Continuous positive airway pressure requirements in patients with tetraplegia and obstructive sleep apnoea

Abstract

Study design: Clinic-based retrospective case-control study. Objectives: To compare continuous positive airway pressure (CPAP) requirements between patients with tetraplegia and able-bodied patients with obstructive sleep apnoea (OSA). Setting: Melbourne, Australia. Methods: Diagnostic and CPAP titration polysomnograms of 219 able-bodied, and 25 patients with tetraplegia and OSA were compared for apnoea hypopnoea index (AHI) and CPAP levels required to effectively treat OSA. Demographics and body mass index (BMI) were obtained for each patient. ASIA score and injury date were obtained for patients with tetraplegia. Results: There was no significant difference in AHI (P ¼ 0.102) between the two groups; however, able-bodied patients were significantly older (P ¼ 0.003), required significantly higher levels of CPAP to control their OSA (Po0.001) and had higher BMIs (P ¼ 0.009) than patients with tetraplegia. In the tetraplegia group, there was no significant correlation between AHI and effective CPAP (r ¼ 0.022, P ¼ 0.92) or between AHI and BMI (r ¼ À0.196, P ¼ 0.35). There was a significant correlation between effective CPAP and BMI (r ¼ 0.411, P ¼ 0.041). Among able-bodied patients, over two-thirds (68.8%) required 10-16 cm H 2 0 to control their OSA and nearly one-third required over 16 cm H 2 0. In contrast, over two-thirds (68.8%) in the tetraplegia group required less than 10 cm H 2 0 of CPAP to control their OSA. Conclusion: This retrospective study suggests that OSA patients with tetraplegia require significantly less CPAP to treat their OSA at any given AHI than those who are able-bodied. This suggests that additional unknown factors may contribute to the high prevalence of OSA in tetraplegia.

Respiratory problems and management in people with spinal cord injury

“…People with tetraplegia are far more likely to need CPAP for OSA, yet upper-limb motor dysfunction, reduced independence for donning and doffing of masks, and the associated need for increased carer support time challenge adherence. The less claustrophobic nature of nasal pillows may mean that they are well suited to tetraplegic users and the lower pressures required by many tetraplegic CPAP users allows for greater flexibility in interface choice as leakage is less likely at lower pressures [151]. These practical challenges to the use of CPAP for OSA in tetraplegia and the uncertainty as to the real benefit of the therapy in SCI limit the ability of clinicians to provide evidence-based advice to their patients.…”

Sleep disordered breathing in spinal cord injury: A systematic review

“…The control group had higher BMI and required higher CPAP pressure to control obstructive sleep apnea. 28 In a prospective cohort study of 19 cervical spinal cord injury patients where AHI greater than 10 during a diagnostic overnight sleep study was used as a criterion for SDB, 14/19 (74%) met this criterion. Auto-titration CPAP was initiated with intensive clinical support.…”

Sleep apnea and periodic leg movements in the first year after spinal cord injury

“…1), as suggested by the mean of SpO2 nadir value (89%). This observation, along with the finding that a conspicuous number of tetraplegic patients with SDB require significantly lower levels of CPAP pressures than able-bodied SDB subjects [31], suggests that other factors, different from the high airway collapse, might favor the occurrence of SDB [3].…”