Non-REM sleep-predominant reversible paradoxical breathing effort indicates dysregulation of diaphragm movements in multiple system atrophy.

STUDY

OBJECTIVES

In multiple system atrophy, sleep-disordered breathing has a broad spectrum of phenotypes, among them inspiratory stridor and obstructive sleep apnea being most frequent.

METHODS

We present a case of a 59-year-old woman with cerebellar-type multiple system atrophy, who showed transient paradoxical breathing effort during non-rapid eye movement sleep on diagnostic polysomnography. Because this thoraco-abdominal paradox was atypical for and did not coincide with upper airway obstruction, it most likely indicated central dysregulation of the diaphragm.

RESULTS

Continuous positive airway pressure therapy with low pressure (5 cm H₂O) was sufficient to completely resolve this type of respiratory dysregulation.

CONCLUSIONS

This case extends the clinical spectrum of sleep-disordered breathing in multiple system atrophy.