Tracheostomy can fatally exacerbate sleep-disordered breathing in multiple system atrophy.

Tracheostomy has been employed to release the airway obstruction at the glottic level and to prevent sudden death in patients with multiple system atrophy (MSA). However, sudden death is possible even after tracheostomy. Nocturnal polysomnography showed that the apnea-hypopnea index became higher after tracheostomy, and all tracheostomized patients had frequent central sleep apneas.