RESEARCH: Effective nasal CPAP therapy for heavy snoring and paradoxical respiration

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Rinsho Shinkeigaku 1998 Dec;38(12):1059-63

Effective nasal CPAP therapy for heavy snoring and paradoxical respiration

during sleep in a case of multiple system atrophy

Miyamoto M, Miyamoto T, Katayama S, Hirata K.

Department of Neurology, Dokkyo University School of Medicine, Tochigi,

Japan.

A 64-year-old man with multiple system atrophy complained of daytime

sleepiness, fatigue, and snoring. Neurological examination revealed severe

autonomic failure, mild cerebellar ataxia and akinesia. Daytime blood gas

analysis showed respiratory acidosis with hypoxia and hypercapnia. MR

imaging of the brain showed atrophy of the pons, cerebellum and bilateral

frontal lobes. Although paralysis of the vocal cord abduction was not found

by laryngoscopy during daytime examination, polysomnography (PSG) showed

heavy snoring with paradoxical respiration associated with severe

desaturation during sleep as well as reduced slow wave sleep and REM sleep.

He was diagnosed as having sleep-related upper airway obstructive breathing

disorder probably due to Gerhardt syndrome. Tracheostomy was considered, but

we performed nasal CPAP therapy during sleep because this therapy is

non-invasive and would not impair his daily life. After nasal CPAP therapy,

daytime sleepiness, fatigue, and snoring with desaturation improved, and PSG

showed increased slow wave sleep. These results demonstrate that nasal CPAP

therapy improves the quality of sleep and should be considered in patients

with early stages of multiple system atrophy who exhibit sleep-related

breathing disorders.