Two case study reports of sleep apnoea in patients with paraplegia

The impact of spinal cord injury on breathing during sleep

The prevalence of sleep disordered breathing (SDB) following spinal cord injury (SCI) is considerably greater than in the general population. While the literature on this topic is still relatively small, and in some cases contradictory, a few general conclusions can be drawn. First, while both central and obstructive sleep apnea (OSA) has been reported after SCI, OSA appears to be more common. Second, SDB after SCI likely reflects a complex interplay between multiple factors including body mass, lung volume, autonomic function, sleep position, and respiratory neuroplasticity. It is not yet possible to pinpoint a "primary factor" which will predispose an individual with SCI to SDB, and the underlying mechanisms may change during progression from acute to chronic injury. Given the prevalence and potential health implications of SDB in the SCI population, we suggest that additional studies aimed at defining the underlying mechanisms are warranted.

Long-Term Treatment of Sleep Apnea in Persons with Spinal Cord Injury

OBJECTIVE

Although numerous studies have documented a high prevalence of sleep apnea in persons with spinal cord injury, relatively little has been published regarding treatment of sleep apnea in this population. The purpose of this study was to describe long-term treatment outcomes and side effects of sleep apnea treatment in persons with spinal cord injury.

DESIGN

Descriptive, postal mail survey to spinal cord injury individuals with sleep apnea followed by a Veterans Affairs Spinal Cord Injury Service.

RESULTS

The response rate to the mailed survey was 54%, with complete surveys obtained from 40 individuals with spinal cord injury and sleep apnea. The majority of participants (93%) had been diagnosed with sleep apnea through routine clinical care, and patients had been diagnosed a mean of 4 yrs earlier. Continuous positive airway pressure was the most commonly used treatment. Continuous positive airway pressure was tried by 80% of patients, and of these, 63% continued to use continuous positive airway pressure, with mean usage 6.5 nights per week and 6.9 hrs per night. Continuous positive airway pressure was rated as beneficial in comparison with its side effects. The most common side effects were nasal congestion and mask discomfort.

CONCLUSION

Many spinal cord injury individuals with sleep apnea become long-term users of continuous positive airway pressure and perceive a subjective benefit from the treatment.