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During the course of PD, degeneration of serotoninergic neurons also occurs,59 important for maintaining the patency of the upper airway, where its absence can contribute to pharyngeal collapse.33This mechanism however, does not appear to play a significant role in the development of OSA in PD patients.60.
Patients with OSA and PD have a different clinical profile to OSA patients without PD. Parkinsonians generally have a lower body mass index61,62 and less marked falls in saturation of oxyhemoglobin during apnea and hypopnea events.39,62,63 Excessive daytime sleepiness, an important symptom of OSA, was not correlated with AHI in PD patients.50,51 Recent metanalyses suggest that parkinsonians do not have a greater risk of developing OSA compared to controls,61,63 but acknowledged the limitation of studies in reaching definitive conclusion on the relationship between PD and OSA.
ncbi.nlm.nih.gov/pmc/articl...
Multiple system atrophy and OSA. Multiple System Atrophy (MSA) is characterized by a combination of parkinsonianism, cerebellar, dysautonomic and pyramidal features, in which respiratory disturbances such as OSA, stridor and central apnea represent important features of clinical evolution.65.
Visualization of the upper airway in MSA patients using fibre-optic laryngoscopy has shown narrowing of the airway at the level of the vocal folds, base of the tongue and soft palate,66 as well as rhythmic, bilateral contractions of the arytenoids54,66 plus the presence of "floppy epiglottis" 66 - a condition in which the epiglottis is sucked into the glottis during inspiration. As in PD, these findings suggest dysfunction of the muscles of the upper airway due to parkinsonism symptoms of the disease.
Besides these changes, degeneration of the serotoninergic and cholinergic system are found in MSA,68both important neurotransmitters involved in the respiratory physiology, whose deficiency can lead to the risk of developing OSA in these patients.33,68.
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