Vetrugno Roberto, Provini Federica, Cortelli Pietro, Plazzi Giuseppe, Lotti Enrico M, Pierangeli Giulia, Canali Carlotta, Montagna Pasquale
Department of Neurological Sciences, University of Bologna, Via Ugo Foscolo 7, 40123 Bologna, Italy.
Sleep Med. 2004 Jan;5(1):21-30. doi: 10.1016/j.sleep.2003.07.002.
The reciprocal relation between breathing, heart and motor system abnormalities during sleep was studied in multiple system atrophy (MSA) by means of video-polysomnographic recordings (VPSG).
Nineteen consecutive MSA patients underwent VPSG with scoring for sleep, respiratory abnormalities, heart (HR) and breathing (BR) rates, and abnormal motor activities. A comparative analysis was performed versus 10 patients with obstructive sleep apnoea syndrome (OSAS).
All MSA patients displayed snoring, 42% stridor, and 37% OSAS. Mean sleep SaO(2) was 92.7%, and lowest SaO(2) 86%. Patients with stridor had a significant increase in BR from Wake to NREM and REM sleep, and higher HR during sleep. Respiratory muscles and tibialis anterior EMG tonic activity was frequently found, more often in patients with stridor. All patients had REM sleep behaviour disorders (RBD) and 88% periodic limb movements during sleep (PLMS). No OSAS patient had RBD or respiratory muscles and tibialis anterior tonic activity.
MSA patients, especially those with associated stridor, commonly display impaired breathing and abnormal control of respiratory and limb muscles during sleep. Breathing and motor abnormalities are often concomitant in the same patient, indicating a diffuse impairment of sleep homeostatic integration that should be included within the diagnostic features of MSA.
通过视频多导睡眠图记录（VPSG）研究多系统萎缩（MSA）患者睡眠期间呼吸、心脏和运动系统异常之间的相互关系。
19例连续的MSA患者接受了VPSG检查，对睡眠、呼吸异常、心率（HR）、呼吸频率（BR）及异常运动活动进行评分。与10例阻塞性睡眠呼吸暂停综合征（OSAS）患者进行了对比分析。
所有MSA患者均有打鼾，42%有喘鸣，37%有OSAS。平均睡眠期血氧饱和度（SaO₂）为92.7%，最低SaO₂为86%。有喘鸣的患者从清醒到非快速眼动（NREM）睡眠和快速眼动（REM）睡眠期间BR显著增加，睡眠期间HR更高。经常发现呼吸肌和胫前肌肌电图有紧张性活动，在有喘鸣的患者中更常见。所有患者均有快速眼动睡眠行为障碍（RBD），88%有睡眠期周期性肢体运动（PLMS）。OSAS患者均无RBD或呼吸肌及胫前肌紧张性活动。
MSA患者，尤其是伴有喘鸣的患者，睡眠期间通常存在呼吸功能受损以及呼吸和肢体肌肉控制异常。呼吸和运动异常在同一患者中常同时出现，表明睡眠稳态整合存在弥漫性损害，应纳入MSA的诊断特征。
