Brief communication Continuous positive airway pressure for sleep-related breathing disorders in multiple system atrophy: long-term acceptance Imad Ghorayeb a, * , Farid Yekhlef b , Bernard Bioulac a , Franc ¸ois Tison b a Service d’Explorations Fonctionnelles du Syste `me Nerveux, Ho ˆpital Pellegrin, Place Ame ´lie Raba-Le ´on, 33076 Bordeaux Cedex, France b Service de Neurologie, CHU de Bordeaux, Bordeaux, France Received 4 August 2004; received in revised form 26 August 2004; accepted 12 October 2004 Abstract Background and purpose: To assess the long-term acceptance of non-invasive nasal continuous positive air pressure (CPAP) in multiple system atrophy (MSA) patients with polysomnographic (PSG)-confirmed sleep apneas and/or nocturnal stridor. Patients and methods: Sleep-related breathing disorders were investigated by PSG in 22 MSA patients in whom stridor and sleep-related respiratory disturbances were clinically suspected. Patients in whom the first PSG disclosed either a sleep apnea/hypopnea index (AHI)R10 or stridor with or without apneas underwent a second PSG for CPAP titration. Results: Three patients presented with an obstructive sleep apnea syndrome without stridor, whereas 15 patients presented stridor occurring alone or accompanied by apneas. Twelve patients pursued CPAP. Two severely disabled patients died a few days after CPAP initiation, and five discontinued CPAP because of discomfort. One patient died after 17 months of follow-up. Since the onset of CPAP, the four remaining patients reported more efficacious sleep and improved daytime alertness. These patients had significantly less severe disease at the time of CPAP initiation. Age, disease duration, the presence of sleep complaints, excessive daytime somnolence (EDS) and AHI did not account for CPAP compliance. Conclusion: The severity of motor impairment at the initiation of treatment appears to be the most significant limiting factor for CPAP long- term acceptance. q 2004 Elsevier B.V. All rights reserved. Keywords: Multiple system atrophy; Stridor; Sleep apnea; Continuous positive airway pressure 1. Introduction In multiple system atrophy (MSA), the diffuse neurode- generative process results in a more aggressive course, dopaminergic drug resistance, and more frequent sleep disorders and excessive daytime somnolence (EDS) com- pared to patients with Parkinson’s disease [1]. Often associated with sleep-related breathing disorders, nocturnal stridor appears to be of poor prognosis associated with increased risk of sudden death during sleep [2]. Tracheost- omy and vocal cord surgery are the invasive options usually proposed to suppress stridor, and recently botulinum toxin has also been proposed [3]. However, only non-invasive continuous positive air pressure (CPAP) has been shown to be effective in suppressing both stridor and sleep apneas [4]. We investigated sleep-related breathing disorders by means of audio–video monitored polysomnography (PSG) in 22 MSA patients in whom nocturnal stridor and sleep-related respiratory disturbances were clinically suspected, and studied the effect and long-term acceptance of CPAP in patients with PSG-confirmed sleep apneas and/or nocturnal stridor. 2. Patients and methods The University of Bordeaux 2 ethical committee approved the study. A total of 22 patients fulfilling the MSA clinical diagnostic criteria for ‘possible’ or ‘probable’ MSA [5] were 1389-9457/$ - see front matter q 2004 Elsevier B.V. All rights reserved. doi:10.1016/j.sleep.2004.10.002 Sleep Medicine 6 (2005) 359–362 www.elsevier.com/locate/sleep * Corresponding author. Tel.: C33 5 56 79 55 13; fax: C33 5 56 79 61 09. E-mail address: imad.ghorayeb@umr5543.u-bordeaux2.fr (I. Ghorayeb).