Prevalences of sleep-related breathing disorders and severity factors in chronic spinal cord injury and abled-bodied individuals undergoing rehabilitation: a comparative study

Patrícia Souza Bastos; Tatiana Leal Dutra Amaral; Hani Camille Yehia; Almir Tavares

doi:10.5664/jcsm.11084

Prevalences of sleep-related breathing disorders and severity factors in chronic spinal cord injury and abled-bodied individuals undergoing rehabilitation: a comparative study

J Clin Sleep Med. 2024 Feb 29. doi: 10.5664/jcsm.11084. Online ahead of print.

Authors

Patrícia Souza Bastos^{1

2}, Tatiana Leal Dutra Amaral¹, Hani Camille Yehia^{1

3}, Almir Tavares^{1

4}

Affiliations

¹ Programa de Neurociências, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil.
² Unidade de Polissonografia, Rede SARAH de Hospitais de Reabilitação, Belo Horizonte, MG, Brazil.
³ Departamento de Engenharia Eletrônica, Faculdade de Engenharia, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil.
⁴ Departamento de Psiquiatria, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil.

PMID: 38420961
DOI: 10.5664/jcsm.11084

Abstract

Study objectives: The objective of this study is to discern distinguishing characteristics of sleep-related breathing disorders (SRBD) in individuals with chronic spinal cord injury (CSCI) compared to able-bodied participants (non-CSCI). Additionally, the study investigates factors associated with SRBD severity.

Methods: This is a cross-sectional analysis of 123 able-bodied individuals, 40 tetraplegics, and 48 paraplegics, who underwent attended or partially supervised full polysomnography, for suspected SRBD, in a rehabilitation center. Polysomnographic, transcutaneous capnography, and clinical data were collected and compared between the groups.

Results: Among tetraplegics prevailed apnea-hypopnea index ≥ 30 (67.5%, p=0.003), central apnea (17.5%, p=0.007), and higher oxygen-desaturation index (80.0%, p=0.01). Sleep-related hypoventilation was present in 15,4% of tetraplegics and 15,8% of paraplegics, compared to 3,2% in able-bodied participants (p=0.05). In the able-bodied and paraplegic groups, snoring and neck circumference were positively correlated with obstructive sleep apnea (OSA) severity. A positive correlation between waist circumference and OSA severity was identified in all groups, and multivariate logistic regression analysis showed that loud snoring and waist circumference had the greatest impact on OSA severity.

Conclusions: Severe OSA and Central Sleep Apnea prevailed in tetraplegic participants. Sleep-related hypoventilation was more common in tetraplegics and paraplegics compared to able-bodied participants. Loud snoring and waist circumference had an impact on OSA severity in all groups. We recommend the routine implementation of transcutaneous capnography in individuals with CSCI. We underscore the significance of conducting a comprehensive sleep assessment in the rehabilitation process of individuals with CSCI.

Keywords: central sleep apnea; hypoventilation; hypoxemia; obstructive sleep apnea; quadriplegias; rehabilitation; sleep apnea syndromes; sleep-disordered breathing; spinal cord diseases; spinal cord disorders; spinal paraplegias; tetraplegia.