Specific patterns of laryngeal electromyography during wakefulness are associated to sleep disordered breathing and nocturnal stridor in multiple system atrophy

E Alfonsi; M Terzaghi; G Cosentino; C Tassorelli; R Manni; N Pozzi; R De Icco; G Bertino; M Todisco; E Alvisi; M Fresia; C Pacchetti; R Zangaglia; P Prunetti; A Moglia

doi:10.1016/j.parkreldis.2016.07.017

Specific patterns of laryngeal electromyography during wakefulness are associated to sleep disordered breathing and nocturnal stridor in multiple system atrophy

Parkinsonism Relat Disord. 2016 Oct:31:104-109. doi: 10.1016/j.parkreldis.2016.07.017. Epub 2016 Aug 2.

Authors

E Alfonsi¹, M Terzaghi², G Cosentino³, C Tassorelli⁴, R Manni², N Pozzi⁵, R De Icco⁴, G Bertino⁶, M Todisco⁴, E Alvisi⁴, M Fresia⁴, C Pacchetti⁵, R Zangaglia⁵, P Prunetti⁴, A Moglia⁴

Affiliations

¹ Spinal and Brainstem Reflexes Laboratory, C. Mondino National Neurological Institute, University of Pavia, Pavia, Italy. Electronic address: enrico.alfonsi@mondino.it.
² Sleep Disorders Center, C. Mondino National Neurological Institute, University of Pavia, Pavia, Italy.
³ Department of Experimental Biomedicine and Clinical Neurosciences (BioNec), University of Palermo, Palermo, Italy.
⁴ Spinal and Brainstem Reflexes Laboratory, C. Mondino National Neurological Institute, University of Pavia, Pavia, Italy.
⁵ Parkinson's Disease Center, C. Mondino National Neurological Institute, University of Pavia, Pavia, Italy.
⁶ Department of Otorhinolaryngology, IRCCS Policlinico San Matteo Foundation, University of Pavia, Pavia, Italy.

PMID: 27510647
DOI: 10.1016/j.parkreldis.2016.07.017

Abstract

Background: Nocturnal stridor and respiratory abnormalities are important features of multiple system atrophy (MSA) with relevance to patient survival, and they are detected and evaluated mainly through video-polysomnography (video-PSG). Diurnal laryngoscopy seems to yield abnormal findings only in the presence of significant vocal cord (VC) dysfunction.

Aim: To assess whether specific electrophysiological patterns of diurnal EMG of VC muscles may indicate nocturnal stridor or respiratory dysfunctions in MSA patients.

Materials and methods: Seventeen patients with probable MSA were examined. A full-night video-PSG to collect standard breathing parameters (apnea/hypopnea index, mean HbSAO₂, oxygen desaturation index, total sleep time with HbSaO₂ below 90%) was performed in all the patients. Laryngoscopy and EMG investigation of adductor (thyroarytenoid-TA) and abductor (posterior cricoarytenoid-PCA) muscles of the VCs were also performed.

Results: Both the laryngeal EMG abnormalities (based on MUAP analysis and kinesiologic EMG investigation of VC muscles) and the laryngoscopic alterations correlated with video-PSG respiratory abnormalities. Specific patterns of EMG findings were consistently found in MSA subjects with nocturnal stridor detected at PSG. In particular, the following EMG findings were related to the severity of breathing abnormalities and the presence of stridor on video-PSG: neurogenic pattern on MUAP analysis of the PCA, paradoxical activation of the TA during inspiration and tonic EMG activity of the TA during quiet breathing.

Conclusions: Electromyographic/kinesiologic investigation of VC muscles during wakefulness provides additional information on the pathophysiology of the respiratory abnormalities in MSA patients that could be useful for guiding the choice of the best appropriate treatment and care.

Keywords: Laryngeal electromyography; Laryngoscopy; Multiple system atrophy; Nocturnal stridor; Sleep disordered breathing.

MeSH terms

Aged
Circadian Rhythm / physiology*
Electromyography
Female
Humans
Laryngeal Muscles / physiopathology*
Male
Middle Aged
Multiple System Atrophy / complications*
Polysomnography
Respiratory Sounds / physiopathology*
Severity of Illness Index
Sleep Apnea Syndromes / etiology*
Wakefulness / physiology*