scholarly journals 0597 Precision of Sleep-Disordered Breathing Event Classification Using Simulated Home Sleep Apnea Testing in Patients with Spinal Cord Injury, or Disease

SLEEP ◽  
2020 ◽  
Vol 43 (Supplement_1) ◽  
pp. A228-A229
Author(s):  
S Zeineddine ◽  
A Sankari ◽  
k Arvai ◽  
A Salloum ◽  
Y Abu Awad ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Patient Population ◽  
Sleep Disordered Breathing ◽  
Apnea Hypopnea Index ◽  
Respiratory Events ◽  
Respiratory Event ◽  
Cord Injury ◽  
The Mean ◽  
Disordered Breathing

Abstract Introduction Sleep-disordered breathing (SDB) is highly prevalent among patients with spinal cord injury or disease (SCI/D). In-laboratory polysomnography (PSG) is difficult for these patients due to functional limitations and the physical construction of most sleep laboratories. Our objective was to evaluate the concordance between simulated HSAT and PSG in identifying SDB severity and subtypes of respiratory events in this patient population. Methods Within a larger study, 33 Veterans with SCI/D completed one night of in-laboratory PSG. Limited-channel HSAT was simulated by extracting 5 channels from PSG signals to include nasal pressure, thermistor, thoracic and abdominal belts, and oxygen saturation. Results Mean age of patients was 59.8 ± 10.9 years; 87.9% were male, and the average BMI was 28.1 ± 6.3. The mean Apnea-Hypopnea Index (AHI) from PSG was 35.5 ± 22.7. The mean Respiratory Event Index (REI) based on simulated HSAT was 22.5 ± 18.6. Thirty-one patients (93.9%) had SDB defined as AHI ≥5/hour. Simulated limited-channel HSAT accurately identified 32 out of 33 patients (96.96%). When SDB was further classified into mild (AHI 5-15 events/hr), moderate (AHI 15-30 events/hr), and severe (AHI>30/hr), simulated HSAT consistently underestimated the severity of underlying SDB. Spearman correlation between estimating AHI (PSG-HSAT) and subtypes of respiratory events was primarily accounted for by the difference in the number of hypopneas (r=0.72, -0.021 and -0.001 for hypopneas, obstructive and central apneas, respectively). Conclusion Our findings support the diagnostic utility of HSAT in SCI/D patients with SDB; however, HSAT underestimation of SDB may lead to difficulties in optimizing therapy. The misclassification of SDB severity is mainly driven by the number of hypopneas. Classification of hypopneas as obstrcutive or central may shed further light on the nature of this difference. Further research on the usability of HSAT devices in this patient population is needed. Support VA Rehabilitation Research and Development Service (RX002116; PI Badr and RX002885; PI Sankari) and NIH/NHLBI (K24HL143055; PI: Martin)

scholarly journals Detection of Sleep-Disordered Breathing in Patients with Spinal Cord Injury Using a Smartphone

Sensors ◽  
2021 ◽  
Vol 21 (21) ◽  
pp. 7182
Author(s):  
Yolanda Castillo-Escario ◽  
Hatice Kumru ◽  
Ignasi Ferrer-Lluis ◽  
Joan Vidal ◽  
Raimon Jané
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Supine Position ◽  
Sleep Disordered Breathing ◽  
Cost Effective ◽  
Apnea Hypopnea Index ◽  
Accelerometer Data ◽  
Increased Risk ◽  
Cord Injury ◽  
Disordered Breathing

Patients with spinal cord injury (SCI) have an increased risk of sleep-disordered breathing (SDB), which can lead to serious comorbidities and impact patients’ recovery and quality of life. However, sleep tests are rarely performed on SCI patients, given their multiple health needs and the cost and complexity of diagnostic equipment. The objective of this study was to use a novel smartphone system as a simple non-invasive tool to monitor SDB in SCI patients. We recorded pulse oximetry, acoustic, and accelerometer data using a smartphone during overnight tests in 19 SCI patients and 19 able-bodied controls. Then, we analyzed these signals with automatic algorithms to detect desaturation, apnea, and hypopnea events and monitor sleep position. The apnea–hypopnea index (AHI) was significantly higher in SCI patients than controls (25 ± 15 vs. 9 ± 7, p < 0.001). We found that 63% of SCI patients had moderate-to-severe SDB (AHI ≥ 15) in contrast to 21% of control subjects. Most SCI patients slept predominantly in supine position, but an increased occurrence of events in supine position was only observed for eight patients. This study highlights the problem of SDB in SCI and provides simple cost-effective sleep monitoring tools to facilitate the detection, understanding, and management of SDB in SCI patients.

scholarly journals Sleep-disordered breathing is associated with brain vascular reactivity in spinal cord injury

Neurology ◽  
2019 ◽  
Vol 93 (24) ◽  
pp. e2181-e2191
Author(s):  
Jordan W. Squair ◽  
Amanda H.X. Lee ◽  
Zoe K. Sarafis ◽  
Geoff Coombs ◽  
Otto Barak ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Sleep Apnea ◽  
Sleep Disordered Breathing ◽  
Population Level ◽  
Chronic Fatigue ◽  
Severity Of Injury ◽  
Cord Injury ◽  
Meta Analyses ◽  
Disordered Breathing

ObjectiveTo determine the population-level odds of individuals with spinal cord injury (SCI) experiencing fatigue and sleep apnea, to elucidate relationships with level and severity of injury, and to examine associations with abnormal cerebrovascular responsiveness.MethodsWe used population-level data, meta-analyses, and primary physiologic assessments to provide a large-scale integrated assessment of sleep-related complications after SCI. Population-level and meta-analyses included more than 60,000 able-bodied individuals and more than 1,800 individuals with SCI. Physiologic assessments were completed on a homogenous sample of individuals with cervical SCI and matched controls. We examined the prevalence of (1) self-reported chronic fatigue, (2) clinically identified sleep apnea, and 3) cerebrovascular responsiveness to changing CO2.ResultsLogistic regression revealed a 7-fold elevated odds of chronic fatigue after SCI (odds ratio [OR] 7.9, 95% confidence interval [CI] 3.5–16.2), and that fatigue and trouble sleeping are correlated with the level and severity of injury. We further show that those with SCI experience elevated risk of clinically defined sleep-disordered breathing in more than 600 individuals with SCI (pooled OR 3.1, 95% CI 1.3–7.5). We confirmed that individuals with SCI experience a high rate of clinically defined sleep apnea using primary polysomnography assessments. We then provide evidence using syndromic analysis that sleep-disordered breathing is a factor strongly associated with impaired cerebrovascular responsiveness to CO2 in patients with SCI.ConclusionsIndividuals with SCI have an increased prevalence of sleep-disordered breathing, which may partially underpin their increased risk of stroke. There is thus a need to integrate sleep-related breathing examinations into routine care for individuals with SCI.

scholarly journals Sleep Disordered Breathing in Chronic Spinal Cord Injury

2014 ◽  
Vol 10 (01) ◽  
pp. 65-72 ◽  
Author(s):  
Abdulghani Sankari ◽  
Amy Bascom ◽  
Sowmini Oomman ◽  
M. Safwan Badr
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Sleep Disordered Breathing ◽  
Chronic Spinal Cord Injury ◽  
Cord Injury ◽  
Disordered Breathing

scholarly journals Sleep disordered breathing induced by cervical spinal cord injury and effect of adenosine A1 receptors modulation in rats

2019 ◽  
Vol 127 (6) ◽  
pp. 1668-1676 ◽  
Author(s):  
Abdulghani Sankari ◽  
Zeljka Minic ◽  
Pershang Farshi ◽  
Medea Shanidze ◽  
Wafaa Mansour ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Sleep Disordered Breathing ◽  
Cervical Spinal Cord ◽  
Cervical Spinal Cord Injury ◽  
Adenosine A1 Receptor ◽  
Cord Injury ◽  
Adenosine A1 ◽  
A1 Receptor ◽  
Disordered Breathing

Sleep-disordered breathing (SDB) is very common after spinal cord injury (SCI). The present study was designed to evaluate the therapeutic efficacy of adenosine A1 receptor blockade (8-cyclopentyl-1,3-dipropylxanthine, DPCPX) on SDB in a rodent model of SCI. We hypothesized that SCI induced via left hemisection of the second cervical segment (C2Hx) results in SDB. We further hypothesized that blockade of adenosine A1 receptors following C2Hx would reduce the severity of SDB. In the first experiment, adult male rats underwent left C2Hx or sham (laminectomy) surgery. Unrestrained whole body plethysmography (WBP) and implanted wireless electroencephalogram (EEG) were used for assessment of breathing during spontaneous sleep and for the scoring of respiratory events at the acute (~1 wk), and chronic (~6 wk) time points following C2Hx. During the second experiment, the effect of oral administration of adenosine A1 receptor antagonist (DPCPX, 3 times a day for 4 days) on SCI induced SDB was assessed. C2Hx animals exhibited a higher apnea-hypopnea index (AHI) compared with the sham group, respectively (35.5 ± 12.6 vs. 19.1 ± 2.1 events/h, P < 0.001). AHI was elevated 6 wk following C2Hx ( week 6, 32.0 ± 5.0 vs. week 1, 42.6 ± 11.8 events/h, respectively, P = 0.12). In contrast to placebo, oral administration of DPCPX significantly decreased AHI 4 days after the treatment (159.8 ± 26.7 vs. 69.5 ± 8.9%, P < 0.05). Cervical SCI is associated with the development of SDB in spontaneously breathing rats. Adenosine A1 blockade can serve as a therapeutic target for SDB induced by SCI. NEW & NOTEWORTHY The two key novel findings of our study included that 1) induced cervical spinal cord injury results in sleep-disordered breathing in adult rats, and 2) oral therapy with an adenosine A1 receptor blockade using DPCPX is sufficient to significantly reduce apnea-hypopnea index following induced cervical spinal cord injury.

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

2016 ◽  
Vol 97 (3) ◽  
pp. 363-371 ◽  
Author(s):  
Kristy A. Bauman ◽  
Armando Kurili ◽  
Helena M. Schotland ◽  
Gianna M. Rodriguez ◽  
Anthony E. Chiodo ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Sleep Disordered Breathing ◽  
Simplified Approach ◽  
Cord Injury ◽  
Disordered Breathing

Upper airway mechanics in chronic spinal cord injury during sleep

2014 ◽  
Vol 116 (11) ◽  
pp. 1390-1395 ◽  
Author(s):  
Abdulghani Sankari ◽  
Amy T. Bascom ◽  
M. Safwan Badr
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Duty Cycle ◽  
Sleep Disordered Breathing ◽  
Upper Airway ◽  
Compensatory Responses ◽  
Cord Injury ◽  
Critical Closing Pressure ◽  
Closing Pressure ◽  
Disordered Breathing

Sleep-disordered breathing has been shown to be more prevalent in patients with spinal cord injury (SCI) than the general population. The pathogenesis of increased sleep-disordered breathing in individuals with chronic SCI is unknown. The purpose of this study is to determine whether SCI level affects upper airway (UA) collapsibility and neuromuscular compensatory responses to obstruction. Twenty-four participants (8 cervical SCI, 8 thoracic SCI, and 8 controls) were studied. The ventilation, timing, UA resistance, and pharyngeal collapsibility, defined by critical closing pressure, were determined during non-rapid eye movement sleep. Inspiratory duty cycle and minute ventilation were observed in response to increasing severity of UA obstruction. Compared with controls, both cervical and thoracic SCI participants demonstrated elevated passive critical closing pressure (0.5 ± 2.2 and 0.9 ± 2.7 vs. −2.5 ± 1.0 cmH2O, respectively; P = 0.01). No difference in UA resistance was observed between groups. Cervical and thoracic SCI individuals exhibited a similar degree of hypoventilation and dose-dependent increase in inspiratory duty cycle in response to UA obstruction. Passive UA collapsibility is increased in both cervical and thoracic SCI compared with control. The neuromuscular compensatory responses to UA obstruction during sleep are preserved in chronic SCI and are independent of the level of injury.

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