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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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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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Graco M, Schembri R, Ross J, Green SE, Booker L, Cistulli PA, Ayas NT, Berlowitz DJ. Continuous Positive Airway Pressure Use for Obstructive Sleep Apnea in Acute, Traumatic Tetraplegia. Arch Phys Med Rehabil 2019; 100:2276-2282. [PMID: 31421094 DOI: 10.1016/j.apmr.2019.07.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Revised: 06/26/2019] [Accepted: 07/22/2019] [Indexed: 12/21/2022]
Abstract
OBJECTIVE To describe continuous positive airway pressure (CPAP) use for treatment of obstructive sleep apnea (OSA) in acute tetraplegia, including adherence rates and associated factors. DESIGN Secondary analysis of CPAP data from a multinational randomized controlled trial. SETTING Inpatient rehabilitation units of 11 spinal cord injury centers. PARTICIPANTS People with acute, traumatic tetraplegia and OSA (N=79). INTERVENTIONS Autotitrating CPAP for OSA for 3 months. MAIN OUTCOME MEASURES Adherence measured as mean daily hours of use. Adherent (yes/no) was defined as an average of at least 4 hours a night throughout the study. Regression analyses determined associations between baseline factors and adherence. CPAP device pressure and leak data were analyzed descriptively. RESULTS A total of 79 participants from 10 spinal units (91% men; mean age ± SD, 46±16; 78±64d postinjury) completed the study in the treatment arm and 33% were adherent. Mean daily CPAP use ± SD was 2.9±2.3 hours. Better adherence was associated with more severe OSA (P=.04) and greater CPAP use in the first week (P<.01). Average 95th percentile pressure was low (9.3±1.7 cmH2O) and 95th percentile leak was high (27.1±13.4 L/min). CONCLUSION Adherence to CPAP after acute, traumatic tetraplegia is low. Early acceptance of therapy and more severe OSA predict CPAP use over 3 months. People with acute tetraplegia require less pressure to treat their OSA than the nondisabled; however, air leak is high. These findings highlight the need for further investigation of OSA treatment in acute tetraplegia.
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Affiliation(s)
- Marnie Graco
- Institute for Breathing and Sleep, Austin Health, Melbourne, Victoria, Australia; Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Victoria, Australia.
| | - Rachel Schembri
- Institute for Breathing and Sleep, Austin Health, Melbourne, Victoria, Australia
| | - Jacqueline Ross
- Institute for Breathing and Sleep, Austin Health, Melbourne, Victoria, Australia; Victorian Spinal Cord Service, Austin Hospital, Melbourne, Victoria, Australia
| | - Sally E Green
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Lauren Booker
- Institute for Breathing and Sleep, Austin Health, Melbourne, Victoria, Australia
| | - Peter A Cistulli
- Department of Respiratory and Sleep Medicine, Royal North Shore, St. Leonard's, New South Wales, Australia; Charles Perkins Centre and Faculty of Medicine and Health, University of Sydney, New South Wales, Australia
| | - Najib T Ayas
- University of British Columbia, Faculty of Medicine. Vancouver, British Columbia, Canada
| | - David J Berlowitz
- Institute for Breathing and Sleep, Austin Health, Melbourne, Victoria, Australia; School of Physiotherapy, The University of Melbourne, Melbourne, Victoria, Australia
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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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Apnoea and hypopnoea scoring for people with spinal cord injury: new thresholds for sleep disordered breathing diagnosis and severity classification. Spinal Cord 2019; 57:372-379. [PMID: 30626976 DOI: 10.1038/s41393-018-0229-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2018] [Revised: 11/22/2018] [Accepted: 11/27/2018] [Indexed: 11/08/2022]
Abstract
STUDY DESIGN Descriptive study. OBJECTIVES To determine the effect of respiratory event rule-set changes on the apnoea hypopnoea index, and diagnostic and severity thresholds in people with acute and chronic spinal cord injury. SETTING Eleven acute spinal cord injury inpatient hospitals across Australia, New Zealand, Canada and England; community dwelling chronic spinal cord injury patients in their own homes. METHODS Polysomnography of people with acute (n = 24) and chronic (n = 78) tetraplegia were reanalysed from 1999 American Academy of Sleep Medicine (AASM) respiratory scoring, to 2007 AASM 'alternative' and 2012 AASM respectively. Equivalent cut points for published 1999 AASM sleep disordered breathing severity ranges were calculated using receiver operator curves, and results presented alongside analyses from the able-bodied. RESULTS In people with tetraplegia, shift from 1999 AASM to 2007 AASM 'alternative' resulted in a 22% lower apnoea hypopnoea index, and to 2012 AASM a 17% lower index. In people with tetraplegia, equivalent cut-points for 1999 AASM severities of 5,15 and 30 were calculated at 2.4, 8.1 and 16.3 for 2007 AASM 'alternative' and 3.2, 10.0 and 21.2 for 2012 AASM. CONCLUSION Interpreting research, prevalence and clinical polysomnography results conducted over different periods requires knowledge of the relationship between different rule-sets, and appropriate thresholds for diagnosis of disease. SPONSORSHIP This project was proudly supported by the Traffic Accident Commission (Program grant) and the National Health and Medical Research Council (PhD stipend 616605).
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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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Peters AEJ, van Silfhout L, Graco M, Schembri R, Thijssen D, Berlowitz DJ. Periodic limb movements in tetraplegia. J Spinal Cord Med 2018; 41:318-325. [PMID: 28464758 PMCID: PMC6055951 DOI: 10.1080/10790268.2017.1320874] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
OBJECTIVE To establish the prevalence of Periodic Limb Movements during Sleep (PLMS) in patients with tetraplegia, controlling for obstructive sleep apnea. To explore whether demographic and injury characteristics affect PLMS. STUDY DESIGN Retrospective cohorts. SETTING AND PARTICIPANTS One hundred seventy-three participants with acute (<12 months) and 92 with chronic (>12 months) tetraplegia who underwent full overnight diagnostic sleep studies. INTERVENTIONS AND OUTCOME MEASURES Two hundred sixty-two sleep study recordings were included. A randomly selected subgroup of 21 studies was assessed for PLM during wakefulness. Data were analysed according to the current American Academy of Sleep Medicine guidelines. RESULTS Of the participants, 41.6% (43(15.7) years and 14.9% female) had a motor and sensory complete lesion. Sleep was poor with both OSA (87.8% with apnea hypopnoea index ≥ 5) and PLMS (58.4% with PLMS per hour PLMSI > 15) highly prevalent. There was no difference in the PLMSI between those with OSA (36.3(39.8)) or without (42.2(37.7), P = 0.42). PLMS were evident during REM and NREM sleep in all of the 153 patients with PLMSI > 15. All 21 participants in the subgroup of studies analysed for the PLM during quiet wakefulness, exhibited limb movements. None of the modelled variables (injury completeness, gender, OSA severity or time since injury) significantly predicted a PLMSI > 15 (P = 0.343). CONCLUSION In conclusion, this study confirms the high prevalence of PLM in tetraplegia and the presence of leg movements in NREM and REM sleep along with wakefulness after controlling for OSA. No associations between the presence of PLMS and patient characteristics or injury specific aspects were found.
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Affiliation(s)
- Annemieke Emma Josina Peters
- a Institute for Breathing and Sleep , Austin Health , Melbourne , Australia.,b Department of Physiology , Radboud University Nijmegen Medical Centre , Nijmegen , The Netherlands
| | - Lysanne van Silfhout
- a Institute for Breathing and Sleep , Austin Health , Melbourne , Australia.,b Department of Physiology , Radboud University Nijmegen Medical Centre , Nijmegen , The Netherlands
| | - Marnie Graco
- a Institute for Breathing and Sleep , Austin Health , Melbourne , Australia
| | - Rachel Schembri
- a Institute for Breathing and Sleep , Austin Health , Melbourne , Australia
| | - Dick Thijssen
- a Institute for Breathing and Sleep , Austin Health , Melbourne , Australia
| | - David J Berlowitz
- a Institute for Breathing and Sleep , Austin Health , Melbourne , Australia
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Schembri R, Spong J, Peters A, Rochford P, Wilksch P, O’Donoghue FJ, Greenwood KM, Barnes M, Kennedy GA, Berlowitz DJ. Light sensors for objective light measurement in ambulatory polysomnography. PLoS One 2017; 12:e0188124. [PMID: 29145507 PMCID: PMC5690677 DOI: 10.1371/journal.pone.0188124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2017] [Accepted: 11/01/2017] [Indexed: 11/18/2022] Open
Abstract
Ambulatory polysomnography (PSG) does not commonly include an objective measure of light to determine the time of lights off (Loff), and thus cannot be used to calculate important indices such as sleep onset latency and sleep efficiency. This study examined the technical specifications and appropriateness of a prototype light sensor (LS) for use in ambulatory Compumedics Somte PSG.Two studies were conducted. The first examined the light measurement characteristics of the LS when used with a portable PSG device, specifically recording trace range, linearity, sensitivity, and stability. This involved the LS being exposed to varying incandescent and fluorescent light levels in a light controlled room. Secondly, the LS was trialled in 24 home and 12 hospital ambulatory PSGs to investigate whether light levels in home and hospital settings were within the recording range of the LS, and to quantify the typical light intensity reduction at the time of Loff. A preliminary exploration of clinical utility was also conducted. Linearity between LS voltage and lux was demonstrated, and the LS trace was stable over 14 hours of recording. The observed maximum voltage output of the LS/PSG device was 250 mV, corresponding to a maximum recording range of 350 lux and 523 lux for incandescent and fluorescent light respectively. At the time of Loff, light levels were within the recording range of the LS, and on average dropped by 72 lux (9–245) in the home and 76 lux (4–348) in the hospital setting. Results suggest that clinical utility was greatest in hospital settings where patients are less mobile. The LS was a simple and effective objective marker of light level in portable PSG, which can be used to identify Loff in ambulatory PSG. This allows measurement of additional sleep indices and support with clinical decisions.
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Affiliation(s)
- Rachel Schembri
- The Institute for Breathing and Sleep, Austin Health, Heidelberg, VIC, Australia
- Department of Medicine, Dentistry and Health Sciences, The University of Melbourne, Parkville, VIC, Australia
- * E-mail:
| | - Jo Spong
- The Institute for Breathing and Sleep, Austin Health, Heidelberg, VIC, Australia
- College of Science, Health and Engineering, La Trobe Rural Health School, La Trobe University, Bendigo, VIC, Australia
| | - Allison Peters
- Melbourne Sleep Disorders Centre, Melbourne, VIC, Australia
| | - Peter Rochford
- The Institute for Breathing and Sleep, Austin Health, Heidelberg, VIC, Australia
| | - Philip Wilksch
- School of Science, RMIT University, Melbourne, VIC, Australia
| | - Fergal J. O’Donoghue
- The Institute for Breathing and Sleep, Austin Health, Heidelberg, VIC, Australia
- Department of Medicine, Dentistry and Health Sciences, The University of Melbourne, Parkville, VIC, Australia
| | | | - Maree Barnes
- The Institute for Breathing and Sleep, Austin Health, Heidelberg, VIC, Australia
- Department of Medicine, Dentistry and Health Sciences, The University of Melbourne, Parkville, VIC, Australia
| | - Gerard A. Kennedy
- The Institute for Breathing and Sleep, Austin Health, Heidelberg, VIC, Australia
- School of Health and Biomedical Sciences, RMIT University, Melbourne, VIC, Australia
| | - David J. Berlowitz
- The Institute for Breathing and Sleep, Austin Health, Heidelberg, VIC, Australia
- Department of Medicine, Dentistry and Health Sciences, The University of Melbourne, Parkville, VIC, Australia
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Schembri R, Spong J, Graco M, Berlowitz DJ. Neuropsychological Function in Patients With Acute Tetraplegia and Sleep Disordered Breathing. Sleep 2017; 40:2666483. [PMID: 28364492 DOI: 10.1093/sleep/zsw037] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/05/2016] [Indexed: 12/12/2022] Open
Abstract
Study objectives To investigate the relationship between apnea severity and neuropsychological function in patients with acute-onset tetraplegia and sleep disordered breathing. Methods Polysomnography and neuropsychological testing were performed on 104 participants (age M = 45.60, SD = 16.38; 10 female) across 11 international sites, 2 months postinjury (M = 60.70 days, SD = 39.48). Neuropsychological tests assessed attention, information processing, executive function, memory, learning, mood, and quality of life. Results More severe sleep apnea was associated with poorer attention, information processing, and immediate recall. Deficits did not extend to memory. Higher preinjury intelligence and being younger reduced the associations with sleep disordered breathing; however, these protective factors were insufficient to counter the damage to attention, immediate recall, and information processing associated with sleep disordered breathing. Conclusions These data suggest that new spinal cord injury may function as a model of "acute sleep apnea" and that more widespread sleep apnea-related deficits, including memory, may only be seen with longer exposure to apnea. These findings have important implications for functioning and skill acquisition during rehabilitation and, as such, highlight the importance of sleep health following tetraplegia.
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Affiliation(s)
- Rachel Schembri
- Department of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Australia.,Institute for Breathing and Sleep, Austin Health, Melbourne, Australia.,COSAQ multinational collaborative research group
| | - Jo Spong
- Institute for Breathing and Sleep, Austin Health, Melbourne, Australia.,COSAQ multinational collaborative research group.,La Trobe Rural Health School. College of Science, Health and Engineering. La Trobe University, Bendigo, Australia
| | - Marnie Graco
- Department of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Australia.,Institute for Breathing and Sleep, Austin Health, Melbourne, Australia.,COSAQ multinational collaborative research group
| | - David J Berlowitz
- Department of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Australia.,Institute for Breathing and Sleep, Austin Health, Melbourne, Australia.,COSAQ multinational collaborative research group
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Berlowitz DJ, Wadsworth B, Ross J. Respiratory problems and management in people with spinal cord injury. Breathe (Sheff) 2016; 12:328-340. [PMID: 28270863 PMCID: PMC5335574 DOI: 10.1183/20734735.012616] [Citation(s) in RCA: 108] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
Spinal cord injury (SCI) is characterised by profound respiratory compromise secondary to the level of loss of motor, sensory and autonomic control associated with the injury. This review aims to detail these anatomical and physiological changes after SCI, and outline their impact on respiratory function. Injury-related impairments in strength substantially alter pulmonary mechanics, which in turn affect respiratory management and care. Options for treatments must therefore be considered in light of these limitations. KEY POINTS Respiratory impairment following spinal cord injury (SCI) is more severe in high cervical injuries, and is characterised by low lung volumes and a weak cough secondary to respiratory muscle weakness.Autonomic dysfunction and early-onset sleep disordered breathing compound this respiratory compromise.The mainstays of management following acute high cervical SCI are tracheostomy and ventilation, with noninvasive ventilation and assisted coughing techniques being important in lower cervical and thoracic level injuries.Prompt investigation to ascertain the extent of the SCI and associated injuries, and appropriate subsequent management are important to improve outcomes. EDUCATIONAL AIMS To describe the anatomical and physiological changes after SCI and their impact on respiratory function.To describe the changes in respiratory mechanics seen in cervical SCI and how these changes affect treatments.To discuss the relationship between injury level and respiratory compromise following SCI, and describe those at increased risk of respiratory complications.To present the current treatment options available and their supporting evidence.
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Affiliation(s)
- David J. Berlowitz
- Institute for Breathing and Sleep, Austin Health, Heidelberg, Australia
- University of Melbourne, Faculty of Medicine, Dentistry and Health Sciences, Melbourne, Australia
| | - Brooke Wadsworth
- School of Human Services and Social Work, Griffith University, Logan Campus, Australia
- Physiotherapy Department, Princess Alexandra Hospital, Woolloongabba, Australia
| | - Jack Ross
- Victorian Spinal Cord Service, Austin Health, Heidelberg, Australia
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11
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Wolfe LF, Patwari PP, Mutlu GM. Sleep Hypoventilation in Neuromuscular and Chest Wall Disorders. Sleep Med Clin 2014. [DOI: 10.1016/j.jsmc.2014.05.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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