Non-REM sleep-predominant reversible paradoxical breathing effort indicates dysregulation of diaphragm movements in multiple system atrophy

Study Objectives: In multiple system atrophy, sleep-disordered breathing has a broad spectrum of phenotypes, among them inspiratory stridor and obstructive sleep apnea being most frequent. Methods: We present a case of a 59-year-old woman with cerebellar-type multiple system atrophy, who showed transient paradoxical breathing effort during non-rapid eye movement sleep on diagnostic polysomnography. Because this thoraco-abdominal paradox was atypical for and did not coincide with upper airway obstruction, it most likely indicated central dysregulation of the diaphragm. Results: Continuous positive airway pressure therapy with low pressure (5 cm H2O) was sufficient to completely resolve this type of respiratory dysregulation. Conclusions: This case extends the clinical spectrum of sleep-disordered breathing in multiple system atrophy.