Patients with MSA can develop breathing problems as their disease progresses. These can include obstructive sleep apnea, low oxygenation, breathlessness and stridor. Stridor, or a high-pitched wheezing sound heard on inspiration, occurs in up to 40% of MSA patients and may be a predictor of poor disease outcome. Stridor occurs as a result of overactive vocal cord muscles that fail to relax normally during inspiration. It can occur any time of the day, but when it occurs during sleep can result in obstructive sleep apnea, which involves frequent periods during sleep when breathing stops. Breathing problems during sleep has been reported in 15%-37% of MSA patients.
1. Non-Pharmaceutical treatment of breathing problems
The primary treatment of sleep apnea is the use of continuous positive airway pressure (CPAP) for patients with mild to moderate stridor and can be useful for symptomatic control, although its impact on survival is unclear. CPAP does not have good adherence by patients as MSA progresses due to discomfort.
2. Medications for the treatment of breathing problems