Nocturnal sleep in multisystem atrophy with autonomic failure: polygraphic findings in ten patients

A nocturnal polysomnographic study with infrared video-monitoring was performed in ten patients with multisystem atrophy with autonomic failure (MSA-AF) (seven males, three females; median age: 54 years), selected irrespective of the presence of sleep complaints. The MSA-AF patients showed disrupted sleep patterns. Quantitative and qualitative alterations of REM sleep were found, some of which resembled those seen in patients with REM sleep behaviour syndrome. However, only one patient reported episodes of REM behaviour. Six patients showed arterial oxyhaemoglobin (HbS_aO₂) drops below 90% during sleep in relation to recurrent apnoeas or hypopnoeas (HbS_aO₂ nadir 70%). The apnoea hypopnoea index was above the upper limit of the normal range in three of these patients in the absence of obesity or bronchopulmonary diseases. Among patients with sleep-related breathing impairment, laryngeal stridor (three cases) or snoring (one case) were observed. Patients with sleep-related breathing disorders (SBD) exhibited a higher degree of autonomic dysfunction than patients without SBD.