Mechanisms and prevention of sudden death in multiple system atrophy

Takayoshi Shimohata, Naotaka Aizawa, Hideaki Nakayama, Hiroshige Taniguchi, Yasuyoshi Ohshima, Hitoshi Okumura, Tetsuya Takahashi, Akio Yokoseki, Makoto Inoue, Masatoyo Nishizawa

Research output: Contribution to journalReview article

5 Citations (Scopus)

Abstract

Background Sudden death in multiple system atrophy (MSA) usually occurs during sleep and was therefore attributed to suffocation resulting from vocal cord abductor paralysis, a characteristic laryngeal finding of MSA. This led to the use of tracheostomy and noninvasive positive pressure ventilation (NPPV) for the prevention of sudden death. However, neither method has been able to prevent sudden death, and both have occasionally precipitated treatment-related complications, including central sleep apneas and exacerbation of floppy epiglottis. Therefore, it is important to determine the mechanisms and prevention of sudden death in MSA. Methods We reviewed the literature on the mechanisms and prevention of sudden death in patients with MSA. Results Sudden death in MSA is hypothesized to be a consequence of disordered central respiration, suffocation caused by sputum and food, upper airway obstruction from NPPV acting on a floppy epiglottis, cardiac autonomic disturbance, or a combination of these factors. Conclusion Various factors may be involved in the mechanism of sudden death in MSA. A multidisciplinary approach is needed to prevent sudden death, and this requires an organized system of several medical specialties. Neurologists require a cooperative network that includes experts in otorhinolaryngology, sleep medicine, dysphagia rehabilitation, and cardiology.

Original languageEnglish
Pages (from-to)1-6
Number of pages6
JournalParkinsonism and Related Disorders
Volume30
DOIs
Publication statusPublished - 01-09-2016

Fingerprint

Multiple System Atrophy
Sudden Death
Epiglottis
Positive-Pressure Respiration
Asphyxia
Sleep
Medicine
Central Sleep Apnea
Vocal Cord Paralysis
Tracheostomy
Otolaryngology
Airway Obstruction
Deglutition Disorders
Cardiology
Sputum
Respiration
Rehabilitation
Food

All Science Journal Classification (ASJC) codes

  • Neurology
  • Geriatrics and Gerontology
  • Clinical Neurology

Cite this

Shimohata, Takayoshi ; Aizawa, Naotaka ; Nakayama, Hideaki ; Taniguchi, Hiroshige ; Ohshima, Yasuyoshi ; Okumura, Hitoshi ; Takahashi, Tetsuya ; Yokoseki, Akio ; Inoue, Makoto ; Nishizawa, Masatoyo. / Mechanisms and prevention of sudden death in multiple system atrophy. In: Parkinsonism and Related Disorders. 2016 ; Vol. 30. pp. 1-6.
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abstract = "Background Sudden death in multiple system atrophy (MSA) usually occurs during sleep and was therefore attributed to suffocation resulting from vocal cord abductor paralysis, a characteristic laryngeal finding of MSA. This led to the use of tracheostomy and noninvasive positive pressure ventilation (NPPV) for the prevention of sudden death. However, neither method has been able to prevent sudden death, and both have occasionally precipitated treatment-related complications, including central sleep apneas and exacerbation of floppy epiglottis. Therefore, it is important to determine the mechanisms and prevention of sudden death in MSA. Methods We reviewed the literature on the mechanisms and prevention of sudden death in patients with MSA. Results Sudden death in MSA is hypothesized to be a consequence of disordered central respiration, suffocation caused by sputum and food, upper airway obstruction from NPPV acting on a floppy epiglottis, cardiac autonomic disturbance, or a combination of these factors. Conclusion Various factors may be involved in the mechanism of sudden death in MSA. A multidisciplinary approach is needed to prevent sudden death, and this requires an organized system of several medical specialties. Neurologists require a cooperative network that includes experts in otorhinolaryngology, sleep medicine, dysphagia rehabilitation, and cardiology.",
author = "Takayoshi Shimohata and Naotaka Aizawa and Hideaki Nakayama and Hiroshige Taniguchi and Yasuyoshi Ohshima and Hitoshi Okumura and Tetsuya Takahashi and Akio Yokoseki and Makoto Inoue and Masatoyo Nishizawa",
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Shimohata, T, Aizawa, N, Nakayama, H, Taniguchi, H, Ohshima, Y, Okumura, H, Takahashi, T, Yokoseki, A, Inoue, M & Nishizawa, M 2016, 'Mechanisms and prevention of sudden death in multiple system atrophy', Parkinsonism and Related Disorders, vol. 30, pp. 1-6. https://doi.org/10.1016/j.parkreldis.2016.04.011

Mechanisms and prevention of sudden death in multiple system atrophy. / Shimohata, Takayoshi; Aizawa, Naotaka; Nakayama, Hideaki; Taniguchi, Hiroshige; Ohshima, Yasuyoshi; Okumura, Hitoshi; Takahashi, Tetsuya; Yokoseki, Akio; Inoue, Makoto; Nishizawa, Masatoyo.

In: Parkinsonism and Related Disorders, Vol. 30, 01.09.2016, p. 1-6.

Research output: Contribution to journalReview article

TY - JOUR

T1 - Mechanisms and prevention of sudden death in multiple system atrophy

AU - Shimohata, Takayoshi

AU - Aizawa, Naotaka

AU - Nakayama, Hideaki

AU - Taniguchi, Hiroshige

AU - Ohshima, Yasuyoshi

AU - Okumura, Hitoshi

AU - Takahashi, Tetsuya

AU - Yokoseki, Akio

AU - Inoue, Makoto

AU - Nishizawa, Masatoyo

PY - 2016/9/1

Y1 - 2016/9/1

N2 - Background Sudden death in multiple system atrophy (MSA) usually occurs during sleep and was therefore attributed to suffocation resulting from vocal cord abductor paralysis, a characteristic laryngeal finding of MSA. This led to the use of tracheostomy and noninvasive positive pressure ventilation (NPPV) for the prevention of sudden death. However, neither method has been able to prevent sudden death, and both have occasionally precipitated treatment-related complications, including central sleep apneas and exacerbation of floppy epiglottis. Therefore, it is important to determine the mechanisms and prevention of sudden death in MSA. Methods We reviewed the literature on the mechanisms and prevention of sudden death in patients with MSA. Results Sudden death in MSA is hypothesized to be a consequence of disordered central respiration, suffocation caused by sputum and food, upper airway obstruction from NPPV acting on a floppy epiglottis, cardiac autonomic disturbance, or a combination of these factors. Conclusion Various factors may be involved in the mechanism of sudden death in MSA. A multidisciplinary approach is needed to prevent sudden death, and this requires an organized system of several medical specialties. Neurologists require a cooperative network that includes experts in otorhinolaryngology, sleep medicine, dysphagia rehabilitation, and cardiology.

AB - Background Sudden death in multiple system atrophy (MSA) usually occurs during sleep and was therefore attributed to suffocation resulting from vocal cord abductor paralysis, a characteristic laryngeal finding of MSA. This led to the use of tracheostomy and noninvasive positive pressure ventilation (NPPV) for the prevention of sudden death. However, neither method has been able to prevent sudden death, and both have occasionally precipitated treatment-related complications, including central sleep apneas and exacerbation of floppy epiglottis. Therefore, it is important to determine the mechanisms and prevention of sudden death in MSA. Methods We reviewed the literature on the mechanisms and prevention of sudden death in patients with MSA. Results Sudden death in MSA is hypothesized to be a consequence of disordered central respiration, suffocation caused by sputum and food, upper airway obstruction from NPPV acting on a floppy epiglottis, cardiac autonomic disturbance, or a combination of these factors. Conclusion Various factors may be involved in the mechanism of sudden death in MSA. A multidisciplinary approach is needed to prevent sudden death, and this requires an organized system of several medical specialties. Neurologists require a cooperative network that includes experts in otorhinolaryngology, sleep medicine, dysphagia rehabilitation, and cardiology.

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SN - 1353-8020

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