Identification and treatment of sleep-disordered breathing in chronic spinal cord injury

Abstract

Study design: A follow up on an ongoing prospective cohort study.

Objective: Spinal cord injury or disorder (SCI/D) patients have higher rates of sleep-disordered breathing (SDB) than the general population. The objectives of this study were to examine predictors of SDB diagnosis and to estimate rates of SDB treatment in SCI/D patients.

Setting: A SCI clinical sleep research laboratory.

Methods: Twenty-eight SCI/D patients (7 women, age 42.8 ± 15.8 years; 16 cervical and 12 thoracic level injuries) completed a battery of questionnaires (Epworth Sleepiness Scale (ESS), Pittsburgh Sleep Quality Index (PSQI), Berlin questionnaire (BQ) and fatigue severity scale (FSS)) and had one night of attended laboratory polysomnography (PSG). Participants were then notified of the results of their PSG and were interviewed approximately 1 year later to assess clinical outcomes.

Results: The majority of patients reported poor sleep quality on all questionnaires. On the basis of PSG, 22 (79%) patients had SDB (apnea-hypopnea index (AHI)⩾ 5 events per hour), and 17 (61%) had moderate/severe SDB (AHI⩾15 events per hour). Higher ESS scores were associated with a higher risk of AHI ⩾ 5; however, other questionnaires did not distinguish between those with and without SDB using either AHI cutoff. In follow-up interviews, only 50% of patients had spoken to a health-care provider about SDB and only six patients with SDB were prescribed treatment, four of whom were using the treatment at follow-up.

Conclusion: SDB is common and severe among SCI/D patients. Screening questionnaires do not appear to differentiate between those with and without SDB. Even when SDB was recognized, many patients remained untreated. The increased prevalence of cardiovascular disease in SCI/D patients could represent a consequence of untreated SDB, and improving diagnosis and management of SDB has the potential to improve outcomes for these patients.