Characteristics of sleep apnea syndrome in tetraplegic patients

E, Stockhammer; Tobón, Ángela M.; Michel, Franz; Eser, Prisca; Scheuler, W.; Bauer, Walter; Baumberger, Michael; Müller, Wolfgang‐Ulrich; Kakebeeke, Tanja H.; Knecht, Hans; Zäch, G A

doi:10.1038/sj.sc.3101301

Cited by 76 publications

(67 citation statements)

References 40 publications

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“…5 This is consistent with other research showing a relationship with severity of sleep apnoea and daytime sleepiness. 6,17,18 Although our KSS scores may be within the normal range, the known relationship between objective sleep disturbances and daytime sleepiness suggests that therapies that treat sleep-disordered breathing could result in clinically significant improvements in sleepiness; however, this remains speculative.…”

Section: Discussionmentioning

confidence: 81%

Subjective sleep disturbances and quality of life in chronic tetraplegia

et al. 2015

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Study design: This is a cross-sectional survey. Objectives: The objective of this study was to evaluate the subjective sleep disturbances and quality of life in chronic tetraplegia. Setting: This study was conducted in a community sample from Victoria, Australia. Methods: People with tetraplegia were mailed a survey battery including the following: demographic questions; Karolinska Sleepiness Scale (KSS); Basic Nordic Sleepiness Questionnaire; Functional Outcomes of Sleep Questionnaire (FOSQ); Multivariate Apnoea Prediction Index and Assessment of Quality of Life (AQoL) Questionnaire. Scores were compared with the best available normative data. Results: A total of 163 of 424 (38%) surveys were returned (77% male; 39% sensory and motor complete; mean age±s.d. = 46±14 years; mean years since injury = 11±8 years). The AQoL health utility score (0.31±0.29) was significantly lower than published population norms. FOSQ total (17.55±2.57) and KSS (3.93±2.27) scores were no different from the best available population data. People with tetraplegia reported worse sleep habits, symptoms and quality than a normal population, as indicated on 17 of 21 questions on the Basic Nordic Sleep Questionnaire. Multivariate analysis found that greater injury severity (coefficient (95% CI) = 0.14 (0.10, 0.18)), increasing age (−0.004 (−0.008, − 0.001)) and worse sleep symptoms (−0.005 (−0.009, − 0.0003)) were all significantly associated with reduced quality of life. Conclusion: People with chronic tetraplegia experience more subjective sleep problems and worse quality of life than their able-bodied counterparts. Quality of life is related to injury severity, age and sleep symptoms. Treating the sleep disorders experienced by people living with tetraplegia has the potential to improve their health and well-being.

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Section: Discussionmentioning

confidence: 81%

Subjective sleep disturbances and quality of life in chronic tetraplegia

et al. 2015

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“…In patients with tetraplegia, apnoeas -especially the obstructive kind -have been found to be a significant problem (prevalence between 15 and 48%), interfering negatively with the quality of sleep. [26][27][28] Unfortunately, apnoeas cannot be verified by subjective reports. Apnoeas can be associated with, among other things, obesity (a high body-mass index) and the use of antispastic medication.…”

Section: Discussionmentioning

confidence: 99%

Quality of sleep in individuals with spinal cord injury: a comparison between patients with and without pain

2004

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Study design: A cross-sectional descriptive study of self-reported quality of sleep in individuals with a spinal cord injury (SCI). Objectives: To assess and describe subjective quality of sleep in patients with SCI, with and without pain. Setting: Spinalis SCI unit, Stockholm, Sweden. Methods: A total of 230 patients with an SCI were mailed a questionnaire containing queries about pain intensities, pain unpleasantness, mood, and sleep quality (Basic Nordic Sleep Questionnaire) to assess quality of sleep in patients with SCI with and without pain. Results: Of the 192 questionnaires that were returned (response rate 83.4%), 191 were analysed. Patients were divided into three groups: (1) those who reported no pain (n ¼ 50), (2) those who reported intermittent pain (n ¼ 42), and (3) those who suffered from continuous pain (n ¼ 99). Patients suffering from continuous pain rated pain intensity and unpleasantness significantly higher than those who only suffered from intermittent pain. The group with continuous pain also reported the poorest quality of sleep and the highest ratings of anxiety and depression of the three groups. Anxiety, together with pain intensity and depression, were the main predictors for poor sleep quality. Conclusions: Poor subjective sleep quality was associated with higher ratings of pain intensity, anxiety, and depression. It is possible that melatonin serves as a modulator of these different aspects. Sponsorship: This study was made possible by grants from Spinalis Foundation.Spinal Cord (2005) 43, 85-95.

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“…30 Sleep fragmentation might be very relevant to tetraplegic patients, who are already known to have increased occurrences of spasticity, pain and periodic leg movements. 12 As a result of these alterations between sleep onset and arousal, repetitive perturbations in ventilatory control can occur throughout sleep. Subtle autonomic arousals, without EEG changes may also contribute to the genesis of unstable breathing and poor sleep quality.…”

Section: Discussionmentioning

confidence: 99%

“…High prevalence of OSA has been reported in many previous studies-up to 60%, particularly in the tetraplegic population. [4][5][6][7][8][9][10][11][12][13] However, SDB in SCI patients is usually classified under the rubric "obstructive sleep apnea." Most studies utilized unattended, limited recordings lacking the precision to characterize the type of events reliably.…”

Section: Discussionmentioning

confidence: 99%

Sleep Disordered Breathing in Chronic Spinal Cord Injury

Sankari

Bascom

Oomman

et al. 2014

Journal of Clinical Sleep Medicine

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Study Objectives: Spinal cord injury (SCI) is associated with 2-5 times greater prevalence of sleep disordered breathing (SDB) than the general population. The contribution of SCI on sleep and breathing at different levels of injury using two scoring methods has not been assessed. The objectives of this study were to characterize the sleep disturbances in the SCI population and the associated physiological abnormalities using quantitative polysomnography and to determine the contribution of SCI level on the SDB mechanism. Methods: We studied 26 consecutive patients with SCI (8 females; age 42.5 ± 15.5 years; BMI 25.9 ± 4.9 kg/m 2 ; 15 cervical and 11 thoracic levels) by spirometry, a battery of questionnaires and by attended polysomnography with fl ow and pharyngeal pressure measurements. Inclusion criteria for SCI: chronic SCI (> 6 months post injury), level T6 and above and not on mechanical ventilation. Ventilation, end-tidal CO 2 (P ET CO 2 ), variability in minute ventilation (V I -CV) and upper airway resistance (R UA ) were monitored during wakefulness and NREM sleep in all subjects. Each subject completed brief history and exam, Epworth Sleepiness Scale (ESS), Pittsburgh Sleep Quality Index (PSQI), Berlin questionnaire (BQ) and fatigue severity scale (FSS). Sleep studies were scored twice, fi rst using standard 2007 American Academy of Sleep Medicine (AASM) criteria and second using new 2012 recommended AASM criteria. Results: Mean PSQI was increased to 10.3 ± 3.7 in SCI patients and 92% had poor sleep quality. Mean ESS was increased 10.4 ± 4.4 in SCI patients and excessive daytime sleepiness (ESS ≥ 10) was present in 59% of the patients. Daytime fatigue (FSS > 20) was reported in 96% of SCI, while only 46% had high-risk score of SDB on BQ. Forced vital capacity (FVC) in SCI was reduced to 70.5% predicted in supine compared to 78.5% predicted in upright positions (p < 0.05). Likewise forced expiratory volume in fi rst second (FEV1) was 64.9% predicted in supine compared to 74.7% predicted in upright positions (p < 0.05). Mean AHI in SCI patients was 29.3 ± 25.0 vs. 20.0 ± 22.8 events/h using the new and conventional AASM scoring criteria, respectively (p < 0.001). SCI patients had SDB (AHI > 5 events/h) in 77% of the cases using the new AASM scoring criteria compared to 65% using standard conventional criteria (p < 0.05). In cervical SCI, V I decreased from 7.2 ± 1.6 to 5.5 ± 1.3 L/min, whereas P ET CO 2 and V I -CV, increased during sleep compared to thoracic SCI. Conclusion:The majority of SCI survivors have symptomatic SDB and poor sleep that may be missed if not carefully assessed. Decreased V I and increased P ET CO 2 during sleep in patients with cervical SCI relative to thoracic SCI suggests that sleep related hypoventilation may contribute to the pathogenesis SDB in patients with chronic cervical SCI. S C I E N T I F I C I N V E S T I G A T I O N SS pinal cord injury (SCI) affects a large number of adults worldwide, with an estimated incidence rate of 15 to 40 cases per million populations. The ...

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Characteristics of sleep apnea syndrome in tetraplegic patients

Cited by 76 publications

References 40 publications

Subjective sleep disturbances and quality of life in chronic tetraplegia

Subjective sleep disturbances and quality of life in chronic tetraplegia

Quality of sleep in individuals with spinal cord injury: a comparison between patients with and without pain

Sleep Disordered Breathing in Chronic Spinal Cord Injury

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