Original article
A Longitudinal Evaluation of Sleep and Breathing in the First Year After Cervical Spinal Cord Injury

https://doi.org/10.1016/j.apmr.2004.11.033Get rights and content

Abstract

Berlowitz DJ, Brown DJ, Campbell DA, Pierce RJ. A longitudinal evaluation of sleep and breathing in the first year after cervical spinal cord injury. Arch Phys Med Rehabil 2005;86:1193–9.

Objectives

To establish the incidence of sleep disordered breathing (SDB) after acute tetraplegia and to determine the relation between the Apnea-Hypopnea Index (AHI) score and the previously postulated predictors of SDB in tetraplegia.

Design

Inception cohort. We performed full polysomnography immediately after acute tetraplegia and at 2, 4, 13, 26, and 52 weeks postinjury. Spirometry, maximum inspiratory and expiratory pressures, medication usage, and neck and abdominal girth were also assessed. Preinjury SDB was estimated using the multivariate apnea prediction equation.

Setting

Acute care, subacute care, and community.

Participants

Consecutive sample with acute tetraplegia. Thirty subjects (25 men) were initially included. Thirteen completed 12 months of follow-up.

Interventions

Not applicable.

Main Outcome Measures

SDB (AHI score >10 events/h) and respiratory function.

Results

Three subjects (10%; 95% confidence interval [CI], 2%–28%) had probable SDB before injury. In the first 48 hours after injury, no subject had SDB. At 2 weeks, 60% (95% CI, 26%–88%) had SDB; at 4 weeks, 62% (95% CI, 38%–82%); at 13 weeks, 83% (95% CI, 61%–95%); at 26 weeks, 68% (95% CI, 44%–88%); and at 52 weeks, 62% (95% CI, 32%–86%). No consistent relation was found between the previously postulated predictors and SDB.

Conclusions

SDB is highly prevalent within 4 weeks of acute tetraplegia.

Section snippets

Methods

All subjects who had sustained a new spinal cord lesion at the T1 vertebra or above (ie, tetraplegia) and were between 14 and 70 years were eligible for inclusion in the study. Exclusion criteria were an inability to give informed consent, any significant head injury, and preexisting respiratory or cardiac disease. The study was approved by the institutional human ethics and research committee. All subjects gave informed consent before inclusion in the trial.

Assessments were performed as soon

Results

One hundred seven acute patients were admitted during the 18 months of recruitment. Fifty-nine were initially classified as quadriplegic, and 25 of these were excluded. Eleven subjects were older than 70 years, 2 were younger than 14 years, 3 had sustained a head injury, 3 remained ventilator dependent after injury, 3 returned interstate and 3 had early complete neurologic resolution. Four subjects declined to participate in the study or were unable to give informed consent. Thirty subjects (25

Discussion

This study is the first to examine the sleep and breathing of patients with tetraplegia in the first year postinjury. SDB was not apparent until 2 weeks postinjury, and the prevalence peaked at 83% at 3 months postinjury. Both the prevalence and the degree of SDB improved in the second 6 months of the study, but the response varied. This variability was predominantly due to changes in abdominal girth: in those subjects who experienced the largest rise in waist circumference, the AHI score

Conclusions

Despite the high prevalence of SDB observed in this study, few of the patients were suspected clinically to have SDB or OSA. We therefore suggest that clinical staff should increase their surveillance for signs of SDB and that further research be conducted to examine the treatment of SDB after cervical SCI.

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