Article

Characteristics of sleep apnea syndrome in tetraplegic patients

Swiss Paraplegic Center, Nottwil, Switzerland.
Spinal Cord (Impact Factor: 1.8). 07/2002; 40(6):286-94. DOI: 10.1038/sj.sc.3101301
Source: PubMed

ABSTRACT

To include a larger number of tetraplegics than in previous studies, in order to more reliably characterize the pathogenesis and predisposing factors of sleep apnea in tetraplegia.
Sleep breathing data and oxymetric values were investigated in 50 randomly selected tetraplegic patients and discussed in context with age, gender, BMI, neck circumference, type and height of lesion, time after injury, spirometric values and medication. A non-validated short questionnaire on daytime complaints was added.
Thirty-one patients out of 50 had an RDI > or =15, defined as sleep disordered breathing (SDB); 24 of them combined with an apnea index of 5 or more, these cases were diagnosed as sleep apnea syndrome (SAS). SAS was apparent in 55% and 20% of the studied men and women, respectively. Regression analyses showed no significant correlation between RDI and lesion level, ASIA impairment scale or spirometric values. In contrast, a significant correlation between RDI and age, BMI, neck circumference and time after injury could be shown. Kruskal-Wallis test for dichotomous non-parametric factors, such as gender, cardiac medication and daytime complaints, showed significant differences with regard to RDI. In contrast to able-bodied people with SAS, daytime complaints were only present in tetraplegic patients with severe pathology (RDI>40).
Incidence of SAS is high in tetraplegia, particularly in older male patients with large neck circumference, long standing spinal cord injury and under cardiac medication. As tetraplegics with RDI between 15 and 40 reported no daytime complaints and often have normal BMI, these tetraplegics are not clinically suspicious for SAS. The increased use of cardiac medication in tetraplegics with SAS may implicate a link between SAS and cardiovascular morbidity, one of the leading causes of death in tetraplegia.

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Available from: Hans Knecht, Apr 04, 2014
    • "Indeed, despite differences in methodology and patient selection (low representation of women and paraplegic patients), the medical literature indicates a prevalence of SDB in patients with SCI that is at least twice the reported prevalence in the general population [7] [8] [10]. Moreover, among SCI patients, subjects with cervical lesions seem to be more prone to develop SDB [12]; and, within SDB, obstructive sleep apnea rather than central sleep apnea predominates [8] [13]. However, the pathogenic mechanisms that cause SDB in SCI patients are still unclear. "
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    ABSTRACT: Background: Sleep disturbances are frequently reported by patients with spinal cord injury (SCI). Studies have shown an increased incidence of sleep-disordered breathing (SDB) and periodic leg movements during sleep (PLMS) in people with stable long-term SCI. Methods: This was a prospective observational study in order to evaluate the features and possible predisposing factors of SDB and PLMS in a heterogenic population of consecutive SCI patients admitted at the Spinal Unit of the Niguarda Hospital within the first year after injury. Each patient underwent a clinical assessment, full polysomnography and arterial blood gas analysis before and immediately after sleep. Multiple logistic regressions were applied in order to evaluate factors associated with SDB and PLMS. Results: Thirty-five (15 tetraplegic and 20 paraplegic) patients were enrolled. Nine patients (25.7%) had an obstructive SDB and 10 (28.6%) had PLMS. The frequency of SDB was higher in tetraplegic with respect to paraplegic patients (Wald statistic: 7.71; P = 0.0055), whereas PLMs were significantly more frequent in patients with an incomplete motor lesion than in subjects with a complete motor lesion (Wald statistic: 6.14; P = 0.013). Conclusion: This study confirms a high frequency of SDB and PLMS in SCI patients in the first year following injury. Independently from possible sub-acute and chronic clinical variables, the level and the completeness of the spinal cord lesion are the main factors associated respectively with an early development of SDB and PLMS.
    No preview · Article · Oct 2014 · Sleep Medicine
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    • "Indeed, despite differences in methodology and patient selection (low representation of women and paraplegic patients), the medical literature indicates a prevalence of SDB in patients with SCI that is at least twice the reported prevalence in the general population [7] [8] [10]. Moreover, among SCI patients, subjects with cervical lesions seem to be more prone to develop SDB [12]; and, within SDB, obstructive sleep apnea rather than central sleep apnea predominates [8] [13]. However, the pathogenic mechanisms that cause SDB in SCI patients are still unclear. "
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    • "Reports of CPAP treatment in quadriplegia in uncontrolled studies are disappointing, with low levels of compliance with therapy reported. Stockhammer et al. [10] found 31 cases of sleep-disordered breathing after screening 50 subjects with quadriplegia. Only 16 of the 31 had previously used CPAP, with 11 (35%) continuing to use the device for at least a few weeks. "
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    ABSTRACT: BackgroundQuadriplegia is a severe, catastrophic injury that predominantly affects people early in life, resulting in lifelong physical disability. Obstructive sleep apnoea is a direct consequence of quadriplegia and is associated with neurocognitive deficits, sleepiness and reduced quality of life. The usual treatment for sleep apnoea is nasal continuous positive airway pressure (CPAP); however, this is poorly tolerated in quadriplegia. To encourage patients to use this therapy, we have to demonstrate that the benefits outweigh the inconvenience. We therefore propose a prospective, multinational randomized controlled trial of three months of CPAP for obstructive sleep apnoea after acute quadriplegia.Methods/designSpecialist spinal cord injury centres across Australia, New Zealand, the UK and Canada will recruit medically stable individuals who have sustained a (new) traumatic quadriplegia (complete or incomplete second cervical to first thoracic level lesions). Participants will be screened for obstructive sleep apnoea using full, portable sleep studies. Those with an apnoea hypopnoea index greater than 10 per hour will proceed to an initial three-night trial of CPAP. Those who can tolerate CPAP for at least 4 hours on at least one night of the initial trial will be randomized to either usual care or a 3-month period of auto-titrating CPAP. The primary hypothesis is that nocturnal CPAP will improve neuropsychological functioning more than usual care alone. The secondary hypothesis is that the magnitude of improvement of neuropsychological function will be predicted by the severity of baseline sleepiness measures, sleep fragmentation and sleep apnoea. Neuropsychological tests and full polysomnography will be performed at baseline and 3 months with interim measures of sleepiness and symptoms of autonomic dysfunction measured weekly. Spirometry will be performed monthly. Neuropsychological tests will be administered by blinded assessors. Recruitment commenced in July 2009.DiscussionThe results of this trial will demonstrate the effect of nocturnal CPAP treatment of obstructive sleep apnoea in acute quadriplegia. If CPAP can improve neurocognitive function after injury, it is likely that rehabilitation and subsequent community participation will be substantially improved for this group of predominantly young and severely physically disabled people.Trial registrationAustralian New Zealand Clinical Trial Registry ACTRN12605000799651
    Full-text · Article · Jun 2013 · Trials
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