Sleep Disorders |

Home-Based Diagnosis of Sleep-Disordered Breathing Complicating Spinal Cord Injury FREE TO VIEW

Kristy Bauman, MD; Armando Kurili, BS; Gianna Rodriguez, MD; Anthony Chiodo, MD; Helena Schotland, MD; Robert Sitrin, MD
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University of Michigan, Ann Arbor, MI

Chest. 2013;144(4_MeetingAbstracts):997A. doi:10.1378/chest.1703485
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SESSION TITLE: Sleep Posters

SESSION TYPE: Original Investigation Poster

PRESENTED ON: Wednesday, October 30, 2013 at 01:30 PM - 02:30 PM

PURPOSE: Individuals with spinal cord injury (SCI) commonly suffer from sleep-disordered breathing due to obstructive sleep apnea (OSA) or nocturnal hypoventilation (NH) from respiratory muscle weakness. Standard polysomnograms (PSG) reliably diagnose OSA, but carbon dioxide (pCO2) measurements are not performed routinely, and SCI patients often have difficulty accessing sleep centers. We sought to determine the prevalence of OSA and NH in SCI patients, utilizing concurrent in-home PSG and transcutaneous capnography. Additionally, we examined the reliability of common clinical predictors for OSA or NH.

METHODS: Adults with C1-T6 SCI were studied prospectively. Anthropometric data, Epworth sleepiness scale (ESS), and spirometry were measured at baseline. An in-home, unsupervised overnight PSG (Stardust II class III system, Phillips Respironics) was performed concurrently with transcutaneous pCO2/SpO2 monitoring (SenTec AG, Therwil, Switzerland).

RESULTS: 35 studies were performed successfully. 7 PSG and 4 capnography studies were repeated due to technical problems. 31 subjects (88.6%) had OSA, as defined by an obstructive apnea hypopnea index (OAHI) of ≥ 5 events/hr of recording time (mean 20.7; range 5.4-60). Twelve (34.3%) subjects had NH (transcutaneous pCO2 ≥ 50mmHg for ≥ 5% study time) for a mean of 31.6% of the study time (range 5-99%). Oxygen desaturation (SpO2 ≤ 88% for ≥ 5% of study time) was detected in 7 (20%). The OAHI correlated with neck circumference (p = 0.004) and waist circumference (p = 0.028). ESS, BMI, and forced vital capacity (FVC) did not correlate with OAHI or NH.

CONCLUSIONS: Home-based PSG/transcutaneous capnography is an effective approach for diagnosing OSA and NH in SCI patients. OSA is common and under-recognized. Neck and waist circumference correlate with the severity of OSA, while ESS, FVC and O2 desaturation do not.

CLINICAL IMPLICATIONS: Home-based unsupervised PSG/transcutaneous capnography can facilitate recognition of OSA and NH, removing the obstacles associated with facility-based PSG. Future implications could include early institution of noninvasive ventilation with improved quality of life and decreased morbidity.

DISCLOSURE: The following authors have nothing to disclose: Kristy Bauman, Armando Kurili, Gianna Rodriguez, Anthony Chiodo, Helena Schotland, Robert Sitrin

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