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Locke BW, Brown JP, Sundar KM. The Role of Obstructive Sleep Apnea in Hypercapnic Respiratory Failure Identified in Critical Care, Inpatient, and Outpatient Settings. Sleep Med Clin 2024; 19:339-356. [PMID: 38692757 PMCID: PMC11068091 DOI: 10.1016/j.jsmc.2024.02.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/03/2024]
Abstract
An emerging body of literature describes the prevalence and consequences of hypercapnic respiratory failure. While device qualifications, documentation practices, and previously performed clinical studies often encourage conceptualizing patients as having a single "cause" of hypercapnia, many patients encountered in practice have several contributing conditions. Physiologic and epidemiologic data suggest that sleep-disordered breathing-particularly obstructive sleep apnea (OSA)-often contributes to the development of hypercapnia. In this review, the authors summarize the frequency of contributing conditions to hypercapnic respiratory failure among patients identified in critical care, emergency, and inpatient settings with an aim toward understanding the contribution of OSA to the development of hypercapnia.
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Affiliation(s)
- Brian W Locke
- Division of Respiratory, Critical Care, and Occupational Pulmonary Medicine, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA.
| | - Jeanette P Brown
- Division of Respiratory, Critical Care, and Occupational Pulmonary Medicine, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Krishna M Sundar
- Division of Respiratory, Critical Care, and Occupational Pulmonary Medicine, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA
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2
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Ji W, Nightingale TE, Zhao F, Fritz NE, Phillips AA, Sisto SA, Nash MS, Badr MS, Wecht JM, Mateika JH, Panza GS. The Clinical Relevance of Autonomic Dysfunction, Cerebral Hemodynamics, and Sleep Interactions in Individuals Living With SCI. Arch Phys Med Rehabil 2024; 105:166-176. [PMID: 37625532 DOI: 10.1016/j.apmr.2023.08.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 07/25/2023] [Accepted: 08/06/2023] [Indexed: 08/27/2023]
Abstract
A myriad of physiological impairments is seen in individuals after a spinal cord injury (SCI). These include altered autonomic function, cerebral hemodynamics, and sleep. These physiological systems are interconnected and likely insidiously interact leading to secondary complications. These impairments negatively influence quality of life. A comprehensive review of these systems, and their interplay, may improve clinical treatment and the rehabilitation plan of individuals living with SCI. Thus, these physiological measures should receive more clinical consideration. This special communication introduces the under investigated autonomic dysfunction, cerebral hemodynamics, and sleep disorders in people with SCI to stakeholders involved in SCI rehabilitation. We also discuss the linkage between autonomic dysfunction, cerebral hemodynamics, and sleep disorders and some secondary outcomes are discussed. Recent evidence is synthesized to make clinical recommendations on the assessment and potential management of important autonomic, cerebral hemodynamics, and sleep-related dysfunction in people with SCI. Finally, a few recommendations for clinicians and researchers are provided.
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Affiliation(s)
- Wenjie Ji
- Department of Rehabilitation Science, School of Public Health and Health Professions, University at Buffalo, Buffalo, NY
| | - Tom E Nightingale
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK; Centre for Trauma Science Research, University of Birmingham, Birmingham, UK; International Collaboration on Repair Discoveries (ICORD), University of British Columbia, Vancouver, Canada
| | - Fei Zhao
- Department of Health Care Sciences, Program of Occupational Therapy, Wayne State University, Detroit, MI; John D. Dingell VA Medical Center, Research and Development, Detroit, MI
| | - Nora E Fritz
- Department of Health Care Sciences, Program of Physical Therapy, Detroit, MI; Department of Neurology, Wayne State University, Detroit, MI
| | - Aaron A Phillips
- Department of Physiology and Pharmacology, Cardiac Sciences, Clinical Neurosciences, Biomedical Engineering, Libin Cardiovascular institute, Hotchkiss Brain Institute, Cumming School of Medicine, Calgary, AB, Canada; RESTORE.network, University of Calgary, Calgary, AB, Canad
| | - Sue Ann Sisto
- Department of Rehabilitation Science, School of Public Health and Health Professions, University at Buffalo, Buffalo, NY
| | - Mark S Nash
- Department of Neurological Surgery, Physical Medicine & Rehabilitation Physical Therapy, Miami, FL; Miami Project to Cure Paralysis, University of Miami Miller School of Medicine, Miami, FL
| | - M Safwan Badr
- John D. Dingell VA Medical Center, Research and Development, Detroit, MI; Departments of Physiology and Internal Medicine, Wayne State University, Detroit, MI
| | - Jill M Wecht
- James J Peters VA Medical Center, Department of Spinal Cord Injury Research, Bronx, NY; Icahn School of Medicine Mount Sinai, Departments of Rehabilitation and Human Performance, and Medicine Performance, and Medicine, New York, NY
| | - Jason H Mateika
- John D. Dingell VA Medical Center, Research and Development, Detroit, MI; Departments of Physiology and Internal Medicine, Wayne State University, Detroit, MI
| | - Gino S Panza
- Department of Health Care Sciences, Program of Occupational Therapy, Wayne State University, Detroit, MI; John D. Dingell VA Medical Center, Research and Development, Detroit, MI.
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3
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Aboussouan LS, Badr MS, Sankari A. The quest for accurate evaluation and treatment of sleep disordered breathing in spinal cord injury. Sleep 2023; 46:zsad264. [PMID: 37801685 DOI: 10.1093/sleep/zsad264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Indexed: 10/08/2023] Open
Affiliation(s)
- Loutfi S Aboussouan
- Respiratory and Neurological Institutes, Cleveland Clinic, Cleveland, OH, USA
| | - M Safwan Badr
- Department of Internal Medicine, Liborio Tranchida, MD, Endowed Professor of Medicine, Wayne State University School of Medicine, University Health Center, Detroit, MI, USA
| | - Abdulghani Sankari
- Sleep Research Laboratory, John D. Dingell Veterans Affairs Medical Center, Wayne State University, Detroit, MI, USA
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Panza GS, Sutor T, Gee CM, Graco M, McCully KK, Chiodo A, Badr MS, Nash MS. Is Sleep Disordered Breathing Confounding Rehabilitation Outcomes in Spinal Cord Injury Research? Arch Phys Med Rehabil 2021; 103:1034-1045. [PMID: 34537222 DOI: 10.1016/j.apmr.2021.08.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2021] [Accepted: 08/24/2021] [Indexed: 11/02/2022]
Abstract
The purpose of this article is to highlight the importance of considering sleep-disordered breathing (SDB) as a potential confounder to rehabilitation research interventions in spinal cord injury (SCI). SDB is highly prevalent in SCI, with increased prevalence in individuals with higher and more severe lesions, and the criterion standard treatment with continuous positive airway pressure remains problematic. Despite its high prevalence, SDB is often untested and untreated in individuals with SCI. In individuals without SCI, SDB is known to negatively affect physical function and many of the physiological systems that negatively affect physical rehabilitation in SCI. Thus, owing to the high prevalence, under testing, low treatment adherence, and known negative effect on the physical function, it is contended that underdiagnosed SDB in SCI may be confounding physical rehabilitation research studies in individuals with SCI. Studies investigating the effect of treating SDB and its effect on physical rehabilitation in SCI were unable to be located. Thus, studies investigating the likely integrated relationship among physical rehabilitation, SDB, and proper treatment of SDB in SCI are needed. Owing to rapid growth in both sleep medicine and physical rehabilitation intervention research in SCI, the authors contend it is the appropriate time to begin the conversations and collaborations between these fields. We discuss a general overview of SDB and physical training modalities, as well as how SDB could be affecting these studies.
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Affiliation(s)
- Gino S Panza
- John D. Dingell Veterans Affairs Medical Center, Detroit, MI; Department of Physiology, Wayne State University School of Medicine, Detroit, MI.
| | - Tommy Sutor
- Research Service, Hunter Holmes McGuire Veterans Affairs Medical Center, Richmond, VA
| | - Cameron M Gee
- International Collaboration on Repair Discoveries, Vancouver, BC, Canada
| | - Marnie Graco
- Institute for Breathing and Sleep, Austin Health; and School of Physiotherapy, University of Melbourne, Melbourne, Australia
| | | | - Anthony Chiodo
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI
| | - M Safwan Badr
- John D. Dingell Veterans Affairs Medical Center, Detroit, MI; Department of Internal Medicine, Wayne State University School of Medicine, Detroit, MI
| | - Mark S Nash
- Department of Neurological Surgery, Physical Medicine & Rehabiliation, and Physical Therapy, Miami, FL; The Miami Project to Cure Paralysis, University of Miami Miller School of Medicine, Miami, FL
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5
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Brown J. Tracheostomy to Noninvasive Ventilation: From Acute Care to Home. Sleep Med Clin 2020; 15:593-598. [PMID: 33131668 DOI: 10.1016/j.jsmc.2020.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
The number of patients experiencing prolonged mechanical ventilation is increasing over time. Patients who have a tracheostomy placed in a critical care setting have been described as having an average of 4 separate transitions between the acute care setting, long-term acute care (LTAC), and home. Transition points can be problematic if not addressed adequately; however, proactive planning can optimize patient care. Individual patient factors will determine if the patient will require long-term tracheostomy, transitioned to noninvasive positive pressure ventilation, or able to be decannulated. Patients and caregivers should be included in transition planning to optimize outcomes.
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Affiliation(s)
- Jeanette Brown
- Division of Pulmonary Medicine, University of Utah, 26 North 1900 East, Salt Lake City, UT 84132, USA.
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Graco M, Schembri R, Ross J, Green SE, Booker L, Cistulli PA, Ayas NT, Berlowitz DJ. Continuous Positive Airway Pressure Use for Obstructive Sleep Apnea in Acute, Traumatic Tetraplegia. Arch Phys Med Rehabil 2019; 100:2276-2282. [PMID: 31421094 DOI: 10.1016/j.apmr.2019.07.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Revised: 06/26/2019] [Accepted: 07/22/2019] [Indexed: 12/21/2022]
Abstract
OBJECTIVE To describe continuous positive airway pressure (CPAP) use for treatment of obstructive sleep apnea (OSA) in acute tetraplegia, including adherence rates and associated factors. DESIGN Secondary analysis of CPAP data from a multinational randomized controlled trial. SETTING Inpatient rehabilitation units of 11 spinal cord injury centers. PARTICIPANTS People with acute, traumatic tetraplegia and OSA (N=79). INTERVENTIONS Autotitrating CPAP for OSA for 3 months. MAIN OUTCOME MEASURES Adherence measured as mean daily hours of use. Adherent (yes/no) was defined as an average of at least 4 hours a night throughout the study. Regression analyses determined associations between baseline factors and adherence. CPAP device pressure and leak data were analyzed descriptively. RESULTS A total of 79 participants from 10 spinal units (91% men; mean age ± SD, 46±16; 78±64d postinjury) completed the study in the treatment arm and 33% were adherent. Mean daily CPAP use ± SD was 2.9±2.3 hours. Better adherence was associated with more severe OSA (P=.04) and greater CPAP use in the first week (P<.01). Average 95th percentile pressure was low (9.3±1.7 cmH2O) and 95th percentile leak was high (27.1±13.4 L/min). CONCLUSION Adherence to CPAP after acute, traumatic tetraplegia is low. Early acceptance of therapy and more severe OSA predict CPAP use over 3 months. People with acute tetraplegia require less pressure to treat their OSA than the nondisabled; however, air leak is high. These findings highlight the need for further investigation of OSA treatment in acute tetraplegia.
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Affiliation(s)
- Marnie Graco
- Institute for Breathing and Sleep, Austin Health, Melbourne, Victoria, Australia; Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Victoria, Australia.
| | - Rachel Schembri
- Institute for Breathing and Sleep, Austin Health, Melbourne, Victoria, Australia
| | - Jacqueline Ross
- Institute for Breathing and Sleep, Austin Health, Melbourne, Victoria, Australia; Victorian Spinal Cord Service, Austin Hospital, Melbourne, Victoria, Australia
| | - Sally E Green
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Lauren Booker
- Institute for Breathing and Sleep, Austin Health, Melbourne, Victoria, Australia
| | - Peter A Cistulli
- Department of Respiratory and Sleep Medicine, Royal North Shore, St. Leonard's, New South Wales, Australia; Charles Perkins Centre and Faculty of Medicine and Health, University of Sydney, New South Wales, Australia
| | - Najib T Ayas
- University of British Columbia, Faculty of Medicine. Vancouver, British Columbia, Canada
| | - David J Berlowitz
- Institute for Breathing and Sleep, Austin Health, Melbourne, Victoria, Australia; School of Physiotherapy, The University of Melbourne, Melbourne, Victoria, Australia
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Berlowitz DJ, Schembri R, Graco M, Ross JM, Ayas N, Gordon I, Lee B, Graham A, Cross SV, McClelland M, Kennedy P, Thumbikat P, Bennett C, Townson A, Geraghty TJ, Pieri-Davies S, Singhal R, Marshall K, Short D, Nunn A, Mortimer D, Brown D, Pierce RJ, Cistulli PA. Positive airway pressure for sleep-disordered breathing in acute quadriplegia: a randomised controlled trial. Thorax 2019; 74:282-290. [PMID: 30538163 PMCID: PMC6467247 DOI: 10.1136/thoraxjnl-2018-212319] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Revised: 10/24/2018] [Accepted: 10/29/2018] [Indexed: 12/03/2022]
Abstract
RATIONALE Highly prevalent and severe sleep-disordered breathing caused by acute cervical spinal cord injury (quadriplegia) is associated with neurocognitive dysfunction and sleepiness and is likely to impair rehabilitation. OBJECTIVE To determine whether 3 months of autotitrating CPAP would improve neurocognitive function, sleepiness, quality of life, anxiety and depression more than usual care in acute quadriplegia. METHODS AND MEASUREMENTS Multinational, randomised controlled trial (11 centres) from July 2009 to October 2015. The primary outcome was neurocognitive (attention and information processing as measure with the Paced Auditory Serial Addition Task). Daytime sleepiness (Karolinska Sleepiness Scale) was a priori identified as the most important secondary outcome. MAIN RESULTS 1810 incident cases were screened. 332 underwent full, portable polysomnography, 273 of whom had an apnoea hypopnoea index greater than 10. 160 tolerated at least 4 hours of CPAP during a 3-day run-in and were randomised. 149 participants (134 men, age 46±34 years, 81±57 days postinjury) completed the trial. CPAP use averaged 2.9±2.3 hours per night with 21% fully 'adherent' (at least 4 hours use on 5 days per week). Intention-to-treat analyses revealed no significant differences between groups in the Paced Auditory Serial Addition Task (mean improvement of 2.28, 95% CI -7.09 to 11.6; p=0.63). Controlling for premorbid intelligence, age and obstructive sleep apnoea severity (group effect -1.15, 95% CI -10 to 7.7) did not alter this finding. Sleepiness was significantly improved by CPAP on intention-to-treat analysis (mean difference -1.26, 95% CI -2.2 to -0.32; p=0.01). CONCLUSION CPAP did not improve Paced Auditory Serial Addition Task scores but significantly reduced sleepiness after acute quadriplegia. TRIAL REGISTRATION NUMBER ACTRN12605000799651.
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Affiliation(s)
- David J Berlowitz
- Institute for Breathing and Sleep, Austin Health, Heidelberg, Victoria, Australia
- Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Victoria, Australia
| | - Rachel Schembri
- Institute for Breathing and Sleep, Austin Health, Heidelberg, Victoria, Australia
| | - Marnie Graco
- Institute for Breathing and Sleep, Austin Health, Heidelberg, Victoria, Australia
| | - Jacqueline M Ross
- Institute for Breathing and Sleep, Austin Health, Heidelberg, Victoria, Australia
- Victorian Spinal Cord Service, Austin Hospital, Heidelberg, Victoria, Australia
| | - Najib Ayas
- Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Ian Gordon
- Statistical Consulting Centre, School of Mathematics and Statistics, University of Melbourne, Melbourne, Victoria, Australia
| | - Bonne Lee
- Prince of Wales Hospital, Randwick, New South Wales, Australia
| | - Allison Graham
- National Spinal Injuries Centre, Stoke Mandeville Hospital, Aylesbury, UK
| | - Susan V Cross
- National Spinal Injuries Centre, Stoke Mandeville Hospital, Aylesbury, UK
| | - Martin McClelland
- Princess Royal Spinal Cord Injuries Centre, Northern General Hospital, Sheffield, UK
| | - Paul Kennedy
- National Spinal Injuries Centre, Stoke Mandeville Hospital, Aylesbury, UK
| | - Pradeep Thumbikat
- Princess Royal Spinal Cord Injuries Centre, Northern General Hospital, Sheffield, UK
| | | | - Andrea Townson
- Department of Physical Medicine and Rehabilitation, University of British Columbia, Vancouver, British Columbia, Canada
| | - Timothy J Geraghty
- Queensland Spinal Cord Injuries Service and The Hopkins Centre, Research for Rehabilitation and Resilience, Metro South Health and Griffith University, Woolloongabba, Queensland, Australia
| | - Sue Pieri-Davies
- North West Regional Spinal Injuries Centre, Southport and Ormskirk Hospital NHS Trust, Southport, UK
| | - Raj Singhal
- Burwood Spinal Unit, Burwood Hospital, Canterbury District Health Board, Christchurch, New Zealand
| | - Karen Marshall
- Burwood Spinal Unit, Burwood Hospital, Canterbury District Health Board, Christchurch, New Zealand
| | - Deborah Short
- The Robert Jones & Agnes Hunt Orthopaedic Hospital, Oswestry, UK
| | - Andrew Nunn
- Victorian Spinal Cord Service, Austin Hospital, Heidelberg, Victoria, Australia
| | - Duncan Mortimer
- Centre for Health Economics, Monash Business School, Monash University, Clayton, Victoria, Australia
| | - Doug Brown
- Spinal Research Institute, Austin Hospital, Melbourne, Victoria, Australia
| | - Robert J Pierce
- Institute for Breathing and Sleep, Austin Health, Heidelberg, Victoria, Australia
| | - Peter A Cistulli
- Department of Respiratory and Sleep Medicine, Royal North Shore Hospital, St Leonards, New South Wales, Australia
- Sydney Medical School, University of Sydney, Melbourne, New South Wales, Australia
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Sankari A, Badr MS, Martin JL, Ayas NT, Berlowitz DJ. Impact Of Spinal Cord Injury On Sleep: Current Perspectives. Nat Sci Sleep 2019; 11:219-229. [PMID: 31686935 PMCID: PMC6800545 DOI: 10.2147/nss.s197375] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Accepted: 09/20/2019] [Indexed: 12/22/2022] Open
Abstract
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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Affiliation(s)
- Abdulghani Sankari
- Department of Internal Medicine, John D. Dingell VA Medical Center, Detroit, MI, USA.,Department of Internal Medicine, Wayne State University, Detroit, MI, USA
| | - M Safwan Badr
- Department of Internal Medicine, John D. Dingell VA Medical Center, Detroit, MI, USA.,Department of Internal Medicine, Wayne State University, Detroit, MI, USA
| | - Jennifer L Martin
- Geriatric Research, Education and Clinical Center, VA Greater Los Angeles Healthcare System, North Hills, CA, USA.,Geriatric Research, Education and Clinical Center, David Geffen School of Medicine at the University of California, Los Angeles, CA, USA
| | - Najib T Ayas
- Department of Medicine, The University of British Columbia, Vancouver, BC, Canada
| | - David J Berlowitz
- Department of Physiotherapy, University of Melbourne, Melbourne, Australia.,Department of Physiotherapy, Austin Health, Melbourne, Australia.,Institute for Breathing and Sleep, Austin Health, Melbourne, Australia
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Graco M, Green SE, Tolson J, Stevens B, Barnes M, Rigoni A, Henderson S, Nicholls C, Berlowitz DJ. Worth the effort? Weighing up the benefit and burden of continuous positive airway pressure therapy for the treatment of obstructive sleep apnoea in chronic tetraplegia. Spinal Cord 2018; 57:247-254. [PMID: 30356181 DOI: 10.1038/s41393-018-0210-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Revised: 09/22/2018] [Accepted: 10/04/2018] [Indexed: 11/09/2022]
Abstract
STUDY DESIGN Mixed methods OBJECTIVES: Continuous positive airway pressure (CPAP) therapy is the recommended treatment for obstructive sleep apnoea (OSA). The aim of this study was to estimate CPAP adherence in people with tetraplegia and OSA, and to explore the barriers and facilitators to CPAP use. SETTING Hospital outpatient department in Melbourne, Australia METHODS: People with chronic tetraplegia and OSA were commenced with auto-titrating CPAP and supported for 1 month. Semi-structured interviews were conducted with participants at one month and analysed thematically. CPAP usage was measured at 1, 6 and 12 months, with "adherent" defined as achieving more than 4 h average per night. RESULTS Sixteen participants completed the study (80% male; mean age 56 (SD = 15)). Mean nightly CPAP use at one month was 3.1 h (SD = 2.5; 38% adherent), and at 6 months and 12 months were 2.6 h (SD = 2.8; 25% adherent) and 2.1 h (SD = 3.2; 25% adherent). The perceived benefit/burden balance strongly influenced ongoing use. Burden attributed to CPAP use was common, and included mask discomfort, and physical and emotional problems. Adherent participants were motivated by the immediate daytime benefits to mood, alertness and sleepiness. There was a tendency to not recognise symptoms of OSA until after they were treated. CONCLUSION CPAP use is challenging for people with tetraplegia, who experience substantial burden from using the device. When tolerated, the proximate benefits are substantial. People with tetraplegia need more intensive support for longer to help them overcome the burdens of CPAP and benefit from the treatment.
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Affiliation(s)
- Marnie Graco
- Institute for Breathing and Sleep, Austin Health, Melbourne, Victoria, Australia. .,The University of Melbourne, Department of Medicine, Melbourne, Victoria, Australia.
| | - Sally E Green
- Monash University, School of Public Health and Preventive Medicine, Melbourne, Victoria, Australia
| | - Julie Tolson
- Institute for Breathing and Sleep, Austin Health, Melbourne, Victoria, Australia
| | - Bronwyn Stevens
- Institute for Breathing and Sleep, Austin Health, Melbourne, Victoria, Australia
| | - Maree Barnes
- Institute for Breathing and Sleep, Austin Health, Melbourne, Victoria, Australia.,The University of Melbourne, Department of Medicine, Melbourne, Victoria, Australia
| | - Alyssa Rigoni
- Institute for Breathing and Sleep, Austin Health, Melbourne, Victoria, Australia
| | - Sandra Henderson
- Institute for Breathing and Sleep, Austin Health, Melbourne, Victoria, Australia
| | - Carmel Nicholls
- Institute for Breathing and Sleep, Austin Health, Melbourne, Victoria, Australia
| | - David J Berlowitz
- Institute for Breathing and Sleep, Austin Health, Melbourne, Victoria, Australia.,The University of Melbourne, Department of Physiotherapy, Melbourne, Victoria, Australia
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Sankari A, Vaughan S, Bascom A, Martin JL, Badr MS. Sleep-Disordered Breathing and Spinal Cord Injury: A State-of-the-Art Review. Chest 2018; 155:438-445. [PMID: 30321507 DOI: 10.1016/j.chest.2018.10.002] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Revised: 09/20/2018] [Accepted: 10/02/2018] [Indexed: 12/15/2022] Open
Abstract
Individuals living with spinal cord injury or disease (SCI/D) are at increased risk for sleep-disordered breathing (SDB), with a prevalence that is three- to fourfold higher than the general population. The main features of SDB, including intermittent hypoxemia and sleep fragmentation, have been linked to adverse cardiovascular outcomes including nocturnal hypertension in patients with SCI/D. The relationship between SDB and SCI/D may be multifactorial in nature given that level and completeness of injury can affect central control of respiration and upper airway collapsibility differently, promoting central and/or obstructive types of SDB. Despite the strong association between SDB and SCI/D, access to diagnosis and management remains limited. This review explores the role of SCI/D in the pathogenesis of SDB, poor sleep quality, the barriers in diagnosing and managing SDB in SCI/D, and the alternative approaches and future directions in the treatment of SDB, such as novel pharmacologic and nonpharmacologic treatments.
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Affiliation(s)
- Abdulghani Sankari
- John D. Dingell VA Medical Center, Detroit, MI; Department of Medicine, Wayne State University, Detroit, MI
| | - Sarah Vaughan
- John D. Dingell VA Medical Center, Detroit, MI; Department of Medicine, Wayne State University, Detroit, MI
| | - Amy Bascom
- John D. Dingell VA Medical Center, Detroit, MI
| | - Jennifer L Martin
- VA Greater Los Angeles Healthcare System, North Hills, CA; David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA
| | - M Safwan Badr
- John D. Dingell VA Medical Center, Detroit, MI; Department of Medicine, Wayne State University, Detroit, MI.
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Abstract
RATIONALE About 60,0000 people are involved in traffic accident each year in China and spinal cord injury (SCI) often occurs. Pregnant women with paraplegia is rare, and they face higher risk during pregnancy and childbirth. PATIENT CONCERNS We report a case of a 35-year-old patient with SCI, who had vaginal forceps delivery at 38 weeks and 5 days of gestation. DIAGNOSES The patient was diagnosed with term pregnancy with traumatic tetraplegia. INTERVENTIONS A vaginal forceps delivery was performed at 38 weeks and 5 days of gestation. OUTCOMES A vaginal forceps delivery of the patient was smooth. After delivery the patient recovered quickly, her vaginal blood was less, blood pressure was favoring. LESSONS This study presents a case with traumatic tetraplegia during pregnancy. We suggest that regular prenatal care is necessary.
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Affiliation(s)
- Changfang Yao
- Department of Obstetrics and Gynecology, the Third Affiliated Hospital, Soochow University
| | - Yongjuan Xu
- Department of Obstetrics and Gynecology, Changzhou Maternal and Child Health Care Hospital, Changzhou, Jiangsu, China
| | - Li Dai
- Department of Obstetrics and Gynecology, the Third Affiliated Hospital, Soochow University
| | - Yan Lv
- Department of Obstetrics and Gynecology, the Third Affiliated Hospital, Soochow University
| | - Xiaoli Xu
- Department of Obstetrics and Gynecology, the Third Affiliated Hospital, Soochow University
| | - Wenfeng Ye
- Department of Obstetrics and Gynecology, the Third Affiliated Hospital, Soochow University
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