Simplified Approach to Diagnosing Sleep-Disordered Breathing and Nocturnal Hypercapnia in Individuals With Spinal Cord Injury

Kristy A Bauman; Armando Kurili; Helena M Schotland; Gianna M Rodriguez; Anthony E Chiodo; Robert G Sitrin

doi:10.1016/j.apmr.2015.07.026

Simplified Approach to Diagnosing Sleep-Disordered Breathing and Nocturnal Hypercapnia in Individuals With Spinal Cord Injury

Arch Phys Med Rehabil. 2016 Mar;97(3):363-71. doi: 10.1016/j.apmr.2015.07.026. Epub 2015 Aug 20.

Authors

Kristy A Bauman¹, Armando Kurili², Helena M Schotland³, Gianna M Rodriguez⁴, Anthony E Chiodo⁴, Robert G Sitrin²

Affiliations

¹ Pulmonary and Critical Care Medicine Division, Department of Internal Medicine, University of Michigan Health System, Ann Arbor, MI. Electronic address: krisbaum@umich.edu.
² Pulmonary and Critical Care Medicine Division, Department of Internal Medicine, University of Michigan Health System, Ann Arbor, MI.
³ Pulmonary and Critical Care Medicine Division, Department of Internal Medicine, University of Michigan Health System, Ann Arbor, MI; Department of Neurology, Sleep Disorders Center, University of Michigan Health System, Ann Arbor, MI.
⁴ Department of Physical Medicine and Rehabilitation, University of Michigan Health System, Ann Arbor, MI.

PMID: 26297810
DOI: 10.1016/j.apmr.2015.07.026

Abstract

Objective: To evaluate a strategy of home-based testing to diagnose sleep-disordered breathing and nocturnal hypercapnia in individuals with spinal cord injury (SCI).

Design: Case series.

Setting: Referral center.

Participants: Adults with C1-T6 SCI (N=81). Individuals were eligible if ≥ 18 years old, with SCI of ≥ 3 months' duration, living within 100 miles of the study site, and not meeting exclusion criteria. Of the 161 individuals recruited from the SCI Model System database who were not enrolled, reasons were not interested in participating, change of location, prior positive pressure ventilation use, or medical contraindication. Ten individuals did not complete the study.

Interventions: Performance of an unsupervised home sleep apnea test combined with transcutaneous partial pressure of carbon dioxide/oxygen saturation by pulse oximetry monitoring.

Main outcome measures: Prevalence of sleep-disordered breathing and nocturnal hypercapnia. Clinical and physiological variables were examined to determine which, if any, correlate with the severity of sleep-disordered breathing.

Results: Obstructive sleep apnea (OSA) was found in 81.3% of individuals, central sleep apnea (CSA) was found in 23.8%, and nonspecific hypopnea events, where respiratory effort was too uncertain to classify, were present in 35%. Nonspecific hypopnea events correlated strongly with CSA but weakly with OSA, suggesting that conventional sleep apnea test scoring may underestimate central/neuromuscular hypopneas. Nocturnal hypercapnia was present in 28% and oxygen desaturation in 18.3%. Neck circumference was the primary predictor for OSA, whereas baclofen use and obstructive apnea/hypopnea index weakly predicted CSA. Awake transcutaneous partial pressure of carbon dioxide and CSA were only marginally associated with nocturnal hypercapnia.

Conclusions: Unsupervised home sleep apnea testing with transcutaneous capnography effectively identifies sleep-disordered breathing and nocturnal hypercapnia in individuals with SCI.

Trial registration: ClinicalTrials.gov NCT01882257.

Keywords: Hypercapnia; Rehabilitation; Spinal cord injuries.

Publication types

Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

Adult
Aged
Female
Humans
Hypercapnia / diagnosis*
Hypercapnia / etiology*
Male
Middle Aged
Oximetry / methods*
Sleep Apnea Syndromes / diagnosis*
Sleep Apnea Syndromes / etiology*
Spinal Cord Injuries / complications*

Associated data

ClinicalTrials.gov/NCT01882257