Nocturnal Pulse Event Frequency Is Reduced in Multiple System Atrophy

Stuart J. McCarter, Elizabeth A. Coon, Eduardo E. Benarroch, Michael H. Silber, Erik K. St. Louis

Research output: Contribution to journalArticlepeer-review


Risk of sudden death in multiple system atrophy (MSA) is greatest during sleep with unknown mechanisms. We compared nocturnal pulse event frequency in 46 MSA patients and age-/sex-matched controls undergoing overnight pulse oximetry. Nocturnal oxyhemoglobin desaturation indices and pulse event indices (PEIs) were recorded, and relationships between pulse oximetry variables and survival were analyzed. MSA patients had lower PEI (3.1 ± 5.3 vs. 12.8 ± 10.8, p < 0.001) despite greater hypoxic burden and similar frequency of respiratory events. Nocturnal pulse events were not associated with severity of daytime autonomic failure. Two MSA patients had suspected sudden death, both with severely reduced PEI. MSA patients have fewer nocturnal pulse events compared with controls, despite similar respiratory event frequency, suggesting abnormal cardiac responses to sleep-disordered breathing. Whether this contributes to sudden death in MSA requires further study. ANN NEUROL 2023;93:205–212.

Original languageEnglish (US)
Pages (from-to)205-212
Number of pages8
JournalAnnals of neurology
Issue number1
StatePublished - Jan 2023

ASJC Scopus subject areas

  • Neurology
  • Clinical Neurology


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