Inspiratory muscle reflex control after incomplete cervical spinal cord injury

Abstract

In healthy individuals, loading inspiratory muscles by brief inspiratory occlusion produces a short-latency inhibitory reflex (IR) in the electromyographic activity (EMG) of scalene and diaphragm muscles. This IR may play a protective role to prevent aspiration and airway collapse during sleep. In people with motor and sensory complete cervical spinal cord injury (cSCI), who were able to breathe independently, this IR was predominantly absent. Here, we investigated the reflex response to brief airway occlusion in 16 participants with sensory incomplete cSCI (American Spinal Injury Association Impairment Scale (AIS) score B or C). Surface EMG was recorded from scalene muscles and the lateral chest wall (overlying diaphragm). The airway occlusion evoked a small change in mouth pressure resembling a physiological occlusion. The short-latency IR was present in 10 (63%) sensory incomplete cSCI participants; significantly higher than the IR incidence observed in complete cSCI participants in our previous study (14%; p=0.003). When present, mean IR latency across all muscles was 58 ms (range 29-79 ms) and mean rectified EMG amplitude decreased to 37% pre-occlusion levels. Participants without an IR had untreated severe obstructive sleep apnoea (OSA), in contrast to those with an IR, who had either had no, mild or treated OSA (p=0.002). Insufficient power did not allow statistical comparison between IR presence, or absence and participant clinical characteristics. In conclusion, spared sensory connections or intersegmental connections may be necessary to generate the IR. Future studies to establish whether IR presence is related to respiratory morbidity in the tetraplegic population are required.