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Multiple system atrophy presenting as central sleep apnoea

¹ Dept of Respiratory Medicine, and ² The Lane-Fox Unit, St. Thomas' Hospital and ³ The National Institute of Neurology, London, UK

CORRESPONDENCE: L.J. Cormican, Dept of Respiratory Medicine, St. Thomas' Hospital, Lambeth Palace Road, London, SE1 7EH, UK. Fax: 44 2079228281. E-mail: liam.cormican@gstt.sthames.nhs.uk

Keywords: Central sleep apnoea, multiple system atrophy

Received: October 16, 2003
Accepted February 11, 2004

Abstract

A 61-yr-old male presented with apparent idiopathic central sleep apnoea but after 4 yrs developed features of autonomic, cerebellar and extrapyramidal dysfunction consistent with a diagnosis of multiple system atrophy (MSA).

Though central sleep apnoea can occur in multiple sleep apnoea, it is less frequent than obstructive sleep apnoea and occurs in the later stages of the disease.

The pathogenesis of MSA involves gliosis and neuronal cell loss in specific areas of the central nervous system. Central sleep apnoea in MSA may be due to the depletion of cholinergic neurons in the arcuate nucleus of the medulla by apoptosis.

This is the first description of multiple system atrophy presenting as central sleep apnoea. The current authors believe that multiple system atrophy should be considered in the differential diagnosis of late onset central sleep apnoea and progressive hypoventilation.

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