{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,11,11]],"date-time":"2025-11-11T13:52:42Z","timestamp":1762869162808,"version":"3.41.2"},"reference-count":33,"publisher":"Oxford University Press (OUP)","issue":"11","license":[{"start":{"date-parts":[[2023,7,18]],"date-time":"2023-07-18T00:00:00Z","timestamp":1689638400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2023,11,8]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Study Objectives<\/jats:title>\n                  <jats:p>Patients with Parkinson\u2019s disease and multiple system atrophy may be subject to sleep state dissociation. Motivated by the fortuitous observation of prominent facial muscle activity during video-polysomnography in patients with multiple system atrophy, we assessed facial motor activity and chin muscle tone during sleep in multiple system atrophy compared to Parkinson\u2019s disease and controls.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>A sleep expert blinded to pathology and sleep stage retrospectively analyzed facial activity in 62 video-polysomnography (11 multiple system atrophy, 38 Parkinson\u2019s disease, and 13 controls). Facial movements were classified into six categories: \u201cEyes closing\/opening,\u201d \u201cEyebrows frowning,\u201d \u201cRaising eyebrows,\u201d \u201cSmiling,\u201d \u201cOther mouth movements,\u201d and \u201cStrained face,\u201d an expression involving both the superior and inferior parts of the face. Chin electromyography activity was quantified during Rapid Eye Movement (REM) and Non-Rapid Eye Movement (NREM) sleep using the atonia index, a validated algorithm.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Multiple system atrophy patients had an increased number of all facial movements compared to controls during NREM. \u201cStrained face\u201d was significantly more frequent in multiple system atrophy compared to Parkinson\u2019s disease, even after adjusting for the presence of REM sleep behavior disorder (RBD). Atonia index was lower in multiple system atrophy compared to controls and Parkinson\u2019s disease during REM and NREM sleep. This difference remained significant compared to Parkinson\u2019s disease in NREM sleep during N1 and N2 after adjusting for the presence of RBD.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>Facial movements during sleep are frequent in multiple system atrophy, \u201cstrained face\u201d appears to be a hallmark of this condition. The presence of increased facial activity and elevated muscle tone during all stages of sleep in multiple system atrophy may be a manifestation of sleep state dissociation, reflecting more severe neurodegeneration.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/sleep\/zsad180","type":"journal-article","created":{"date-parts":[[2023,7,18]],"date-time":"2023-07-18T20:19:41Z","timestamp":1689711581000},"source":"Crossref","is-referenced-by-count":2,"title":["Strained face during sleep in multiple system atrophy: not just a bad dream"],"prefix":"10.1093","volume":"46","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5116-5073","authenticated-orcid":false,"given":"Lecca","family":"Rosamaria","sequence":"first","affiliation":[{"name":"Sleep and EEG, Neurophysiology Unit, Neurology Department, CHU University Hospital and UMR 6602-Universit\u00e9 Clermont Auvergne, CNRS, Institute Pascal , Clermont-Ferrand , France"},{"name":"Sleep Disorder Center, Department of Medical Science and 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