Table 10

Respiratory and sleep

SymptomTreatment approach
Stridor and other respiratory issues
  • Referral to ENT for laryngoscopy in the first instance to exclude mechanical lesions or other secondary causes of vocal cord dysfunction.

  • Urgent referral for patients reporting laryngospasm.

  • Drug-induced sleep endoscopy or video polysomnography if awake investigations show no cause.50

  • CPAP therapy reduces stridor symptoms, but with no evidence of increased survival.50

  • Tracheostomy eliminates stridor symptoms, and may increase survival, but evidence for this is weak.50

Sleep-related syndromes
  • REM sleep behaviour disorder. Discuss creating a safe-sleep environment for patient and partner. If medication needed for MSA patients, first line is melatonin and second line is clonazepam, owing to potential drowsiness and stridor.34

  • Obstructive sleep apnoea. If symptoms interfere with quality of life or Epworth scores >9, refer to a sleep specialist.

  • Restless legs syndrome. Check serum iron concentrations in all patients and replace iron as appropriate. For ongoing symptoms treat with gabapentin/pregabalin or consider a dopamine agonist (eg, ropinirole).

  • CPAP, continuous positive airway pressure; ENT, ear, nose and throat; MSA, multiple system atrophy; REM, rapid eye movement .