{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,15]],"date-time":"2026-09-15T15:52:17Z","timestamp":1789487537627,"version":"build-2803163510"},"reference-count":45,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,9,15]],"date-time":"2026-09-15T00:00:00Z","timestamp":1789430400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"},{"start":{"date-parts":[[2026,9,15]],"date-time":"2026-09-15T00:00:00Z","timestamp":1789430400000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["movementdisorders.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Movement Disord Clin Pract"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Parkinson's disease (PD) and multiple system atrophy (MSA) are \u03b1\u2010synucleinopathies with overlapping autonomic and sleep dysfunction, but distinct trajectories.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>This study compared sleep and autonomic profiles in PD and MSA and elucidated disease\u2010specific associations using structural equation modeling (SEM).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      We retrospectively analyzed drug\u2010na\u00efve patients with PD and MSA presenting with sleep complaints. All participants underwent polysomnography (PSG), autonomic function tests, and cardiac [I\u2010123] metaiodobenzylguanidine (MIBG) scintigraphy. Significant parameters with moderate correlations (Spearman's\n                      <jats:italic>\u03c1<\/jats:italic>\n                      \u2009\u2265\u20090.35) were included in SEM to examine domain relationships.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      A total of 136 PD and 67 MSA patients were included. Patients with PD were older, with comparable sex, disease duration, and diabetes mellitus frequency. In PSG, patients with MSA showed lower\u2010stage N3 sleep, higher apnea\u2013hypopnea index (35.4 vs. 23.2 events\/h), and lower minimum oxygen saturation. Autonomic testing revealed that the MSA group demonstrated greater orthostatic blood pressure drops and higher total composite autonomic severity scores. Cardiac MIBG uptake was significantly reduced in the PD group. A directional SEM model in MSA revealed a significant association between autonomic dysfunction and increased sleep disruption (\n                      <jats:italic>\u03b2<\/jats:italic>\n                      \u2009=\u2009\u22120.68,\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u20090.006), with substantially greater explanatory power than observed in PD (\n                      <jats:italic>R<\/jats:italic>\n                      <jats:sup>2<\/jats:sup>\n                      \u2009=\u20090.54 vs. 0.29).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Both autonomic and sleep parameters were significantly more impaired in patients with MSA than in those with PD. SEM further indicated that these domains were closely linked in MSA, with greater autonomic dysfunction associated with poorer sleep quality. This highlights the need for integrated management of both domains.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/mdc3.70817","type":"journal-article","created":{"date-parts":[[2026,9,15]],"date-time":"2026-09-15T14:47:56Z","timestamp":1789483676000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Sleep\u2010Autonomic Interactions in\n                    <scp>Parkinson's Disease<\/scp>\n                    and Multiple System Atrophy: A Comparative Study Using Structural Equation Modeling"],"prefix":"10.1002","author":[{"ORCID":"https:\/\/orcid.org\/0009-0007-2095-1531","authenticated-orcid":false,"given":"Bora","family":"Jin","sequence":"first","affiliation":[{"name":"Department of Neurology, College of Medicine Dong\u2010A University  Busan Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yoonkyung","family":"Lee","sequence":"additional","affiliation":[{"name":"Department of Neurology, College of Medicine Dong\u2010A University  Busan Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7069-267X","authenticated-orcid":false,"given":"Seungho","family":"Lee","sequence":"additional","affiliation":[{"name":"Department of Preventive Medicine, College of Medicine Dong\u2010A University  Busan Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4350-3551","authenticated-orcid":false,"given":"Byeol\u2010A","family":"Yoon","sequence":"additional","affiliation":[{"name":"Department of Neurology, College of Medicine Dong\u2010A University  Busan Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7611-8185","authenticated-orcid":false,"given":"Young Jin","family":"Jeong","sequence":"additional","affiliation":[{"name":"Department of Nuclear Medicine, College of Medicine Dong\u2010A University  Busan Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5905-2188","authenticated-orcid":false,"given":"Sang\u2010Myung","family":"Cheon","sequence":"additional","affiliation":[{"name":"Department of Neurology, College of Medicine Dong\u2010A University  Busan Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,9,15]]},"reference":[{"issue":"3","key":"e_1_2_10_2_1","doi-asserted-by":"crossref","first-page":"1045","DOI":"10.1074\/jbc.RA118.004471","article-title":"Parkinson's disease and multiple system atrophy have distinct \u03b1\u2010synuclein seed characteristics","volume":"294","author":"Yamasaki TR","year":"2019","journal-title":"J. Biol. Chem."},{"issue":"1","key":"e_1_2_10_3_1","doi-asserted-by":"crossref","first-page":"7","DOI":"10.1186\/s40035-025-00469-6","article-title":"Refining \u03b1\u2010synuclein seed amplification assays to distinguish Parkinson's disease from multiple system atrophy","volume":"14","author":"Wiseman JA","year":"2025","journal-title":"Transl. Neurodegener."},{"issue":"2","key":"e_1_2_10_4_1","doi-asserted-by":"crossref","first-page":"323","DOI":"10.1016\/j.jsmc.2021.03.001","article-title":"Sleep Disorders in Parkinson Disease","volume":"16","author":"Stefani A","year":"2021","journal-title":"Sleep Med. Clin."},{"issue":"5","key":"e_1_2_10_5_1","doi-asserted-by":"crossref","first-page":"464","DOI":"10.1007\/s11940-012-0189-2","article-title":"Sleep dysfunction in multiple system atrophy","volume":"14","author":"Ferini\u2010Strambi L","year":"2012","journal-title":"Curr. Treat. 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Clin. Sleep Med."},{"issue":"3","key":"e_1_2_10_42_1","doi-asserted-by":"crossref","first-page":"S93","DOI":"10.1016\/S1353-8020(09)70790-4","article-title":"Sleep dysfunction and role of dysautonomia in Parkinson's disease","volume":"15","author":"Mitra T","year":"2009","journal-title":"Parkinsonism Relat. Disord."},{"issue":"5","key":"e_1_2_10_43_1","doi-asserted-by":"crossref","first-page":"525","DOI":"10.1016\/j.parkreldis.2012.01.023","article-title":"Heart rate variability in patients with idiopathic Parkinson's disease with and without obstructive sleep apnea syndrome","volume":"18","author":"Valko PO","year":"2012","journal-title":"Parkinsonism Relat. Disord."},{"issue":"1","key":"e_1_2_10_44_1","doi-asserted-by":"crossref","first-page":"26","DOI":"10.1007\/s10072-025-08694-7","article-title":"Influence of autonomic dysfunction on sleep disturbance in drug\u2010na\u00efve patients with Parkinson's disease","volume":"47","author":"Ozawa M","year":"2025","journal-title":"Neurol. Sci."},{"key":"e_1_2_10_45_1","doi-asserted-by":"crossref","first-page":"97","DOI":"10.1016\/j.parkreldis.2020.04.011","article-title":"The impact of supine hypertension on target organ damage and survival in patients with synucleinopathies and neurogenic orthostatic hypotension","volume":"75","author":"Palma JA","year":"2020","journal-title":"Parkinsonism Relat. Disord."},{"key":"e_1_2_10_46_1","doi-asserted-by":"crossref","DOI":"10.1016\/j.autneu.2019.102563","article-title":"Obstructive sleep apnea syndrome and autonomic dysfunction","volume":"221","author":"Lombardi C","year":"2019","journal-title":"Auton. 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