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Graco M, Ruehland WR, Schembri R, Churchward TJ, Saravanan K, Sheers NL, Berlowitz DJ. Prevalence of central sleep apnea in people with tetraplegic spinal cord injury: a retrospective analysis of research and clinical data. Sleep 2023; 46:zsad235. [PMID: 37691432 DOI: 10.1093/sleep/zsad235] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 08/08/2023] [Indexed: 09/12/2023] Open
Abstract
STUDY OBJECTIVES Over 80% of people with tetraplegia have sleep-disordered breathing (SDB), but whether this is predominantly obstructive or central is unclear. This study aimed to estimate the prevalence of central sleep apnea (CSA) in tetraplegia and the contributions of central, obstructive, and hypopnea respiratory events to SDB summary indices in tetraplegia. METHODS Research and clinical data from 606 individuals with tetraplegia and full overnight polysomnography were collated. The proportions of different respiratory event types were calculated; overall and for mild, moderate, and severe disease. The prevalence of Predominant CSA (Central Apnea Index [CAI] ≥ 5 and more central than obstructive apneas) and Any CSA (CAI ≥ 5) was estimated. Prevalence of sleep-related hypoventilation (SRH) was estimated in a clinical sub-cohort. RESULTS Respiratory events were primarily hypopneas (71%), followed by obstructive (23%), central (4%), and mixed apneas (2%). As severity increased, the relative contribution of hypopneas and central apneas decreased, while that of obstructive apneas increased. The prevalence of Predominant CSA and Any CSA were 4.3% (26/606) and 8.4% (51/606) respectively. Being male, on opiates and having a high tetraplegic spinal cord injury were associated with CSA. SRH was identified in 26% (26/113) of the clinical sub-cohort. CONCLUSIONS This is the largest study to characterize SDB in tetraplegia. It provides strong evidence that obstructive sleep apnea is the predominant SDB type; 9-18 times more prevalent than CSA. The prevalence of CSA was estimated to be 4%-8%, significantly lower than previously reported.
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Affiliation(s)
- Marnie Graco
- Institute for Breathing and Sleep, Austin Health, Heidelberg, VIC, Australia
- Department of Respiratory and Sleep Medicine, Austin Health, Heidelberg, VIC, Australia
- Department of Physiotherapy, University of Melbourne, Parkville, VIC, Australia
| | - Warren R Ruehland
- Institute for Breathing and Sleep, Austin Health, Heidelberg, VIC, Australia
- Department of Respiratory and Sleep Medicine, Austin Health, Heidelberg, VIC, Australia
| | - Rachel Schembri
- Institute for Breathing and Sleep, Austin Health, Heidelberg, VIC, Australia
- Clinical Epidemiology and Biostatistics Unit, Murdoch Children's Research Institute, Melbourne, VIC, Australia
| | - Thomas J Churchward
- Institute for Breathing and Sleep, Austin Health, Heidelberg, VIC, Australia
- Department of Respiratory and Sleep Medicine, Austin Health, Heidelberg, VIC, Australia
| | - Krisha Saravanan
- Institute for Breathing and Sleep, Austin Health, Heidelberg, VIC, Australia
- Department of Respiratory and Sleep Medicine, Austin Health, Heidelberg, VIC, Australia
| | - Nicole L Sheers
- Institute for Breathing and Sleep, Austin Health, Heidelberg, VIC, Australia
- Department of Respiratory and Sleep Medicine, Austin Health, Heidelberg, VIC, Australia
- Department of Physiotherapy, University of Melbourne, Parkville, VIC, Australia
| | - David J Berlowitz
- Institute for Breathing and Sleep, Austin Health, Heidelberg, VIC, Australia
- Department of Respiratory and Sleep Medicine, Austin Health, Heidelberg, VIC, Australia
- Department of Physiotherapy, University of Melbourne, Parkville, VIC, Australia
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Shi Y, Lou H, Wang H, Zhou Y, Wang L, Li Y, Han D. Analysis of nasal resistance regulation mechanism during postural changes in patients with obstructive sleep apnea by measuring heart rate variability. J Clin Sleep Med 2023; 19:643-650. [PMID: 36661101 PMCID: PMC10071371 DOI: 10.5664/jcsm.10402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Revised: 11/12/2022] [Accepted: 11/14/2022] [Indexed: 01/21/2023]
Abstract
STUDY OBJECTIVES Changes in nasal resistance (NR) during postural changes are influenced by venous filling pressure and autonomic nervous system mediation, and heart rate variability (HRV) can reflect changes in the autonomic nervous system. This study aimed to explore the regulatory mechanisms of NR in patients with obstructive sleep apnea (OSA) during postural changes. METHODS Healthy controls (apnea-hypopnea index < 5 events/h) and patients with OSA were recruited. NR and electrocardiogram data were collected in sitting, supine, left-lateral, and right-lateral postures. HRV parameters were obtained by analyzing the electrocardiogram data from each posture. Subgroups were divided according to sitting-supine NR changes, and HRV parameters were compared between different postures and groups/subgroups. RESULTS In total, 34 healthy controls and 39 patients with OSA (mean apnea-hypopnea index 34.34 ± 22.44 events/h) were recruited. During sitting-supine postural changes, the NR increased in the control group but did not change significantly in the OSA group. None of the autonomic nervous system-related HRV parameters changed significantly. After the groups were divided into NR-elevated and NR-unchanged subgroups, sympathetic activity-related HRV parameters were higher in the NR-unchanged subgroup but only statistically significant in the OSA group. When comparing the left and right postures, there was no significant change in NR; however, the OSA group had lower parasympathetic activity-related HRV parameters when in the right posture. CONCLUSIONS During postural changes from the sitting to supine positions, the total NR increases, and this increment is smaller in patients with OSA. This is likely due to overregulation of sympathetic activity, which may occur in patients with OSA. CITATION Shi Y, Lou H, Wang H, et al. Analysis of nasal resistance regulation mechanism during postural changes in obstructive sleep apnea patients by measuring heart rate variability. J Clin Sleep Med. 2023;19(4):643-650.
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Affiliation(s)
- Yunhan Shi
- Department of Otolaryngology Head, and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China
- Key Laboratory of Otolaryngology Head and Neck Surgery Capital Medical University, Beijing, China
- Obstructive Sleep Apnea-Hypopnea Syndrome Clinical Diagnosis and Therapy and Research Centre, Capital Medical University, Beijing, China
| | - Hongfei Lou
- Department of Otolaryngology Head, and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China
- Key Laboratory of Otolaryngology Head and Neck Surgery Capital Medical University, Beijing, China
| | - Huijun Wang
- Department of Otolaryngology Head, and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China
- Key Laboratory of Otolaryngology Head and Neck Surgery Capital Medical University, Beijing, China
- Obstructive Sleep Apnea-Hypopnea Syndrome Clinical Diagnosis and Therapy and Research Centre, Capital Medical University, Beijing, China
| | - Yi Zhou
- Department of Otolaryngology Head, and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China
- Key Laboratory of Otolaryngology Head and Neck Surgery Capital Medical University, Beijing, China
| | - Li Wang
- Department of Otolaryngology Head, and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China
- Key Laboratory of Otolaryngology Head and Neck Surgery Capital Medical University, Beijing, China
| | - Yanru Li
- Department of Otolaryngology Head, and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China
- Key Laboratory of Otolaryngology Head and Neck Surgery Capital Medical University, Beijing, China
- Obstructive Sleep Apnea-Hypopnea Syndrome Clinical Diagnosis and Therapy and Research Centre, Capital Medical University, Beijing, China
| | - Demin Han
- Department of Otolaryngology Head, and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China
- Key Laboratory of Otolaryngology Head and Neck Surgery Capital Medical University, Beijing, China
- Obstructive Sleep Apnea-Hypopnea Syndrome Clinical Diagnosis and Therapy and Research Centre, Capital Medical University, Beijing, China
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3
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Wulf MJ, Tom VJ. Consequences of spinal cord injury on the sympathetic nervous system. Front Cell Neurosci 2023; 17:999253. [PMID: 36925966 PMCID: PMC10011113 DOI: 10.3389/fncel.2023.999253] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Accepted: 02/09/2023] [Indexed: 03/06/2023] Open
Abstract
Spinal cord injury (SCI) damages multiple structures at the lesion site, including ascending, descending, and propriospinal axons; interrupting the conduction of information up and down the spinal cord. Additionally, axons associated with the autonomic nervous system that control involuntary physiological functions course through the spinal cord. Moreover, sympathetic, and parasympathetic preganglionic neurons reside in the spinal cord. Thus, depending on the level of an SCI, autonomic function can be greatly impacted by the trauma resulting in dysfunction of various organs. For example, SCI can lead to dysregulation of a variety of organs, such as the pineal gland, the heart and vasculature, lungs, spleen, kidneys, and bladder. Indeed, it is becoming more apparent that many disorders that negatively affect quality-of-life for SCI individuals have a basis in dysregulation of the sympathetic nervous system. Here, we will review how SCI impacts the sympathetic nervous system and how that negatively impacts target organs that receive sympathetic innervation. A deeper understanding of this may offer potential therapeutic insight into how to improve health and quality-of-life for those living with SCI.
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Affiliation(s)
| | - Veronica J. Tom
- Marion Murray Spinal Cord Research Center, Department of Neurobiology and Anatomy, Drexel University College of Medicine, Philadelphia, PA, United States
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4
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Influence of postural changes on nasal resistance in patients with obstructive sleep apnea. Sleep Breath 2022; 27:943-952. [DOI: 10.1007/s11325-022-02685-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Revised: 06/24/2022] [Accepted: 07/18/2022] [Indexed: 10/16/2022]
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Hatt A, Brown E, Berlowitz DJ, O’Donoghue F, Meaklim H, Connelly A, Jackson G, Sutherland K, Cistulli PA, Lee BSB, Bilston LE. Tetraplegic obstructive sleep apnoea patients dilate the airway similarly to able-bodied obstructive sleep apnoea patients. J Spinal Cord Med 2022; 45:536-546. [PMID: 33166204 PMCID: PMC9246266 DOI: 10.1080/10790268.2020.1829418] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
Context/objective: Obstructive sleep apnoea (OSA) develops soon after cervical spinal cord injury (SCI) at rates higher than the general population, but the mechanisms are not understood. This study aimed to determine whether OSA in SCI is associated with altered pharyngeal muscle dilatory mechanics during quiet breathing, as has been observed in the non-SCI injured with obstructive sleep apnoea.Design: Cross sectional imaging study.Setting: Medical research institute.Participants: Eight cervical SCI patients with OSA were recruited and compared to 13 able-bodied OSA patients and 12 able-bodied healthy controls of similar age and BMI.Interventions and outcome measures: 3T MRI scans of upper airway anatomy and tagged-MRI to characterize airway muscle motion during quiet breathing were collected for analysis.Results: Considerable variation in the patterns of inspiratory airway muscle motion was observed in the SCI group, with some participants exhibiting large inspiratory airway dilatory motions, and others exhibiting counterproductive narrowing during inspiration. These patterns were not dissimilar to those observed in the able-bodied OSA participants. The increase in airway cross-sectional area of able-bodied control participants was proportional to increase in BMI, and a similar, but not significant, relationship was present in all groups.Conclusion: Despite the limited sample size, these data suggest that SCI OSA patients have heterogeneous pharyngeal dilator muscle responses to the negative pressures occurring during inspiration but, as a group, appear to be more similar to able-bodied OSA patients than healthy controls of similar age and BMI. This may reflect altered pharyngeal pressure reflex responses in at least some people with SCI.
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Affiliation(s)
- Alice Hatt
- Neuroscience Research Australia, Randwick, Australia
| | - Elizabeth Brown
- Neuroscience Research Australia, Randwick, Australia,Prince of Wales Hospital, Randwick, Australia
| | - David J. Berlowitz
- Institute for Breathing and Sleep, Austin Health, Heidelberg, Australia,Medicine, Dentistry and Health Sciences, University of Melbourne, Parkville, Australia
| | - Fergal O’Donoghue
- Institute for Breathing and Sleep, Austin Health, Heidelberg, Australia,Medicine, Dentistry and Health Sciences, University of Melbourne, Parkville, Australia,The Florey Institute of Neuroscience and Menta l Health, Melbourne Brain Centre, Heidelberg, Australia
| | - Hailey Meaklim
- Institute for Breathing and Sleep, Austin Health, Heidelberg, Australia
| | - Alan Connelly
- The Florey Institute of Neuroscience and Menta l Health, Melbourne Brain Centre, Heidelberg, Australia
| | - Graeme Jackson
- The Florey Institute of Neuroscience and Menta l Health, Melbourne Brain Centre, Heidelberg, Australia
| | - Kate Sutherland
- Department of Respiratory and Sleep Medicine, Royal North Shore Hospital, St. Leonards, Australia,Charles Perkins Centre, University of Sydney, St. Leonards, Australia
| | - Peter A. Cistulli
- Department of Respiratory and Sleep Medicine, Royal North Shore Hospital, St. Leonards, Australia,Charles Perkins Centre, University of Sydney, St. Leonards, Australia
| | - Bon San Bonne Lee
- Neuroscience Research Australia, Randwick, Australia,Prince of Wales Hospital, Randwick, Australia
| | - Lynne E. Bilston
- Neuroscience Research Australia, Randwick, Australia,University of New South Wales, Randwick, Australia,Correspondence to: Lynne Bilston, Neuroscience Research Australia, 139 Barker St, Randwick, NSW2031, Australia; 61293991673, 61293991027.
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Castillo-Escario Y, Kumru H, Ferrer-Lluis I, Vidal J, Jané R. Detection of Sleep-Disordered Breathing in Patients with Spinal Cord Injury Using a Smartphone. SENSORS 2021; 21:s21217182. [PMID: 34770489 PMCID: PMC8587662 DOI: 10.3390/s21217182] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Revised: 10/20/2021] [Accepted: 10/27/2021] [Indexed: 01/10/2023]
Abstract
Patients with spinal cord injury (SCI) have an increased risk of sleep-disordered breathing (SDB), which can lead to serious comorbidities and impact patients’ recovery and quality of life. However, sleep tests are rarely performed on SCI patients, given their multiple health needs and the cost and complexity of diagnostic equipment. The objective of this study was to use a novel smartphone system as a simple non-invasive tool to monitor SDB in SCI patients. We recorded pulse oximetry, acoustic, and accelerometer data using a smartphone during overnight tests in 19 SCI patients and 19 able-bodied controls. Then, we analyzed these signals with automatic algorithms to detect desaturation, apnea, and hypopnea events and monitor sleep position. The apnea–hypopnea index (AHI) was significantly higher in SCI patients than controls (25 ± 15 vs. 9 ± 7, p < 0.001). We found that 63% of SCI patients had moderate-to-severe SDB (AHI ≥ 15) in contrast to 21% of control subjects. Most SCI patients slept predominantly in supine position, but an increased occurrence of events in supine position was only observed for eight patients. This study highlights the problem of SDB in SCI and provides simple cost-effective sleep monitoring tools to facilitate the detection, understanding, and management of SDB in SCI patients.
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Affiliation(s)
- Yolanda Castillo-Escario
- Institute for Bioengineering of Catalonia (IBEC), Barcelona Institute of Science and Technology (BIST), 08028 Barcelona, Spain; (I.F.-L.); (R.J.)
- Department of Automatic Control (ESAII), Universitat Politècnica de Catalunya-Barcelona Tech (UPC), 08028 Barcelona, Spain
- Centro de Investigación Biomédica en Red de Bioingeniería, Biomateriales y Nanomedicina (CIBER-BBN), 28029 Madrid, Spain
- Correspondence: (Y.C.-E.); (H.K.)
| | - Hatice Kumru
- Fundación Institut Guttmann, Institut Universitari de Neurorehabilitació, 08916 Badalona, Spain;
- Universitat Autònoma de Barcelona, 08193 Bellaterra, Spain
- Fundació Institut d’Investigació en Ciències de la Salut Germans Trias i Pujol, 08916 Badalona, Spain
- Correspondence: (Y.C.-E.); (H.K.)
| | - Ignasi Ferrer-Lluis
- Institute for Bioengineering of Catalonia (IBEC), Barcelona Institute of Science and Technology (BIST), 08028 Barcelona, Spain; (I.F.-L.); (R.J.)
- Department of Automatic Control (ESAII), Universitat Politècnica de Catalunya-Barcelona Tech (UPC), 08028 Barcelona, Spain
- Centro de Investigación Biomédica en Red de Bioingeniería, Biomateriales y Nanomedicina (CIBER-BBN), 28029 Madrid, Spain
| | - Joan Vidal
- Fundación Institut Guttmann, Institut Universitari de Neurorehabilitació, 08916 Badalona, Spain;
- Universitat Autònoma de Barcelona, 08193 Bellaterra, Spain
- Fundació Institut d’Investigació en Ciències de la Salut Germans Trias i Pujol, 08916 Badalona, Spain
| | - Raimon Jané
- Institute for Bioengineering of Catalonia (IBEC), Barcelona Institute of Science and Technology (BIST), 08028 Barcelona, Spain; (I.F.-L.); (R.J.)
- Department of Automatic Control (ESAII), Universitat Politècnica de Catalunya-Barcelona Tech (UPC), 08028 Barcelona, Spain
- Centro de Investigación Biomédica en Red de Bioingeniería, Biomateriales y Nanomedicina (CIBER-BBN), 28029 Madrid, Spain
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PAP Adherence and Nasal Resistance. A Randomized Controlled Trial of CPAPflex versus CPAP in World Trade Center Responders. Ann Am Thorac Soc 2021; 18:668-677. [PMID: 33202147 DOI: 10.1513/annalsats.202009-1161oc] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Rationale: Continuous positive airway pressure (CPAP) adherence is often poor in obstructive sleep apnea (OSA) and may be influenced by nasal resistance. CPAP with a reduction of expiratory pressure (CPAPflex) may reduce discomfort in those with high nasal resistance and improve adherence in this subgroup.Objectives: To evaluate the association of positive airway pressure (PAP) treatment adherence to nasal resistance and examine if CPAPflex improves adherence over CPAP in subjects with high nasal resistance.Methods: A randomized double-blind crossover trial of 4 weeks each of CPAPflex versus CPAP in subjects exposed to World Trade Center dust with OSA stratified by nasal resistance, measured by 4-Phase Rhinomanometry.Results: Three hundred seventeen subjects with OSA (mean, apnea-hypopnea index with 4% O2 desaturation for hypopnea = 17 ± 14/h) were randomized. Overall, PAP adherence was poor, but adherence to CPAP (n = 239; mean hours per night [95% confidence interval (CI)]), 1.97 h (1.68 to 2.26) was greater than adherence to CPAPflex (n = 249; 1.65 h [1.39 to 1.91]; difference of 0.31 h [0.03; 0.6]; P < 0.05). Contrary to our hypothesis there was no correlation between nasal resistance and adherence to CPAP (r = 0.098; P = not significant) or CPAPflex (r = 0.056; P = not significant). There was no difference in adherence between CPAP and CPAPflex (mean Δ hours [95% CI]) in subjects with low resistance (0.33 h [-0.10 to 0.76]) or high nasal resistance (0.26 h [-0.14 to 0.66]). No significant differences were observed in any of the secondary outcomes between PAP modes.Conclusions: Contrary to expectations, our data do not show better adherence to CPAPflex than to CPAP in subjects with high or low nasal resistance and do show clinically insignificant better adherence overall with CPAP.Clinical trial registered with www.clinicaltrials.gov (NCT01753999).
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8
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Hultén VDT, Biering-Sørensen F, Jørgensen NR, Jennum PJ. A review of sleep research in patients with spinal cord injury. J Spinal Cord Med 2020; 43:775-796. [PMID: 30513274 PMCID: PMC7808257 DOI: 10.1080/10790268.2018.1543925] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
Study design: Systematic review. Objectives: Sleep disturbances are a common complaint among individuals with spinal cord injury (SCI) and were not usually present before the SCI. Their sleep disturbances, including disrupted sleep, spasms, and problems with initiating and sustaining sleep through the night, affect SCI individuals' overall quality of life due to excessive tiredness and low energy levels during the day. Despite the high prevalence of sleep complaints in this population, current knowledge about sleep in the SCI population has not been systematically assessed. Setting: Capital Region of Denmark. Methods: We systematically reviewed literature identified from the PubMed and EMBASE databases following PRISMA guidelines.Thirty-seven articles met our inclusion criteria, as only controlled studies were included. This could be a comparison of (1) SCI individuals and able-bodied controls, (2) cervical with thoracolumbar SCI individuals, or (3) cervical, thoracolumbar SCI individuals and able-bodied controls. Results: Individuals with SCI have a higher prevalence of sleep-disordered breathing and periodic leg movements during sleep (PLMS), lower heart rate, but no nocturnal lowering of blood pressure. 24-hour energy expenditure and sleeping metabolic rate were significantly lower, and bowel movements were altered. Endocrine alterations were found in investigations of melatonin, cortisol and antidiuretic hormone. Questionnaires revealed a high prevalence of subjectively poorer sleep quality in individuals with SCI compared with able-bodied controls. Conclusions: There are significant differences between groups with SCI and able-bodied controls. SCI objectively and subjectively markedly affects an individual's sleep.
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Affiliation(s)
- Victoria Dreier Thøfner Hultén
- Danish Center for Sleep Medicine, Department of Clinical Neurophysiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark,Correspondence to: Victoria Dreier Thøfner Hultén, Danish Center for Sleep Medicine, Department of Clinical Neurophysiology, Rigshospitalet Glostrup, University of Copenhagen, Nordre Ringvej 57, 2600Glostrup, Denmark; Ph: 0045 50913930. E-mail:
| | - Fin Biering-Sørensen
- Clinic for Spinal Cord Injuries, NeuroScience Centre, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Niklas Rye Jørgensen
- Department of Clinical Biochemistry, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark,OPEN, Odense Patient data Explorative Network, Odense University Hospital/Institute of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Poul Jørgen Jennum
- Danish Center for Sleep Medicine, Department of Clinical Neurophysiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
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9
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Abstract
Individuals with spinal cord injury (SCI) are at increased risk of respiratory complications during wake and sleep. Sleep-disordered breathing (SDB) is commonly associated with SCI and requires an individualized approach to its management. Respiratory control plays a key role in the pathogenesis of SDB in cervical SCI. Noninvasive ventilation plays an important role in the management of respiratory complications in individuals with SCI acutely and in chronic phases. Positive airway pressure treatment may be effective in eliminating SDB and improving sleepiness symptoms, but adherence to treatment is poor and effect on long-term outcomes is questionable.
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Affiliation(s)
- Asil Daoud
- Department of Medicine, John D. Dingell VA Medical Center, Wayne State University, Detroit Medical Center, 3990 John R St, Detroit, MI 48201, USA; Department of Medicine, Wayne State University, Detroit, MI, USA; Detroit Medical Center, Detroit, MI, USA
| | - Samran Haider
- Department of Medicine, John D. Dingell VA Medical Center, Wayne State University, Detroit Medical Center, 3990 John R St, Detroit, MI 48201, USA; Department of Medicine, Wayne State University, Detroit, MI, USA; Detroit Medical Center, Detroit, MI, USA
| | - Abdulghani Sankari
- Department of Medicine, John D. Dingell VA Medical Center, Wayne State University, Detroit Medical Center, 3990 John R St, Detroit, MI 48201, USA; Department of Internal Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, Wayne State University, 3990 John R, 3-Hudson, Detroit, MI 48201, USA; Ascension Providence Hospital, Southfield, MI, USA.
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10
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Tong BK, Tran C, Ricciardiello A, Chiang A, Donegan M, Murray N, Szollosi I, Amatoury J, Carberry JC, Eckert DJ. Efficacy of a novel oral appliance and the role of posture on nasal resistance in obstructive sleep apnea. J Clin Sleep Med 2020; 16:483-492. [PMID: 32003735 DOI: 10.5664/jcsm.8244] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
STUDY OBJECTIVES High nasal resistance is associated with oral appliance treatment failure in obstructive sleep apnea (OSA). A novel oral appliance with a built-in oral airway has been shown to reduce pharyngeal pressure swings during sleep and may be efficacious in those with high nasal resistance. The role of posture and mandibular advancement on nasal resistance in OSA remains unclear. This study aimed to determine (1) the effects of posture and mandibular advancement on nasal resistance in OSA and (2) the efficacy of a new oral appliance device including in patients with high nasal resistance. METHODS A total of 39 people with OSA (7 females, apnea-hypopnea index (AHI) (mean ± standard deviation) = 29 ± 21 events/h) completed split-night polysomnography with and without oral appliance (order randomized). Prior to sleep, participants were instrumented with a nasal mask, pneumotachograph, and a choanal pressure catheter for gold standard nasal resistance quantification seated, supine and lateral (with and without oral appliance, order randomized). RESULTS Awake nasal resistance increased from seated, to supine, to lateral posture (median [interquartile range] = 1.8 [1.4, 2.7], 2.7 [1.7, 3.5], 3.4 [1.9, 4.6] cm H₂O/L/s, P < .001). Corresponding measures of nasal resistance did not change with mandibular advancement (2.3 [1.4, 3.5], 2.5 [1.8, 3.6], 3.5 [1.9, 4.8] cm H₂O/L/s, P = .388). The median AHI reduced by 47% with oral appliance therapy (29 ± 21 versus 18 ± 15 events/h, P = .002). Participants with high nasal resistance (> 3 cm H₂O/L/s) had similar reductions in AHI versus those with normal nasal resistance (61 [-8, 82] versus 40 [-5, 62] %, P = .244). CONCLUSIONS Nasal resistance changes with posture in people with OSA. A novel oral appliance with a built-in oral airway reduces OSA severity in people with OSA, including in those with high nasal resistance. CLINICAL TRIAL REGISTRATION Registry: ANZCTR; Title: Combination therapy for obstructive sleep apnoea; Identifier: ACTRN12617000492358; URL: https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=372279.
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Affiliation(s)
- Benjamin K Tong
- Neuroscience Research Australia (NeuRA), Sydney, New South Wales, Australia.,School of Medical Sciences, University of New South Wales, Sydney, New South Wales, Australia
| | - Carolin Tran
- Neuroscience Research Australia (NeuRA), Sydney, New South Wales, Australia
| | | | - Alan Chiang
- Neuroscience Research Australia (NeuRA), Sydney, New South Wales, Australia
| | - Michelle Donegan
- Neuroscience Research Australia (NeuRA), Sydney, New South Wales, Australia
| | - Nick Murray
- Prince of Wales Hospital, Sydney, New South Wales, Australia
| | - Irene Szollosi
- The Prince Charles Hospital, Brisbane, Queensland, Australia
| | - Jason Amatoury
- Neuroscience Research Australia (NeuRA), Sydney, New South Wales, Australia.,School of Medical Sciences, University of New South Wales, Sydney, New South Wales, Australia.,Biomedical Engineering Program, American University of Beirut, Beirut, Lebanon
| | - Jayne C Carberry
- Neuroscience Research Australia (NeuRA), Sydney, New South Wales, Australia.,School of Medical Sciences, University of New South Wales, Sydney, New South Wales, Australia.,Adelaide Institute for Sleep Health, Flinders University, Adelaide, South Australia, Australia
| | - Danny J Eckert
- Neuroscience Research Australia (NeuRA), Sydney, New South Wales, Australia.,School of Medical Sciences, University of New South Wales, Sydney, New South Wales, Australia.,Adelaide Institute for Sleep Health, Flinders University, Adelaide, South Australia, Australia
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11
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Bosi M, De Vito A, Eckert D, Steier J, Kotecha B, Vicini C, Poletti V. Qualitative Phenotyping of Obstructive Sleep Apnea and Its Clinical Usefulness for the Sleep Specialist. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17062058. [PMID: 32244892 PMCID: PMC7143772 DOI: 10.3390/ijerph17062058] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Revised: 03/12/2020] [Accepted: 03/17/2020] [Indexed: 12/12/2022]
Abstract
INTRODUCTION The anatomical collapsibility of the upper airway, neuromuscular tone and function, sleep-wake and ventilatory control instability, and the arousal threshold all interact and contribute to certain pathophysiologic features that characterize different types of obstructive sleep apnea (OSA). A model of qualitative phenotypizationallowsus to characterize the different pathophysiological traits in OSA patients. METHODS A narrative review was performed, to analyze the available literature evidence, with the purpose of generating a model of qualitative phenotypization to characterize pathophysiological traits in patients with OSA. RESULTS 96 out of 3829 abstracts were selected for full-text review. Qualitative phenotyping model of OSA:Data concerning the OSA qualitative pathophysiological traits' measurement can be deducted by means of clinical PSG, grade of OSA severity, and therapeutic level of Continuous Positive Airway Pressure (CPAP) and are reported in the text. This approach would allow qualitative phenotyping with widely accessible methodology in a routine clinical scenario and is of particular interest for the sleep specialist, surgical treatment decision-making, and customized OSA multimodality treatment.
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Affiliation(s)
- Marcello Bosi
- Pulmonary Operative Unit, Department of Thoracic Diseases, Morgagni-Pierantoni Hospital, Romagna Health Company, 47121 Forlì, Italy;
| | - Andrea De Vito
- Head & Neck Department, Ear Nose Throat (ENT) Unit, Santa Maria delle Croci Hospital, Romagna Health Company, 48121 Ravenna, Italy
- Correspondence:
| | - Danny Eckert
- Adelaide Institute for Sleep Health, A. Flinders University. Centre of Research Excellence, Adelaide 5049, Australia;
| | - Joerg Steier
- Lane Fox Unit/Sleep Disorders Centre, Guy’s & St Thomas’ National Health Service (NHS) Foundation Trust, London SE19RT, UK;
- Centre of Human & Aerospace Physiological Sciences, Faculty of Life Sciences and Medicine, King’s College, London WC2R 2LS, UK
| | - Bhik Kotecha
- Nuffield Health Brentwood, Shenfield Road, Brentwood, Essex CM15 8EH, UK;
| | - Claudio Vicini
- Head & Neck Department, ENT & Oral Surgery Unit, Morgagni-Pierantoni/Infermi Hospital, Romagna Health Company, 47121 Forlì, Italy;
- Ear Nose and Throat (ENT) Clinic, Special Surgery Department, Arcispedale S. Anna Hospital, Ferrara University, 44124 Ferrara, Italy
- Department of Otolaryngology Head and Neck surgery, S.Orsola-Malpighi University Hospital, 40138 Bologna, Italy
| | - Venerino Poletti
- Pulmonary Operative Unit, Department of Thoracic Diseases, Morgagni-Pierantoni Hospital, Romagna Health Company, 47121 Forlì, Italy;
- Department of Respiratory Diseases & Allergy, Aarhus University Hospital, 8200 Aarhus, Denmark
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12
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Lai V, Tong BK, Tran C, Ricciardiello A, Donegan M, Murray NP, Carberry JC, Eckert DJ. Combination therapy with mandibular advancement and expiratory positive airway pressure valves reduces obstructive sleep apnea severity. Sleep 2019; 42:5513371. [DOI: 10.1093/sleep/zsz119] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Revised: 03/07/2019] [Indexed: 12/21/2022] Open
Abstract
AbstractStudy ObjectivesMandibular advancement splint (MAS) therapy is a well-tolerated alternative to continuous positive airway pressure for obstructive sleep apnea (OSA). Other therapies, including nasal expiratory positive airway pressure (EPAP) valves, can also reduce OSA severity. However, >50% of patients have an incomplete or no therapeutic response with either therapy alone and thus remain at risk of adverse health outcomes. Combining these therapies may yield greater efficacy to provide a therapeutic solution for many incomplete/nonresponders to MAS therapy. Thus, this study evaluated the efficacy of combination therapy with MAS plus EPAP in incomplete/nonresponders to MAS alone.MethodsTwenty-two people with OSA (apnea–hypopnea index [AHI] = 22 [13, 42] events/hr), who were incomplete/nonresponders (residual AHI > 5 events/hr) on an initial split-night polysomnography with a novel MAS device containing an oral airway, completed an additional split-night polysomnography with MAS + oral EPAP valve and MAS + oral and nasal EPAP valves (order randomized).ResultsCompared with MAS alone, MAS + oral EPAP significantly reduced the median total AHI, with further reductions with the MAS + oral/nasal EPAP combination (15 [10, 34] vs. 10 [7, 21] vs. 7 [3, 13] events/hr, p < 0.01). Larger reductions occurred in supine nonrapid eye movement AHI with MAS + oral/nasal EPAP combination therapy (ΔAHI = 23 events/hr, p < 0.01). OSA resolved (AHI < 5 events/hr) with MAS + oral/nasal EPAP in nine individuals and 13 had ≥50% reduction in AHI from no MAS. However, sleep efficiency was lower with MAS + oral/nasal EPAP versus MAS alone or MAS + oral EPAP (78 ± 19 vs. 87 ± 10 and 88 ± 10% respectively, p < 0.05).ConclusionsCombination therapy with a novel MAS device and simple oral or oro-nasal EPAP valves reduces OSA severity to therapeutic levels for a substantial proportion of incomplete/nonresponders to MAS therapy alone.Clinical TrialsName: Targeted combination therapy: Physiological mechanistic studies to inform treatment for obstructive sleep apnea (OSA)URL: https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=372279 Registration: ACTRN12617000492358 (Part C)
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Affiliation(s)
- Victor Lai
- Neuroscience Research Australia (NeuRA), Sydney, NSW, Australia
- School of Medical Sciences, University of New South Wales, Sydney, NSW, Australia
| | - Benjamin K Tong
- Neuroscience Research Australia (NeuRA), Sydney, NSW, Australia
- School of Medical Sciences, University of New South Wales, Sydney, NSW, Australia
| | - Carolin Tran
- Neuroscience Research Australia (NeuRA), Sydney, NSW, Australia
| | | | | | | | - Jayne C Carberry
- Neuroscience Research Australia (NeuRA), Sydney, NSW, Australia
- School of Medical Sciences, University of New South Wales, Sydney, NSW, Australia
- Adelaide Institute for Sleep Health, Flinders University, Adelaide, SA, Australia
| | - Danny J Eckert
- Neuroscience Research Australia (NeuRA), Sydney, NSW, Australia
- School of Medical Sciences, University of New South Wales, Sydney, NSW, Australia
- Adelaide Institute for Sleep Health, Flinders University, Adelaide, SA, Australia
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13
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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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14
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A randomised controlled trial of nasal decongestant to treat obstructive sleep apnoea in people with cervical spinal cord injury. Spinal Cord 2019; 57:579-585. [PMID: 30760846 DOI: 10.1038/s41393-019-0256-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2018] [Revised: 01/27/2019] [Accepted: 01/30/2019] [Indexed: 02/06/2023]
Abstract
STUDY DESIGN Prospective, double-blind, randomised, placebo-controlled, cross-over trial of nasal decongestion in tetraplegia. OBJECTIVES Tetraplegia is complicated by severe, predominantly obstructive, sleep apnoea. First-line therapy for obstructive sleep apnoea is nasal continuous positive airway pressure, but this is poorly tolerated. High nasal resistance associated with unopposed parasympathetic activation of the upper airway contributes to poor adherence. This preliminary study tested whether reducing nasal decongestion improved sleep. SETTING Participants' homes in Melbourne and Sydney, Australia. METHODS Two sleep studies were performed in participants' homes separated by 1 week. Participants were given a nasal spray (0.5 mL of 5% phenylephrine or placebo) in random order and posterior nasal resistance measured immediately. Outcomes included sleep apnoea severity, perceived nasal congestion, sleep quality and oxygenation during sleep. RESULTS Twelve middle-aged (average (SD) 52 (12) years) overweight (body mass index 25.3 (6.7) kg/m2) men (C4-6, AIS A and B) participated. Nasal resistance was reduced following administration of phenylephrine (p = 0.02; mean between treatment group difference -5.20: 95% confidence interval -9.09, -1.32 cmH2O/L/s). No differences were observed in the apnoea hypopnoea index (p = 0.15; -6.37: -33.3, 20.6 events/h), total sleep time (p = 0.49; -1.33: -51.8, 49.1 min), REM sleep% (p = 0.50; 2.37: -5.6, 10.3), arousal index (p = 0.76; 1.15: -17.45, 19.75), 4% oxygen desaturation index (p = 0.88; 0.63: -23.5, 24.7 events/h), or the percentage of mouth breathing events (p = 0.4; -8.07: -29.2, 13.0) between treatments. The apnoea hypopnoea index did differ between groups, however, all except one participant had proportionally more hypopnoeas than apnoeas during sleep after decongestion. CONCLUSIONS These preliminary data found that phenylephrine acutely reduced nasal resistance but did not significantly change sleep-disordered breathing severity.
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15
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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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16
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Wijesuriya NS, Gainche L, Jordan AS, Berlowitz DJ, LeGuen M, Rochford PD, O'Donoghue FJ, Ruehland WR, Carberry JC, Butler JE, Eckert DJ. Genioglossus reflex responses to negative upper airway pressure are altered in people with tetraplegia and obstructive sleep apnoea. J Physiol 2018; 596:2853-2864. [PMID: 29658103 DOI: 10.1113/jp275222] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2017] [Accepted: 03/07/2018] [Indexed: 12/21/2022] Open
Abstract
KEY POINTS Protective reflexes in the throat area (upper airway) are crucial for breathing. Impairment of these reflexes can cause breathing problems during sleep such as obstructive sleep apnoea (OSA). OSA is very common in people with spinal cord injury for unknown reasons. This study shows major changes in protective reflexes that serve to keep the upper airway open in response to suction pressures in people with tetraplegia and OSA. These results help us understand why OSA is so common in people with tetraplegia and provide new insight into how protective upper airway reflexes work more broadly. ABSTRACT More than 60% of people with tetraplegia have obstructive sleep apnoea (OSA). However, the specific causes are unknown. Genioglossus, the largest upper-airway dilator muscle, is important in maintaining upper-airway patency. Impaired genioglossus muscle function following spinal cord injury may contribute to OSA. This study aimed to determine if genioglossus reflex responses to negative upper-airway pressure are altered in people with OSA and tetraplegia compared to non-neurologically impaired able-bodied individuals with OSA. Genioglossus reflex responses measured via intramuscular electrodes to ∼60 brief (250 ms) pulses of negative upper-airway pressure (∼-15 cmH2 O at the mask) were compared between 13 participants (2 females) with tetraplegia plus OSA and 9 able-bodied controls (2 females) matched for age and OSA severity. The initial short-latency excitatory reflex response was absent in 6/13 people with tetraplegia and 1/9 controls. Genioglossus reflex inhibition in the absence of excitation was observed in three people with tetraplegia and none of the controls. When the excitatory response was present, it was significantly delayed in the tetraplegia group compared to able-bodied controls: excitation onset latency (mean ± SD) was 32 ± 16 vs. 18 ± 9 ms, P = 0.045; peak excitation latency was 48 ± 17 vs. 33 ± 8 ms, P = 0.038. However, when present, amplitude of the excitation response was not different between groups, 195 ± 26 vs. 219 ± 98% at baseline, P = 0.55. There are major differences in genioglossus reflex morphology and timing in response to rapid changes in airway pressure in people with tetraplegia and OSA. Altered genioglossus function may contribute to the increased risk of OSA in people with tetraplegia. The precise mechanisms mediating these differences are unknown.
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Affiliation(s)
| | - Laura Gainche
- University of Melbourne, Melbourne, Australia.,Institute for Breathing and Sleep (IBAS), Melbourne, Australia
| | - Amy S Jordan
- University of Melbourne, Melbourne, Australia.,Institute for Breathing and Sleep (IBAS), Melbourne, Australia
| | - David J Berlowitz
- University of Melbourne, Melbourne, Australia.,Institute for Breathing and Sleep (IBAS), Melbourne, Australia.,Department of Respiratory and Sleep Medicine, Austin Health, Melbourne, Australia
| | - Mariannick LeGuen
- University of Melbourne, Melbourne, Australia.,Institute for Breathing and Sleep (IBAS), Melbourne, Australia
| | - Peter D Rochford
- Institute for Breathing and Sleep (IBAS), Melbourne, Australia.,Department of Respiratory and Sleep Medicine, Austin Health, Melbourne, Australia
| | - Fergal J O'Donoghue
- University of Melbourne, Melbourne, Australia.,Institute for Breathing and Sleep (IBAS), Melbourne, Australia.,Department of Respiratory and Sleep Medicine, Austin Health, Melbourne, Australia
| | - Warren R Ruehland
- University of Melbourne, Melbourne, Australia.,Institute for Breathing and Sleep (IBAS), Melbourne, Australia.,Department of Respiratory and Sleep Medicine, Austin Health, Melbourne, Australia
| | - Jayne C Carberry
- Neuroscience Research Australia (NeuRA), Randwick, NSW, Australia.,University of New South Wales, Syndney, Australia
| | - Jane E Butler
- Neuroscience Research Australia (NeuRA), Randwick, NSW, Australia.,University of New South Wales, Syndney, Australia
| | - Danny J Eckert
- Neuroscience Research Australia (NeuRA), Randwick, NSW, Australia.,University of New South Wales, Syndney, Australia
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