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Volume 14 No. 10
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Accepted Papers

Scientific Investigations

Breathing Irregularity Is Independently Associated With the Severity of Obstructive Sleep Apnea in Patients With Multiple System Atrophy

Hideaki Nakayama, MD, PhD1,2; Satoshi Hokari, MD, PhD2; Yasuyoshi Ohshima, MD, PhD2; Takayuki Matsuto, MD, PhD3; Takayoshi Shimohata, MD, PhD4
1Department of Respiratory Medicine, Tokyo Medical University, Tokyo, Japan; 2Department of Respiratory Medicine and Infectious Diseases, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan; 3Department of Laboratory Medicine, Niigata University School of Medicine, Niigata, Japan; 4Department of Neurology and Geriatrics, Gifu University Graduate School of Medicine, Gifu, Japan

Study Objectives:

Multiple system atrophy (MSA) is a neurodegenerative disease characterized by the combination of cerebellar ataxia, parkinsonism, and autonomic disturbance. Patients with MSA frequently have sleep-disordered breathing. In some patients with MSA, central sleep apnea manifests during the disease's natural course or as a treatment effect. Breathing instability may be involved in the development of obstructive sleep apnea (OSA); therefore, we investigated whether breathing instability affects the severity of OSA in patients with MSA.


Patients with MSA and a control group of individuals who were matched for age, body mass index (BMI), and supine apnea-hypopnea index (AHI) were recruited. Breathing instability was evaluated by using polysomnography to determine the irregular pattern with approximate entropy (ApEn) of chest respiratory movements during wakefulness before sleep onset. The ApEn values were compared between the groups. The severity of OSA was evaluated with background parameters and ApEn values by regression analysis.


Twenty patients with MSA (9 men; mean age, 61 years; BMI, 24.1 kg/m2; supine AHI, 37.9 events/h) were compared to the control group. The ApEn values were higher in the patients with MSA than those in the control group (1.28 versus 1.11; P < .05). Multiple regression analysis showed that supine AHI was associated with ApEn values but not with BMI in patients with MSA and associated with BMI but not with ApEn values in the individuals in the control group.


Patients with MSA had more breathing irregularity. In patients with MSA, breathing instability may be a more influential factor for OSA than BMI.


A commentary on this article appears in this issue on page 1641.


Nakayama H, Hokari S, Ohshima Y, Matsuto T, Shimohata T. Breathing irregularity is independently associated with the severity of obstructive sleep apnea in patients with multiple system atrophy. J Clin Sleep Med. 2018;14(10):1661–1667.

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