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Patients with high spinal cord injury (SCI) and tetraplegia have a remarkably high prevalence of sleep-disordered breathing (SDB). Most reports describe obstructive sleep apnoeas (OSAs) and hypopnoeas in this population.1 2 OSA impairs health-related quality of life (HRQL) in tetraplegic subjects and is associated with cognitive dysfunction, with repercussions mainly on attention, concentration, memory and learning skills.3 4 Changes in upper airways (UA) in SCI may increase the risk of OSA syndrome (OSAS): increased passive UA collapsibility,5 greater volume of soft palate and lateral pharyngeal walls, increased nasal resistance and nasal congestion.6 7 Breathing at lower volumes may also contribute to the higher prevalence of OSAS in this population.2 8 Coexistent traumatic brain injury, sleep position and medication (opioids, baclofen and benzodiazepines) can affect breathing during sleep with an additional burden of central events9 or nocturnal hypoventilation. It is quite possible that central events are underestimated in available publications because hypopnoeas are most often not specified as being central or obstructive as proposed by the American Academy of Sleep Medicine (AASM) 2012 guidelines.10 Despite the high prevalence of SDB and SDB-related symptoms in SCI, adherence to Continuous Positive Airways Pressure (CPAP) is poor: symptomatic patients treated with SDB by CPAP have a long-term adherence to treatment of 50%–63%.2
Polysomnography (PSG) is the gold standard for the diagnosis of OSA. However, transportation of the patient for in-laboratory PSG may be as complicated as providing unattended portable PSG in a long-term facility. Providing a simple pragmatic alternative to PSG was therefore the main goal for the study by Graco and colleagues published in Thorax.11 The authors describe the performance of a disease-specific two-stage screening tool for moderate to severe OSAS (defined as apnea-hypopnea index (AHI) >21/hour) in tetraplegic patients with SCI, developed using an existing database of …
Contributors DA and J-PJ wrote the manuscript.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests None declared.
Patient consent Not required.
Provenance and peer review Commissioned; internally peer reviewed.
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