Comorbid sleep disorders among individuals with spinal cord injury
Recommended Citation
Sankari A, Aldwaikat A, Habra M, Salloum A, Zeineddine S, Pandya N, Martin JL, and Badr MS. Comorbid sleep disorders among individuals with spinal cord injury. J Clin Sleep Med 2025.
Document Type
Article
Publication Date
5-12-2025
Publication Title
J Clin Sleep Med
Abstract
STUDY OBJECTIVES: To determine the rate of sleep-disordered breathing (SDB) in individuals with spinal cord injury (SCI). and its types (central and obstructive, and combined (COSA) and to assess the response to treatment using positive airway pressure (PAP) (defined as an apnea-hypopnea index (AHI) of less than 5 events per hour on initial PAP titration) in individuals with SCI.
METHODS: Individuals with SCI who underwent a full night of diagnostic polysomnography (PSG) from to 2010-2024 to determine the type of SDB and its severity using the AHI and central apnea index (CAI). The inclusion criteria were individuals with chronic SCI at low cervical or thoracic (at C4-T6 levels). who are not mechanically ventilated or had tracheostomies. "Central sleep apnea (CSA)" is diagnosed with an AHI of 5+ events/h and a CAI of at least 50% of the AHI. "Obstructive sleep apnea (OSA) only" is identified by an AHI of 5+ events/h and a CAI of less than 5 events/h. COSA is characterized by an AHI of 5+ events/h, with a CAI over 5 events/h but under 50% of the total AHI. The positive response to PAP therapy was based on the AHI level of less than 5 events/h after initiating PAP treatment and based on remote monitoring data.
RESULTS: Among the 81 individuals who met the inclusion criteria, 12 patients (15%) were diagnosed with COSA, 4 patients (5%) presented with CSA only, 56 patients (69%) had OSA, and 8 patients (10%) exhibited no SDB. In a subset of participants (N=51) hypopneas were classified as obstructive or central events based on American Academy of Sleep Medicine (AASM) definition and revealed that approximately one-third (32%) had central or COSA, 63% had OSA, and 6% did not have SDB on PSG. A total of 35 (47%) individuals diagnosed with SDB underwent PAP titration and were prescribed PAP. Twenty (27%) individuals received PAP treatment, and only 17 (23%) continued their use for the initial three months. Only 11 patients (15%) demonstrated responsiveness to PAP on day 90 (AHI< 5 during therapy).
CONCLUSIONS: SDB is extremely common in individuals with SCI. The efficacy of PAP therapy is suboptimal, and adherence rates decline significantly over time.
PubMed ID
40353318
ePublication
ePub ahead of print
