Table 2.
Detail outlines of selected articles on SDB in SCI
| Author | Patient selection | Patients | Study parameters | Definition of SDB | Outcome | Correlates |
|---|---|---|---|---|---|---|
| Short (1992) | Consecutive series | 22, greater than 40 > 3 mo post injury | EEG, EMG, EOS Trunk strain gauges O2 sats | Hypopnea is O2 > 4% drop from preceding 10 minute average | 55% AHI > 5 27% AHI > 15 2 central apnea | No relationship to age, time since injury, obesity, spirometry |
| McEvoy (1995) | Regional cohort | 44, C8 and above, ASIA A, B, C >6 mo post injury | Home sleep studyEEG, EOG, submental EMG, body movement, nasal air flow, respiratory movement, SPO2 | Hypopnea = 10 second of >50% airflow drop from baseline | 30% AI ≥ 5 27.5% AHI ≥ 15 | AHI related to systolic bp, diastolic bp, neck circumference, supine position |
| Klefbeck (1998) | Consecutive series | 33 C4-T1 ASIA A-D 3 C4, 12 C5, 9 C6, 5 C7, 1 C8, 2T1 | Hospital sleep labO2, body movement | Hypopnea is O2 > 4% drop | 15% met criteria | Related to ASIA level in ASIA A group only |
| Stockhammer (2002) | Random selection | 50, C3-C8 23 C3-5, 27 C6-8 40 ASIA A-B | Hospital sleep lab O2, nasal thermistor, chest wall motion | Hypopnea 50–90% drop airflow for 10 secApnea > 90% drop for 10 sec | 48% AI ≥ 5 62% AHI ≥ 15 | AHI related to age, male sex, BMI. |
| Berlowitz (2005) | Inception cohort | 30, 13 finished 52 week evaluation C4 9, C5 10, C6 2, C7 1, C8 1 ASIA 1-B 20% | Hospital sleep labEEG, submental and diaphragm EMG, EOG, ECG, nasal thermistor, plethysmography, SP 02 | Hypopnea defined as 50% reduced airflow or <50% airflow and >3% O2 drop Apnea defined as no airflow | 60% AHI ≥ 5 by 2 weeks, then stable | |
| LeDuc (2007) | Prospective cohort | 41 outpatients | Home unsupervised polygrams | Symptoms plus AHI Hypopnea 50% reduction in airflow or >3% drop O2 | 56% AHI ≥ 5 | No relationship of symptoms to AHIOSA related to daytime sleepiness, BMI greater than 30 kg/m2, neck circumference and greater than 3 awakenings at night |
| Berlowitz (2012) | Cross sectional | 78, tetraplegia | Hospital sleep labEEG, submental and diaphragm EMG, EOG, ECG, nasal thermistor, plethysmography, SP 02 | AHI > 10 | 91% complete with SDB 56% incomplete | No relationship between AHI and ASIA level |
| Sankari (2014 J Appl Physiol) | Case Control | 16 SCI (6 cervical) and 16 control | Non-invasive hyperventilation to induce apnea, CO2 trial to abolish central apneaPolysomnogram | AHI > 5 | Central SDB 63% cervical, 13% thoracic CO2 reserve narrower in cervical, best in controls. | |
| Sankari (2014 JCSM) | Consecutive Series | 26, 15 cervical | Hospital sleep study Polysomnogram: EEG, submental EMG, nasal air flow, pharyngeal pressure, ETCO2, upper airway resistance Epworth, Pittsburgh, Berlin, Fatigue severity | AHI > 5 Central AI > 5 | PSQ 10.3, ESS 10.4 Fatigue 96%, daytime sleepiness 59%, Berlin high risk 46%. AHI >5 77%, 89% cervical, 50% thoracic. Central AI 33% cervical, 13% thoracic. | |
| TREATMENT | ||||||
| Burns (2005) | Postal survey | 40 of 72 being treated for SDB | CPAP tried by 80%, used by 63%. Reasons: 67% unable to fall asleep, 42% discomfort, 33% claustrophobia | No difference in symptoms between users and non-users | ||
| Berkowitz (2009) | Prospective cohort | 74% of 19 with SCI and AHI >10 | Auto-titration CPAP with PT support for 3–4 nights | Patients who tolerated CPAP were older, had higher BMI, were sleepier and had more severe OSA | ||
| Leguen (2012) | Retrospective Case Control | 25 SCI, 219 controls with OSA | No relationship between effective use and BMI or AHI |