Both the laryngeal EMG abnormalities (based on MUAP analysis and kinesiologic EMG investigation of VC muscles) and the laryngoscopic alterations correlated with video-PSG respiratory abnormalities. Specific patterns of EMG findings were consistently found in MSA subjects with nocturnal stridor detected at PSG. In particular, the following EMG findings were related to the severity of breathing abnormalities and the presence of stridor on video-PSG: neurogenic pattern on MUAP analysis of the PCA, paradoxical activation of the TA during inspiration and tonic EMG activity of the TA during quiet breathing. CONCLUSIONS: Electromyographic/kinesiologic investigation of VC muscles during wakefulness provides additional information on the pathophysiology of the respiratory abnormalities in MSA patients that could be useful for guiding the choice of the best appropriate treatment and care. SN - 1873-5126 UR - https://www.unboundmedicine.com/medline/citation/27510647/Specific_patterns_of_laryngeal_electromyography_during_wakefulness_are_associated_to_sleep_disordered_breathing_and_nocturnal_stridor_in_multiple_system_atrophy_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1353-8020(16)30281-4 DB - PRIME DP - Unbound Medicine ER -