Neuropsychological Function in Patients With Acute Tetraplegia and Sleep Disordered Breathing

Abstract

Sleep disordered breathing is highly prevalent following spinal cord injury and likely caused by the injury. Beyond the devastating physical consequences of spinal cord injury, neuropsychological dysfunction is also common. In both the able-bodied and chronic spinal cord injury patients, sleep disordered breathing impairs many areas of neuropsychological function. However, this has not been investigated in patients with acute injury. Study objectives: To investigate the relationship between apnea severity and neuropsychological function in patients with acute-onset tetraplegia and sleep disordered breathing. Methods: Polysomnography and neuropsychological testing were performed on 104 participants (age M = 45.60, SD = 16.38; 10 female) across 11 international sites, 2 months postinjury (M = 60.70 days, SD = 39.48). Neuropsychological tests assessed attention, information processing, executive function, memory, learning, mood, and quality of life. Results: More severe sleep apnea was associated with poorer attention, information processing, and immediate recall. Deficits did not extend to memory. Higher preinjury intelligence and being younger reduced the associations with sleep disordered breathing; however, these protective factors were insufficient to counter the damage to attention, immediate recall, and information processing associated with sleep disordered breathing. Conclusions: These data suggest that new spinal cord injury may function as a model of "acute sleep apnea" and that more widespread sleep apnea-related deficits, including memory, may only be seen with longer exposure to apnea. These findings have important implications for functioning and skill acquisition during rehabilitation and, as such, highlight the importance of sleep health following tetraplegia.

Is the Use of Growth hormone and Melatonin Justified in Spinal Cord Injuries?

“…These findings have been attributed to breathing problems rather than to an impaired MT secretion. Similar conclusions have been reported in other studies in which the poor sleep efficiency has been related to sleep apneas and neuromuscular weakness that negatively affects respiratory function [41][42][43]. In any case, people with tetraplegia suffer sleep problems and poor quality of life [44]; moreover, these problems associated to the increased metabolic disorders (as described in the Introduction) place them in an increased risk for suffering stroke or myocardial infarction.…”

Sleep-Disordered Breathing and Spinal Cord Injury

“…Recent data in individuals with acute cervical SCI reported that increased SDB severity was associated with worse attention, information processing, and short-term memory. 36 Despite this high rate of abnormal sleep and daytime symptoms, SDB remains underdiagnosed and undertreated in these patients. 37 Furthermore, commonly used questionnaires (eg, Berlin Questionnaire Sleep Apnea, Pittsburgh Sleep Quality Index, Epworth Sleepiness Scale) are limited in their ability to identify patients with SCI/D likely to suffer from SDB.…”

Reviewing the relationship between OSA and cognition: Where do we go from here?

“…Partly because, many studies that find a relationship between OSA severity and cognitive deficits do not control for cognitive reserve, and the few that do, find no dose–response relationship . Of note, in a recent study that investigated the relationship between severity of apnoea and neuropsychological function in patients with acute‐onset tetraplegia and sleep‐disordered breathing, higher preinjury intelligence and being younger reduced the associations with sleep‐disordered breathing . However, these protective factors were insufficient to offset the damage to attention, immediate recall and information processing associated with sleep‐disordered breathing.…”