Rukmani Malligurki Raghurama, Yadav Ravi, Bhaskarapillai Binukumar, Pal Pramod Kumar, Sathyaprabha Talakad Narasappa
Department of Neurophysiology, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bangalore, India.
Department of Neurology, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bangalore, India.
Sleep Med. 2024 Dec;124:416-420. doi: 10.1016/j.sleep.2024.10.013. Epub 2024 Oct 10.
Multiple system atrophy (MSA) is a fatal alpha-synucleinopathy characterized by variable combinations of parkinsonism, autonomic and cerebellar dysfunction. Sleep in MSA is highly compromised due to various sleep disturbances. Disrupted sleep-wake cycles in MSA contribute to poor health-related quality of life and are negative prognostic factors.
We aimed to study the various sleep disturbances; the effect of parkinsonian and cerebellar phenotypes on sleep; and the correlation of sleep parameters with disease severity in an Asian-Indian cohort of probable MSA patients.
We recruited 60 probable MSA patients (MSA-P = 19; MSA-C = 41). Disease severity was assessed using UPDRS-III, UMSARS-I and UMSARS-II. Detailed history and relevant sleep questionnaires were applied to evaluate the sleep disturbances.
Sleep disturbances were universally observed in probable MSA patients in this cohort. These include REM behavior disorder (RBD)-95 %; poor sleep quality-80 %; secondary insomnia and intermittent awakenings-100 %; excessive daytime sleepiness-26 %; risk for obstructive sleep apnea-51.7 % and snoring-85 %. MSA patients reported 38.2 ± 22.9 percentage improvement in sleep with the medications. There was no significant difference between probable MSA-P and MSA-C patients in any of the sleep parameters. Sleep quality was poor in patients with pre-motor RBD than post-motor RBD (p < 0.01). Poor sleep quality had a moderate positive correlation with RBD duration. Disease severity positively correlated with RBD duration and poor sleep quality.
Sleep disturbances, the negative prognostic factors, were universally observed in this Asian Indian MSA cohort. This study provides supporting evidence that RBD might play a possible role in MSA disease severity, progression, and sleep quality.
多系统萎缩（MSA）是一种致命的α-突触核蛋白病，其特征为帕金森综合征、自主神经功能障碍和小脑功能障碍的不同组合。由于各种睡眠障碍，MSA患者的睡眠受到严重影响。MSA患者睡眠-觉醒周期紊乱会导致健康相关生活质量下降，且是不良预后因素。
我们旨在研究亚洲印度裔可能患有MSA的患者队列中的各种睡眠障碍；帕金森综合征和小脑表型对睡眠的影响；以及睡眠参数与疾病严重程度的相关性。
我们招募了60例可能患有MSA的患者（MSA-P = 19例；MSA-C = 41例）。使用统一帕金森病评定量表第三部分（UPDRS-III）、多系统萎缩评定量表第一部分（UMSARS-I）和第二部分（UMSARS-II）评估疾病严重程度。应用详细病史和相关睡眠问卷评估睡眠障碍。
在该队列中，可能患有MSA的患者普遍存在睡眠障碍。这些包括快速眼动睡眠行为障碍（RBD）-95%；睡眠质量差-80%；继发性失眠和间歇性觉醒-100%；白天过度嗜睡-26%；阻塞性睡眠呼吸暂停风险-51.7%和打鼾-85%。MSA患者报告称，使用药物后睡眠改善了38.2±22.9个百分点。在任何睡眠参数方面，可能患有MSA-P和MSA-C的患者之间均无显著差异。运动前RBD患者的睡眠质量比运动后RBD患者差（p < 0.01）。睡眠质量差与RBD持续时间呈中度正相关。疾病严重程度与RBD持续时间和睡眠质量差呈正相关。
在这个亚洲印度裔MSA队列中普遍观察到睡眠障碍这一不良预后因素。本研究提供了支持性证据，表明RBD可能在MSA疾病严重程度、进展和睡眠质量中发挥作用。
