Treatment of sleep apnoea in spinal cord injured patients

Abstract

Little is known about sleep disorders in spinal cord injured (SCI) patients. Three SCI patients who reported severe daytime sleepiness and sleep complaints were evaluated with nocturnal polysomnography and oxygen saturation with pulsoximeter on several occasions at home. In addition respiratory registration was preformed during overnight stay in the hospital. Two patients who had sleep apnoea episodes with reduced oxygen saturation during sleep were treated with continuous positive airway pressure with good results on sleep architecture, oxygen saturation, and daytime sleepiness. One obese patient was advised to lose weight and to reduce smoking and alcohol consumption, and following this advice his sleep related problems were reduced with no further treatment necessary. It is suggested that SCI patients who complain about sleep related disorders should be appropriately screened, with inclusion of nocturnal polysomnography, oxygen saturation, and respiratory registration and, depending on the screening results, appropriate advice/ treatment applied.

Factors associated with sleep apnea in men with spinal cord injury: a population-based case-control study

“…Biering-Sorensen and coworkers 19 reported on treatment of three cases, two of which were successfully treated with CPAP and one with weight loss. A prior study from our center showed poor acceptance of CPAP/Bi-PAP in SCI patients, and we suggested that treatment acceptance may be less likely in patients with markedly impaired hand function, such as higher level motor-complete tetraplegics.…”

Sleep problems in individuals with spinal cord injury: Frequency and age effects.

“…Sleep problems occur frequently in the general population (Hays & Stewart, 1992), and are even more common in individuals with spinal cord injury (SCI; Biering-Sorensen & Biering-Sorensen, 2001). Although some of the sleep difficulties reported by individuals with SCI are likely related to the high incidence of central sleep apnea that is very common in this population (Biering-Sorensen, Norup, Jacobsen, & Biering-Sorensen, 1995; Burns, Kapur, Yin, & Buhrer, 2001; Burns, Little, Hussey, Lyman, & Lakshminarayanan, 2000), aging is also independently associated with decreases in sleep quality and efficiency and may exacerbate sleep problems associated with SCI. For example, Mellinger and colleagues reported that the rate of serious insomnia in people aged 65 to 79 years was 25%, as compared with only 14% in individuals aged 18 to 34 years (Mellinger, Balter, & Uhlenhuth, 1985).…”

The impact of spinal cord injury on breathing during sleep

“…In addition, we found 13 related clinical case reports (Biering-Sorensen et al, 1995; Danielpour et al, 2007; Goh and Li, 2004; Graham et al, 2004; Heike et al, 2007; Howard et al, 1998; Kam et al, 2009; Kawaguchi et al, 2011; Miyano et al, 2009; Nagaoka et al, 2006; Russian et al, 2011; Star and Osterman, 1988; Vella et al, 1984). Collectively, this literature demonstrates unequivocally that the incidence of SDB increases after SCI, with estimates ranging from 2–5 fold over the general population (Burns et al, 2000; Klefbeck et al, 1998b; Leduc et al, 2007; Stockhammer et al, 2002).…”

“…In cases where central sleep apnea is detected after SCI, it seldom occurs alone. More often, this occurs in combination with upper airway obstruction as a mixed apnea (Biering-Sorensen et al, 1995; Burns et al, 2000; McEvoy et al, 1995; Short et al, 1992). …”

“…The most widely used non-surgical treatment is continuous positive airway pressure (CPAP). CPAP acts as a “pneumatic splint” to hold the upper airway open, and has been shown to improve oxygen saturation and sleep architecture in SCI patients (Biering-Sorensen et al, 1995; Burns et al, 2000; Stockhammer et al, 2002). Berlowitz and colleagues (2009) have demonstrated the feasibility of “auto-titrating” CPAP in patients with acute tetraplegia.…”