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. 2022 Dec;26(4):1779-1789.
doi: 10.1007/s11325-022-02568-4. Epub 2022 Jan 13.

Sleep-related hypoventilation and hypercapnia in multiple system atrophy detected by polysomnography with transcutaneous carbon dioxide monitoring

Atsuhiko Sugiyama  1 , Jiro Terada  2 , Yu Shionoya  3 , Shigeki Hirano  4 , Tatsuya Yamamoto  4   5 , Yoshitaka Yamanaka  4   6 , Nobuyuki Araki  4 , Ken Koshikawa  3 , Hajime Kasai  3 , Shinobu Ikeda  7 , Jiaqi Wang  4 , Kyosuke Koide  4 , Shoichi Ito  4   8 , Satoshi Kuwabara  4
Affiliations

Sleep-related hypoventilation and hypercapnia in multiple system atrophy detected by polysomnography with transcutaneous carbon dioxide monitoring

Atsuhiko Sugiyama et al. Sleep Breath. 2022 Dec.

Abstract

Purpose: We aimed to evaluate sleep-related hypoventilation in multiple system atrophy (MSA) using polysomnography (PSG) with transcutaneous partial pressure of carbon dioxide (PtcCO2) monitoring.

Methods: This prospective study included 34 patients with MSA. Motor and autonomic function, neuropsychological tests, PSG with PtcCO2 monitoring, and pulmonary function tests were performed. Sleep-related hypoventilation disorder (SRHD) was defined according to the International Classification of Sleep Disorders, third edition.

Results: Nine (27%) of the 34 patients met the diagnostic criteria of SRHD. Twenty-nine (85%) patients had sleep-related breathing disorders based on an Apnea-Hypopnea Index of ≥ 5/h. The patients with MSA and SRHD had a higher arousal index (p = 0.017) and obstructive apnea index (p = 0.041) than those without SRHD. There was no difference in the daytime partial pressure of carbon dioxide in arterial blood or respiratory function between MSA patients with and without SRHD.

Conclusion: Sleep-related hypoventilation may occur in patients with MSA even with a normal daytime partial pressure of carbon dioxide. This can be noninvasively detected by PSG with PtcCO2 monitoring. SRBD and sleep-related hypoventilation are common among patients with MSA, and clinicians should take this into consideration while evaluating and treating this population.

Keywords: Carbon dioxide; Hypercapnia; Neuropsychological tests; Respirator function tests; Sleep.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig.1
Fig.1
Study patient flow diagram. MSA, multiple system atrophy; PtcCO2, transcutaneous partial pressure of carbon dioxide; SRHD, sleep-related hypoventilation disorder
Fig.2
Fig.2
Results of polysomnography with monitoring of the transcutaneous partial pressure of carbon dioxide (PtCO2) in each case. SRBD, sleep-related breathing disorder; AHI, apnea–hypopnea index; SRHD, sleep-related hypoventilation disorder; MSA-C, cerebellar subtype of multiple system atrophy; MSA-P, parkinsonian subtype of multiple system atrophy
Fig. 3
Fig. 3
Polysomnographic tracing of a patient with severe sleep-related hypoventilation. A Polysomnography shows nasal airflow limitation meeting the definition of obstructive hypopnea during sleep with PtcCO2 > 50 mmHg. B Polysomnography shows nasal airflow limitation meeting the definition of hypopnea or apnea is not observed during sleep with PtcCO2 > 50 mmHg
See this image and copyright information in PMC

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