Diagnostic accuracy of a two-stage model for detecting obstructive sleep apnoea in chronic tetraplegia

Graco, Marnie; Schembri, Rachel; Cross, Susan; Thiyagarajan, Chinnaya; Shafazand, Shirin; Ayas, Najib; Nash, Mark S.; Vu, Viet H.; Ruehland, Warren R.; Chai-Coetzer, Ching Li; Rochford, Peter D.; Churchward, Thomas J; Green, Sally; Berlowitz, David J

doi:10.1136/thoraxjnl-2017-211131

Cited by 26 publications

(10 citation statements)

References 42 publications

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“…Two OSA screening questionnaires developed for the non-disabled sleep clinic population have been tested in the SCI and both performed poorly in identifying OSA, however their ability to identify individuals at high risk of OSA, who require objective testing has not been evaluated [3, 18]. Recently a two-stage model for identifying moderate to severe OSA in people with chronic tetraplegia has been validated and published [2]. In this model a screening questionnaire identifies patients who require further testing with overnight oximetry.…”

Section: Discussionmentioning

confidence: 99%

“…People with tetraplegia experience a range of complications from their injury, affecting almost every system of their body. Obstructive sleep apnoea (OSA) is one such complication, with prevalence estimates of up to 83% in the acute phase, and up to 97% in the community dwelling chronic population [1, 2]. The quality of life of people with tetraplegia and OSA is up to five times the minimally important clinical difference worse than their peers without OSA [3].…”

Section: Introductionmentioning

confidence: 99%

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Understanding the clinical management of obstructive sleep apnoea in tetraplegia: a qualitative study using the theoretical domains framework

Graco

Berlowitz

Green

2019

BMC Health Serv Res

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Background Clinical practice guidelines recommend further testing for people with tetraplegia and signs and symptoms of obstructive sleep apnoea (OSA), followed by treatment with positive airway pressure therapy. Little is known about how clinicians manage OSA in tetraplegia. The theoretical domains framework (TDF) is commonly used to identify determinants of clinical behaviours. This study aimed to describe OSA management practices in tetraplegia, and to explore factors influencing clinical practice. Methods Semi-structured interviews were conducted with 20 specialist doctors managing people with tetraplegia from spinal units in Europe, UK, Canada, USA, Australia and New Zealand. Interviews were audiotaped for verbatim transcription. OSA management was divided into screening, diagnosis and treatment components for inpatient and outpatient services, allowing common practices to be categorised. Data were thematically coded to the 12 constructs of the TDF. Common beliefs were identified and comparisons were made between participants reporting different practices. Results Routine screening for OSA signs and symptoms was reported by 10 (50%) doctors in inpatient settings and eight (40%) in outpatient clinics. Doctors commonly referred to sleep specialists for OSA diagnosis (9/20 in inpatients; 16/20 in outpatients), and treatment (12/20, 17/20). Three doctors reported their three spinal units were managing non-complicated OSA internally, without referral to sleep specialists. Ten belief statements representing six domains of the TDF were generated about screening. Lack of time and support staff ( Environmental context and resources) and no prompts to screen for OSA (Memory, attention and decision processes) were commonly identified barriers to routine screening. Ten belief statements representing six TDF domains were generated for diagnosis and treatment behaviours . Common barriers to independent management practices were lack of skills (Skills) , low confidence ( Beliefs about capabilities) , and the belief that OSA management was outside their scope of practice (Social/Professional role and identity) . The three units independently managing OSA were well resourced with multidisciplinary involvement (Environmental context and resources) , had ‘clinical champions’ to lead the program (Social influences) . Conclusion Clinical management of OSA in tetraplegia is highly varied. Several influences on OSA management within spinal units have been identified, facilitating the development of future interventions aiming to improve clinical practice. Electronic supplementary material The online version of this article (10.1186/s12913-019-4197-8) contains supplementary material, which...

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Understanding the clinical management of obstructive sleep apnoea in tetraplegia: a qualitative study using the theoretical domains framework

Graco

Berlowitz

Green

2019

BMC Health Serv Res

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“…SDB is underdiagnosed in this population, and this is likely true for other sleep disorders as well 80. Given the high prevalence of sleep disorders in SCI, any substantial sleep-related complaints should be further evaluated so that appropriate treatment can be initiated.…”

Section: Evaluation Of Sleep Disorders In Individuals With Scimentioning

confidence: 99%

<p>Impact Of Spinal Cord Injury On Sleep: Current Perspectives</p>

Sankari¹,

Badr²,

Martin³

et al. 2019

NSS

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Sleep disorders are commonly encountered in people living with spinal cord injury (SCI). Primary sleep disorders such as sleep-disordered breathing (SDB), sleep-related movement disorders, circadian rhythm sleep-wake disorders, and insomnia disorder are common conditions after SCI but remain under-recognized, underdiagnosed and therefore remain untreated for a majority of patients. Sleep disturbances in people living with SCI are associated with significant impairments of daytime function and quality of life. Previous reviews have described findings related mainly to SDB but have not examined the relationship between other sleep disorders and SCI. This narrative review examines various sleep abnormalities and related functional and physical impairments in people living with SCI. It discusses new evidence pertaining to management, highlights existing limitations in the literature and recommends future directions for research.

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“…Graco and colleagues state that the proportion of central (central apnea index: 1.4/hour) or mixed (1.0/hour) events is low in their study population 11. However, no information is provided as to classification of hypopnoeas as central or obstructive according to 2012 AASM recommendations and the majority (74%) of the events reported in the validation group are hypopnoeas.…”

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confidence: 94%

“…However, transportation of the patient for in-laboratory PSG may be as complicated as providing unattended portable PSG in a long-term facility. Providing a simple pragmatic alternative to PSG was therefore the main goal for the study by Graco and colleagues published in Thorax 11. The authors describe the performance of a disease-specific two-stage screening tool for moderate to severe OSAS (defined as apnea-hypopnea index (AHI) >21/hour) in tetraplegic patients with SCI, developed using an existing database of 78 patients who had undergone PSG, and then prospectively validated in a group of 100 subjects with SCI.…”

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confidence: 99%

Estimating the probability of OSA in the spinal cord injury population: specific tools are still needed

Adler

Janssens

2018

Thorax

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Diagnostic accuracy of a two-stage model for detecting obstructive sleep apnoea in chronic tetraplegia

Abstract: Results, ACTRN12615000896572 (The Australian and New Zealand Clinical Trials Registry) and pre-results, NCT02176928 (clinicaltrials.gov).

Cited by 26 publications

References 42 publications

Understanding the clinical management of obstructive sleep apnoea in tetraplegia: a qualitative study using the theoretical domains framework

Understanding the clinical management of obstructive sleep apnoea in tetraplegia: a qualitative study using the theoretical domains framework

<p>Impact Of Spinal Cord Injury On Sleep: Current Perspectives</p>

Estimating the probability of OSA in the spinal cord injury population: specific tools are still needed

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