Non-invasive positive pressure ventilation for laryngeal contraction disorder during sleep in multiple system atrophy

Journal of the Neurological Sciences
Michio NonakaHiroyuki Matsumoto

Abstract

We examined the usefulness of non-invasive positive pressure ventilation (NPPV) in the management of nocturnal laryngeal stridor associated with vocal cord dysfunction in five cases of multiple system atrophy (MSA). First, the patients were investigated during sleep induced by a minimal dose of propofol. Laryngoscopy showed paradoxical vocal cord movement resulting in inspiratory stridor. Electromyographic (EMG) study revealed synchronized bursts in the thyroarytenoid muscles and diaphragm in every inspiratory phase whenever the stridor emerged. NPPV was initiated after paradoxical movement was recognized with laryngoscopy. The NPPV mask was equipped with an additional channel for laryngoscopic monitoring. The optimal pressure for treatment was determined according to laryngoscopic and EMG findings. Next, NPPV was applied to natural sleep using the conditions determined in propofol-induced sleep. In all cases, NPPV eliminated nocturnal stridor and oxygen desaturation during natural sleep. Laryngoscopic observation during induced sleep is recommended as a useful procedure to titrate the optimal pressure for NPPV therapy. Since central hypoventilation progresses in the course of MSA, the choice of NPPV rather than continuous posi...Continue Reading

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Citations

May 28, 2009·Journal of Neurology·Gregor K Wenning, Nadia Stefanova
Apr 9, 2013·Sleep & Breathing = Schlaf & Atmung·Xiao Yan GuoHuifang Shang
Sep 12, 2008·The Neurologist·Martín A Nogués, Eduardo Benarroch
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Aug 7, 2020·Movement Disorders : Official Journal of the Movement Disorder Society·Florin GandorTobias Warnecke
Aug 9, 2020·Neurotherapeutics : the Journal of the American Society for Experimental NeuroTherapeutics·Matthew R Burns, Nikolaus R McFarland
Mar 20, 2021·Journal of Clinical Sleep Medicine : JCSM : Official Publication of the American Academy of Sleep Medicine·Jongmok HaEun Yeon Joo
Jul 8, 2021·BMJ Case Reports·Brian GordonTimothy J Counihan

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