788 Is Dysphagia a Marker for Obstructive Sleep Apnea (OSA) in Traumatic Brain Injury (TBI) Patients: A VA TBI Model System Study

Abstract Introduction Recent work has highlighted prevalent obstructive not central sleep apnea following traumatic brain injury (TBI). Treatment of comorbid OSA may facilitate neurologic recovery but widespread screening is limited. Mixed support exists for the presence of dysphagia as a biomarker of OSA in the general population and stroke patients. Dysphagia is common following TBI; however, no study has examined the relation between OSA and dysphagia in this cohort. Leveraging data from a recent six-center clinical trial of OSA and TBI during inpatient rehabilitation, this secondary analysis examined the association between OSA severity indices and proxy measures of dysphagia. Methods Level 1 polysomnography (PSG) was used to assess OSA (AHI ≥ 5 and ≥ 15) during inpatient rehabilitation for the overall sample (N=248; 203 male; 60.6% severe injury) evaluated at a median of 120.6 days post-TBI and subset ≤ 60 days post-injury. Dysphagia was approximated as the presence of a PEG tube and/or a modified texture diet (MTD) on the day of PSG. Chi square and Fisher’s Exact tests were utilized for group comparisons. Results As previously reported, OSA in this cohort was prevalent (68.2% (n=169) at AHI ≥ 5 and 33.5% (n=83) AHI ≥ 15) with predominantly obstructive events. 27.4% (n=68) met criteria for dysphagia combining proxy measures (34 peg; 49 MTD). No significant difference was found for presence of dysphagia across OSA severity cutoffs (AHI ≥ 5 & 15; p=0.1029 & 0.5959). When examining OSA across the individual proxy measures, persons without a peg tube were significantly more likely to have OSA at AHI ≥ 5 (62.5% vs 5.65%; p=0.0003) and AHI ≥ 15 (31.05% vs 2.42%; p=0.0353). When examining participants less than 60 days post-TBI, the group differences remained. Conclusion The incidence of dysphagia in TBI patients, as indexed by a modified diet or presence of a feeding tube, was not elevated in those with OSA. Sample bias (for undergoing Level 1 PSG and improvement facilitating inpatient rehabilitation admission) may have contributed to findings. Finally, future work with more sensitive indices of dysphagia is needed to accurately evaluate this association. Support (if any) PCORI (CER-1511–33005), NIIDLRR (90DPTB0004)

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806 Barriers to screening and diagnosis of obstructive sleep apnea during inpatient traumatic brain injury rehabilitation

SLEEP ◽

10.1093/sleep/zsab072.803 ◽

2021 ◽

Vol 44 (Supplement_2) ◽

pp. A314-A315

Author(s):

Bridget Cotner ◽

Risa Nakase-Richardson ◽

Becky Gius ◽

Lauren Fournier ◽

Alexa Watach ◽

...

Keyword(s):

Traumatic Brain Injury ◽

Obstructive Sleep Apnea ◽

Brain Injury ◽

Sleep Apnea ◽

Inpatient Rehabilitation ◽

Screening Tools ◽

Diagnostic Tools ◽

Evidence Based ◽

Implementation Barriers ◽

Obstructive Sleep

Abstract Introduction Obstructive Sleep Apnea (OSA) is prevalent after moderate to severe traumatic brain injury (TBI) and may diminish recovery when left untreated. Despite the demonstrated importance of treating OSA following TBI, assessment for OSA during or soon after inpatient rehabilitation for TBI is limited. Little is known about barriers to implementing OSA screening and early diagnosis during inpatient rehabilitation thus hindering the translation of evidence-based OSA assessment procedures into clinical practice and potentially delaying necessary OSA treatment. The current analysis explored facilitators and barriers to implementing OSA screening tools in an inpatient rehabilitation setting from the perspectives of end user stakeholders. Methods Patients, families, industry, clinical providers and administrators participated in a two-day meeting following completion of a diagnostic clinical trial of OSA screening and diagnostic tools during inpatient rehabilitation. Stakeholders were provided with open ended questions generated by study investigators and given the opportunity to respond on paper or a “graffiti wall” (i.e., white board). Example questions include “What are the greatest needs of the healthcare system related to sleep apnea and TBI?” and “What are the key things we need to consider to move results into real-world practice?” Qualitative content analyses using a rapid matrix approach were conducted from stakeholder feedback obtained during the two-day meeting, which included a guided review of emerging OSA research and discussion of potential implementation barriers of OSA assessment during inpatient rehabilitation. Results Improved screening and treatment practices for OSA were the greatest needs identified. To meet these needs, stakeholders identified the importance of improving patient, family, and staff understanding of OSA (e.g., health literacy) and other sleep disorders through education; inpatient rehabilitation access to resources (technology; sleep providers); and reimbursement for additional inpatient procedures. Conclusion Although treatment of OSA is crucial for recovery during inpatient rehabilitation following TBI, barriers to earlier recognition, diagnosis, and treatment of OSA exists across several different domains, including education, resources, and funding policies. Findings support future implementation efforts to translate evidence-based care into practice to improve patient outcomes. Support (if any) PCORI-NCT03033901

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1124 Central Sleep Apnea and Traumatic Brain Injury: A NIDILRR and VA TBI Model System Study

SLEEP ◽

10.1093/sleep/zsaa056.1119 ◽

2020 ◽

Vol 43 (Supplement_1) ◽

pp. A428-A428

Author(s):

G Gulati ◽

D J Schwartz ◽

S Nallu ◽

K Bell ◽

L Wittine ◽

...

Keyword(s):

Brain Injury ◽

Sleep Apnea ◽

Comparative Effectiveness ◽

Central Sleep Apnea ◽

Inpatient Rehabilitation ◽

Apnea Hypopnea Index ◽

Effectiveness Trial ◽

Sleep Related Breathing Disorders ◽

Obstructive Sleep ◽

Medicine Physician

Abstract Introduction Sleep-related breathing disorders are common after TBI. To date, two single site studies have reported divergent findings in post-TBI patients with one reporting predominantly obstructive sleep apnea (OSA, Holcomb et al., 2016) and the other central sleep apnea (CSA, Webster and Bell, 1998). The purpose of this analysis is to explore prevalence, demographics, and injury characteristics of patients with a clinical diagnosis of CSA in a recently-completed multicenter comparative-effectiveness trial during inpatient rehabilitation following moderate to severe TBI. Methods Participants in a six-center diagnostic comparative effectiveness trial underwent Level-1 polysomnography (PSG) during inpatient rehabilitation for TBI. Studies were scored at a centralized scoring center by one of two certified PSG technicians with final interpretation by a board-certified sleep medicine physician. Results 21 of 248 (8.5%) participants evidenced elevated CSA indices >5. Predominant CSA was rare (n=3 [1.2%], age range: 36-59; 100% male; 33-52 days post-TBI). One participant was on opioid, anti-depressant and antiepileptic drugs, one was on an antiepileptic, and another was on an opioid. PAP therapy was not initiated during PSG thus there was no treatment-emergent CSA. All had a central apnea-hypopnea index (AHI) in the moderate to severe range (29-49). Two out of the three had a GCS <8 and one participant had a GCS of 14. Conclusion In this multi-center clinical trial, predominant CSA was rare. The common practice of reducing polypharmacy in order to minimize sedation and optimize mental status in specialized inpatient brain-injury rehabilitation programs may contribute to the low CSA incidence in this cohort. Attention to medication side-effects and their influence on sleep-related breathing should be routinely considered. Support PCORI (CER-1511-33005), GDHS (W91YTZ-13-C-0015) for DVBIC, NIDILRR (90DPTB0008-03-00; 90DPTB0013-01-00).

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Prognosticating Traumatic Brain Injury (TBI): Analysis of CRASH, IMPACT Models and Patient Age in a Cohort of TBI Patients

Neurosurgery ◽

10.1093/neuros/nyz001.nt3 ◽

2019 ◽

Vol 84 (5) ◽

pp. E271-E272 ◽

Cited By ~ 1

Author(s):

Conor Gillespie ◽

Catherine McMahon

Keyword(s):

Traumatic Brain Injury ◽

Brain Injury ◽

Survival Rates ◽

Predictive Performance ◽

Good Survival ◽

Post Injury ◽

Patient Age ◽

Patient Âgé ◽

Significant Difference ◽

Impact Models

Abstract INTRODUCTION Both CRASH and IMPACT models have been developed in recent years to predict the outcome of Traumatic Brain Injury (TBI). However, there is no clear evidence as to how these models perform in a modern cohort of UK-patients. There is also predictive uncertainty with regards to survival rates and functional outcome in elderly (>65 yr) patients. METHODS Patients referred to a tertiary neuroscience center from December 2014 to January 2016 with a suspected TBI were retrospectively examined. For each model, the predicted survival and overall outcome were compared to the actual outcome on admission and at 6 mo post injury, stratified by patient age (>65 yr vs ≤65 yr). RESULTS A total of 161 patients met the initial criteria; mean age 65 yr (SD = 21) and 110 male. Both CRASH and IMPACT correctly predicted 6-mo mortality rates and functional outcomes in most patients (range 61.7%-82.4%), with better predictive performance for patients not accepted to the center (range 84%-98%). There was no significant difference in the initial survival of elderly patients if accepted (78% [95% CI 50.6-104.0] vs 81% [95% CI 67.8-94.8] but were lower for those not accepted (24% [95% CI 4.2-43.7] vs 76% [95% CI 63.5-88.5], P = .027). CONCLUSION Patients >65 yr admitted to tertiary neuroscience center had good survival rates on admission and at 6 mo. The lesser ability of CRASH and IMPACT models to predict poorer outcomes when accepted suggests that acceptance to specialist centers may be able to improve outcome and suggests more optimistic treatment and acceptance of appropriate over 65 yr should be considered.

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The Use of Nasal Trumpet in a Traumatic Brain Injury Patient With Obstructive Sleep Apnea

PM&R ◽

10.1016/j.pmrj.2009.08.452 ◽

2009 ◽

Vol 1 (10) ◽

pp. 977-979 ◽

Cited By ~ 2

Author(s):

Jaspal R. Singh ◽

Miriam Segal ◽

Richard Malone ◽

Mohammed Zubair

Keyword(s):

Traumatic Brain Injury ◽

Obstructive Sleep Apnea ◽

Brain Injury ◽

Sleep Apnea ◽

Traumatic Brain Injury Patient ◽

Obstructive Sleep ◽

Injury Patient

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GERIATRIC TRAUMATIC BRAIN INJURY AND ALZHEIMER’S DISEASE SHARE SIMILAR PATTERNS OF WHITE MATTER DEGRADATION

Innovation in Aging ◽

10.1093/geroni/igz038.363 ◽

2019 ◽

Vol 3 (Supplement_1) ◽

pp. S96-S96

Author(s):

Andrei Irimia ◽

Kenneth Rostowsky ◽

Nikhil Chaudhari ◽

Maria Calvillo ◽

Sean Lee

Keyword(s):

Alzheimer’S Disease ◽

Alzheimer's Disease ◽

Traumatic Brain Injury ◽

Brain Injury ◽

White Matter ◽

Corpus Callosum ◽

Diffusion Tensor ◽

Future Research ◽

Post Injury ◽

Significant Difference

Abstract Although mild traumatic brain injury (mTBI) and Alzheimer’s disease (AD) are associated with white matter (WM) degradation, the nature of these alterations and the outcomes of their comparison have not been elucidated. Diffusion tensor imaging (DTI) has been utilized in both conditions, and has uncovered decreases in the fractional anisotropy (FA) of the corpus callosum and cingulum bundle, compared to healthy control (HC) volunteers [1, 2]. Despite mTBI being a potential risk factor for AD, no systematic quantitative comparison has been drawn between their WM degradation patterns. Here we investigated WM FA differences using DTI and tract-based spatial statistics (TBSS) between age- and sex-matched adults: 33 chronic mTBI patients, 67 AD patients and 81 HC participants. T1-weighted magnetic resonance imaging (MRI) and DTI were acquired at 3T. mTBI patients were scanned acutely and ~6 months post-injury. FSL software was used for artefact correction, FA computation and TBSS implementation. Statistical comparison of WM FA patterns between mTBI and AD patients was achieved by two one-sided t tests (TOSTs) of statistical equivalence, with equivalence bounds defined where Cohen’s d < 0.3. A significant difference was found between the FA means of mTBI vs. HC groups, and the AD vs. HC groups (p < 0.01, corrected). Mean FA differences between mTBI and AD were statistically equivalent in the corpus callosum and in the inferior longitudinal fasciculus (p < 0.05, corrected). Future research should focus on clarifying the similarities between mTBI and AD, potentially leading to novel hypotheses and improved AD diagnosis.

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