Abstract：
BACKGROUND: We determined whether the severity of sleep apnea increases the risk of mortality in patients with multiple system atrophy (MSA) with and without stridor. MethodsThis retrospective study included patients who underwent polysomnography within one year after diagnosis of probable MSA. Stridor, sleep apnea, and arousal from sleep were determined using full-night polysomnography. Disease severity was measured using the Unified MSA Rating Scale (UMSARS). Survival data were collected and analyzed using Cox regression analysis.
RESULTS: Sixty-four patients with MSA were included. During a median follow-up of 34.5 months, 49 (76.6 %) patients died. Stridor was present in 56.3 % of patients. Patients with stridor had more severe sleep apnea and shorter sleep time than those without, but the hazard ratio (HR) for death did not differ between patients with and without stridor. Among patients without stridor, apnea-hypopnea index ≥30/h (HR, 6.850; 95 % confidence interval [CI], 1.983-23.664; p = 0.002) and a score of UMSARS I + II (HR, 1.080; 95 % CI, 1.040-1.121; p < 0.001) were independently associated with death. In contrast, among patients with stridor, frequent arousals from sleep (HR, 0.254; 95 % CI, 0.089-0.729; p = 0.011) were a significant factor associated with longer survival, while MSA-cerebellar type tended to be associated with poor survival (HR, 2.195; 95 % CI, 0.941-5.120; p = 0.069).
CONCLUSIONS: The severity of sleep apnea might be a significant predictor of shorter survival in MSA patients without stridor, whereas frequent arousals from sleep might be a significant predictor for longer survival in MSA patients with stridor.
RESULTS: Sixty-four patients with MSA were included. During a median follow-up of 34.5 months, 49 (76.6 %) patients died. Stridor was present in 56.3 % of patients. Patients with stridor had more severe sleep apnea and shorter sleep time than those without, but the hazard ratio (HR) for death did not differ between patients with and without stridor. Among patients without stridor, apnea-hypopnea index ≥30/h (HR, 6.850; 95 % confidence interval [CI], 1.983-23.664; p = 0.002) and a score of UMSARS I + II (HR, 1.080; 95 % CI, 1.040-1.121; p < 0.001) were independently associated with death. In contrast, among patients with stridor, frequent arousals from sleep (HR, 0.254; 95 % CI, 0.089-0.729; p = 0.011) were a significant factor associated with longer survival, while MSA-cerebellar type tended to be associated with poor survival (HR, 2.195; 95 % CI, 0.941-5.120; p = 0.069).
CONCLUSIONS: The severity of sleep apnea might be a significant predictor of shorter survival in MSA patients without stridor, whereas frequent arousals from sleep might be a significant predictor for longer survival in MSA patients with stridor.
摘要：
背景：我们确定了睡眠呼吸暂停的严重程度是否会增加伴和不伴喘鸣的多系统萎缩（MSA）患者的死亡风险。方法这项回顾性研究包括诊断为可能的MSA后一年内接受多导睡眠监测的患者。斯特雷多,睡眠呼吸暂停,使用整夜多导睡眠图确定从睡眠中唤醒。使用统一MSA评定量表(UMSARS)测量疾病严重程度。收集生存数据并使用Cox回归分析进行分析。
结果：纳入64例MSA患者。在34.5个月的中位随访中，49例（76.6%）患者死亡。56.3%的患者出现喘息。与没有喘鸣的患者相比，喘鸣患者的睡眠呼吸暂停更严重，睡眠时间更短，但是有和没有喘鸣的患者的死亡风险比(HR)没有差异.在没有喘鸣的患者中，呼吸暂停低通气指数≥30/h（HR，6.850；95%置信区间[CI]，1.983-23.664；p=0.002)和UMSARSI+II评分(HR，1.080；95%CI，1.040-1.121；p<0.001）与死亡独立相关。相比之下,在喘鸣患者中，频繁的睡眠唤醒(HR，0.254；95%CI，0.089-0.729；p=0.011）是与更长生存期相关的重要因素，而MSA-小脑型往往与低生存率(HR，2.195；95%CI，0.941-5.120；p=0.069）。
结论：睡眠呼吸暂停的严重程度可能是MSA无喘鸣患者生存期缩短的重要预测因素，而睡眠中的频繁觉醒可能是MSA喘鸣患者生存期更长的重要预测因素。
结果：纳入64例MSA患者。在34.5个月的中位随访中，49例（76.6%）患者死亡。56.3%的患者出现喘息。与没有喘鸣的患者相比，喘鸣患者的睡眠呼吸暂停更严重，睡眠时间更短，但是有和没有喘鸣的患者的死亡风险比(HR)没有差异.在没有喘鸣的患者中，呼吸暂停低通气指数≥30/h（HR，6.850；95%置信区间[CI]，1.983-23.664；p=0.002)和UMSARSI+II评分(HR，1.080；95%CI，1.040-1.121；p<0.001）与死亡独立相关。相比之下,在喘鸣患者中，频繁的睡眠唤醒(HR，0.254；95%CI，0.089-0.729；p=0.011）是与更长生存期相关的重要因素，而MSA-小脑型往往与低生存率(HR，2.195；95%CI，0.941-5.120；p=0.069）。
结论：睡眠呼吸暂停的严重程度可能是MSA无喘鸣患者生存期缩短的重要预测因素，而睡眠中的频繁觉醒可能是MSA喘鸣患者生存期更长的重要预测因素。
