Background. Patients with multiple system atrophy (MSA), similarly to patients with alpha-synucleinopathies, can present with different sleep problems. We sought to analyze sleep problems in the two subtypes of the disease MSA cerebellar type (MSA-C) and MSA parkinsonian type (MSA-P), paying special attention to REM sleep disturbances and periodic limb movements (PLMs). Methods. In the study we included 11 MSA-C and 27 MSA-P patients who underwent one night polysomnography. For the analysis, there were 37 valid polysomnographic studies. Results. Sleep efficiency was decreased in both groups (MSA-C, 64.27% ± 12.04%; MSA-P, 60.64% ± 6.01%). The PLM indices using standard measures, in sleep (PLMS) and while awake (PLMW), were high in both groups (MSA-C patients: PLMS index 72 ± 65, PLMW index 38 ± 33; MSA-P patients: PLMS index 66 ± 63, PLMW index 48 ± 37). Almost one-third of the MSA patients of both groups presented features of RLS on video-polysomnography. RBD was described in 8/11 (73%) patients with MSA-C and 19/25 (76%) patients with MSA-P ( ). Conclusion. Our results showed very similar polysomnographic results for both MSA-P and MSA-C patients as a probable indicator for the similar pathologic mechanism of the disease and especially of its sleep problems. 1. Introduction Nighttime sleep disturbances are a recognized problem in multiple system atrophy (MSA) patients. These disturbances have long been observed, but the studies published to date have only included small sample sizes. Nighttime sleep problems in patients with MSA include REM sleep behavior disorder (RBD) [1], periodic limb movements (PLMs) [2], restless legs syndrome (RLS) [2], or RLS like symptoms [3–6]. All of them lead to sleep fragmentation and decreased sleep efficiency [7, 8]. In MSA, as in other alpha-synucleinopathies, RBD can be present, with a prevalence of up to 90% [9], and sometimes can antedate the occurrence of motor symptoms [10, 11]. RBD and REM sleep without atonia (RWA) in MSA and PD patients may be related to lesions of brainstem nuclei and pontomedullary pathways, as suggested in previous studies [3, 12]. On the other hand, clinically defined RLS seems to be less frequent in MSA patients when compared to patients with other synucleinopathies [13]. However, most patients with RLS have PLMs during sleep, an unspecific sign of both RLS or other sleep disorders. The pathology of PLMs in patients with parkinsonism is not yet clarified, but a few theories have been put forward. One hypothesis concerns the involvement of the dopaminergic system of neurotransmission [14].
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