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

Abstract

None\nIn multiple system atrophy (MSA), sleep-disordered breathing has a broad spectrum of phenotypes, among them inspiratory stridor and obstructive sleep apnea being most frequent. We present a case of 59-year old female with cerebellar-type MSA, who showed transient paradoxical breathing effort during non-REM sleep on diagnostic polysomnography. Since this thoraco-abdominal paradox was atypical for and did not coincide with upper airway obstruction it most likely indicated central dysregulation of the diaphragm. Continuous positive airway pressure therapy with low pressure (5 cmH₂O) was sufficient to completely resolve this type of respiratory dysregulation. This case extends the clinical spectrum of sleep-disordered breathing in MSA.