Intensive support does not improve positive-airway pressure use in spinal cord injury/disease: a randomized clinical trial

Abstract

Objective Treatment of sleep-disordered breathing (SDB) with positive airway pressure (PAP) therapy has unique clinical challenges in individuals living with spinal cord injuries and diseases (SCI/D). Interventions focused on increasing PAP use have not been studied in this population. We aimed to evaluate the benefits of a program to increase PAP use among Veterans with SCI/D and SDB. Methods Randomized controlled trial comparing a behavioral Intervention (n=32) and educational control (n=31), both including one face-to-face and five telephone sessions over three months. The intervention included education about SDB and PAP, goal setting, troubleshooting, and motivational enhancement. The control arm included non-directive sleep education only. Results Primary outcomes were objective PAP use (nights >=4 hours used within 90 days) and sleep quality (PSQI at 3 months). These did not differ between intervention and control (main outcome timepoint; mean difference 3.5 [-9.0, 15.9] nights/week for PAP use; p=.578; -1.1 [-2.8, 0.6] points for PSQI; p=.219). Secondary outcomes included fatigue, depression, function, and quality of life. Only fatigue improved significantly more in the intervention versus the control group (p=.025). Across groups, more PAP use was associated with larger improvements in sleep quality, insomnia, sleepiness, fatigue and depression at some time points. Conclusions PAP use in Veterans with SCI/D and SDB is low, and a 3-month supportive/behavioral program did not show significant benefit compared to education alone. Overall, more PAP use was associated with improved symptoms suggesting more intensive support, such as in-home assistance, may be required to increase PAP use in these patients.