To assess the frequency and characteristics of sleep disorders in a single center, multidisciplinary multiple system atrophy (MSA) clinic population and to evaluate medication and positive airway pressure (PAP) utilization.

The association of sleep disorders with parkinsonism has been extensively studied previously.  However, sleep disorders in MSA populations has been limited to small European and Asian studies.  

Retrospective chart review of patients followed in the University of Texas Southwestern (UTSW) multidisciplinary MSA clinic. Eligibility criteria included a diagnosis of probable or possible MSA in a consented cohort.  Demographic, clinical, and PAP adherence data was reviewed.

There were 57 consented patients diagnosed with probable or possible MSA. Of these, 54 (95%) had sleep complaints, including 51 (89%) patients with parasomnias. Polysomnograms (PSG) were performed on 36 (63%) patients (24 at UTSW). Obstructive sleep apnea (OSA) was diagnosed in 28 (49%) and 45 had clinical symptoms and/or PSG suggestive of REM sleep behavior disorder. PAP therapy was recommended in 26, but adherence data was only available in 15, among whom 5 were known to be non-adherent. Death was reported in 3 of 5 (60%) of non-adherent patients and 4 of 10 (40%) of adherent patients (p=0.46). OSA was associated with a higher BMI (p=0.015) even among MSA patients. There was a significantly higher rate of parasomnias (100% vs 85%, p=0.045) and OSA (86% vs 47%, p=0.011) in cerebellar (MSA-C) versus parkinsonian (MSA-P) subtypes.  There was a non-significant trend towards higher rates of death among patients with witnessed apnea (58% vs 26%, p=0.06).

Sleep disorders are a significant comorbidity in patients with MSA, particularly in MSA-C. Adherence to PAP therapy did not result in a statistically significant survival advantage, however adherence data is limited. Trend lines suggest that MSA patients should be followed with polysomnogram, regular clinic visits, and PAP adherence monitoring.