Sleep apnea syndrome in chronic spinal cord injury: Associated factors and treatment

Burns, Stephen P.; Little, James W.; Hussey, John D.; P, Lyman; Lakshminarayanan, Sonali

doi:10.1053/apmr.2000.9398

Cited by 71 publications

(80 citation statements)

References 38 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Hypercapnia was also more common in this study (29). Burns et al (30) examined the prevalence of sleep apnea among 20 men with various levels and degrees of chronic SCI and found a greater prevalence of sleep apnea with tetraplegia. In a cross-sectional study, Leduc et al (31) reported that 22 of 41 individuals with chronic cervical SCI had OSA-hypopnea syndrome.…”

Section: Discussionsupporting

confidence: 53%

See 1 more Smart Citation

Cardiomyopathy Presenting as Severe Fatigue in a Person With Chronic Spinal Cord Injury

Kam

Sankaran²,

Gowda³

et al. 2009

The Journal of Spinal Cord Medicine

View full text Add to dashboard Cite

Background/Objective: To describe a case of fatigue associated with cardiomyopathy in a man with spinal cord injury. Study Design: Case report. Subject: An obese 35-year-old man with long-term ASIA A L2 paraplegia, accompanied by a 2-year history of progressive severe fatigue. Methods: Physical examination showed obesity, hypertension, tachycardia, and pitting edema. An echocardiogram showed a 20% ejection fraction, severe dilation, and global hypokinesis in the left ventricle and mild to moderate mitral regurgitation. Results: Symptoms improved after treatment with furosemide, warfarin, ramipril, and continuous positive airway pressure for obstructive sleep apnea. Conclusion: Severe progressive fatigue in a patient with chronic SCI may signal cardiomyopathy. Diagnostic studies may be warranted in patients with progressive fatigue.

show abstract

Section: Discussionsupporting

confidence: 53%

“…Various studies (29)(30)(31)(32) have documented a high prevalence of sleep apnea among individuals with tetraplegia. Bach and Wang (29) found that at 5 years after injury, 5 of the 10 individuals with stable traumatic tetraplegia had an increased frequency of transient nocturnal oxyhemoglobin desaturations.…”

Section: Discussionmentioning

confidence: 99%

Cardiomyopathy Presenting as Severe Fatigue in a Person With Chronic Spinal Cord Injury

Kam

Sankaran²,

Gowda³

et al. 2009

The Journal of Spinal Cord Medicine

View full text Add to dashboard Cite

show abstract

“…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

View full text Add to dashboard Cite

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 ...

show abstract

“…1 The most common respiratory sleep disorder in tetraplegia is obstructive sleep apnoea (OSA). The prevalence of OSA in chronic tetraplegia is 2 to 5 times higher [2][3][4][5][6][7][8][9] than that in the general population. 10 In acute tetraplegia, OSA is apparent within weeks of initial injury and affects 60-83% of patients in the first year after injury.…”

Section: Introductionmentioning

confidence: 85%

“…Only 16 of the 31 had used CPAP in the past, with 11 (35%) continuing to use the device for at least a few weeks. Burns et al 6 undertook a cross-sectional postal survey of patients with tetraplegia whose record indicated diagnosis or treatment for OSA. Only 39% were currently using CPAP and an additional 27% had used CPAP but discontinued therapy because of intolerance.…”

mentioning

confidence: 99%

The feasibility of using auto-titrating continuous positive airway pressure to treat obstructive sleep apnoea after acute tetraplegia

et al. 2009

View full text Add to dashboard Cite

Study design: A prospective cohort with acute tetraplegia. Objectives: Obstructive sleep apnoea (OSA) is common within weeks of tetraplegia. This study aimed at determining the feasibility of auto-titrating continuous positive airway pressure (CPAP) to treat OSA after acute tetraplegia. Setting: The Victorian Spinal Cord Service, Melbourne, Australia Methods: Participants underwent full, portable polysomnography. Those with an apnoea hypopnoea index of more than 10 events per hour were defined as having OSA and were offered treatment with CPAP. Treatment adherence was objectively monitored, and measures of quality of life, sleepiness and functional outcomes were determined at enrolment and 3 months later at study conclusion. Results: A total of 44 patients were admitted to our Spinal Cord Service over 9 months, and 19 participated. Fourteen of them had OSA and seven were adherent with therapy for 3 months. Compared with those who did not have OSA, and with those with OSA who were not adherent with CPAP, those who adhered to CPAP were older (mean (s.d.) age 54 years (13) versus non-adherent 28 years (15) and no OSA 29 years (10)) and heavier (body mass index (BMI) 32.5 (11.7), 24.1 (3.7) and 20.6 (3.1), respectively). CPAP-adherant patients and those without OSA showed a 50% or greater improvement in their state sleepiness over the 3 months. Patients with OSA who did not tolerate CPAP had no improvement in sleepiness. Conclusion: Auto-titrating CPAP is a feasible treatment for OSA in acute tetraplegia. Intensive clinical support was required initially, and a tolerance of therapy for at least 4 h for one of the first 3 days was predictive of good CPAP usage. Sponsorship: Transport Accident Commission.

show abstract

Sleep apnea syndrome in chronic spinal cord injury: Associated factors and treatment

Cited by 71 publications

References 38 publications

Cardiomyopathy Presenting as Severe Fatigue in a Person With Chronic Spinal Cord Injury

Cardiomyopathy Presenting as Severe Fatigue in a Person With Chronic Spinal Cord Injury

Sleep Disordered Breathing in Chronic Spinal Cord Injury

The feasibility of using auto-titrating continuous positive airway pressure to treat obstructive sleep apnoea after acute tetraplegia

Contact Info

Product

Resources

About