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Does auto-PAP work in patients with acute quadriplegia and sleep-disordered breathing?
  1. Abdulghani Sankari1,2,
  2. M. Safwan Badr1,2
  1. 1 Division of Pulmonary, Critical Care and Sleep Medicine, Department of Internal Medicine, Wayne State University School of Medicine, Detroit, Michigan, USA
  2. 2 Department of Internal Medicine, John D Dingell VAMC, Detroit, Michigan, USA
  1. Correspondence to Dr Abdulghani Sankari, Wayne State University School of Medicine, Detroit, MI 48201, USA; asankari{at}

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Patients living with spinal cord injury or disease (SCI/D) face numerous hurdles to accessing high-quality care for sleep disorders, from inadequate recognition of sleep health among patients with SCI/D and their providers, to erroneous attribution of daytime symptoms, limited access to sleep diagnostic services and difficulties using medical devices needed to treat sleep-disordered breathing (SDB). The treatment of choice for SDB is positive airway pressure (PAP), which improves sleep quality, metabolic function and quality of life while reducing sleepiness in able-bodied adults. For example, the Apnea Positive Pressure Long-term Efficacy Study (APPLES) trial,1 which recruited from both sleep clinics and the general population, demonstrated that PAP therapy was associated with significant improvement in subjectively and objectively measured sleepiness, but without a significant impact on short-term or long-term cognitive function. Even in able-bodied adults with SDB, adherence to PAP remains a major challenge that requires individualised and intensive education, monitoring and support. There is evidence that patients with SCI/D are less adherent to PAP therapy than able-bodied individuals.2 Reasons for poor adherence include mobility impairment to adjust the mask, increased awakenings due to autonomic dysfunction, nasal congestion, inadequate support and inconvenience due to the presence of other comorbidities.3

SDB in patients with SCI/D combines features of obstructive and central SDB. For example, increased upper airway collapsibility is noted in all patients with SCI4 and the use of opioid analgesics may increase the risk of central SDB. In addition, …

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  • Contributors Both authors contributed to drafting and approving the final version of this editorial.

  • Funding Dr Sankari is supported by the United States VA Office of Research and Development, Department of Veterans Affairs No. 1IK2CX000547, and RX002885 and the National Heart, Lung, and Blood Institute Award No. R21HL140447. Dr Badr is supported by the VA Office of Research and Development, Department of Veterans Affairs No. 1I01RX002116, the National Heart, Lung, and Blood Institute Award No. R01HL130552 and the Department of Defense No. SC150201.

  • Disclaimer This was not an industry-supported study. The opinions expressed in this article reflect those of the authors and do not necessarily represent the official views of the US Government, the Department of Veterans Affairs or the National Institute of Health.

  • Competing interests None declared.

  • Patient consent Not required.

  • Provenance and peer review Commissioned; internally peer reviewed.

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