Article

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.
CI - Copyright (c) 2016 American Congress of Rehabilitation Medicine. Published by
Elsevier Inc. All rights reserved.

Langue : ANGLAIS