Home-Based Diagnosis and Management of Sleep-Related Breathing Disorders in Spinal Cord Injury.

摘要

Patients with spinal cord injury (SCI) commonly have sleep- disordered breathing due to obstructive sleep apnea (OSA) and/or nocturnal hypoventilation (NH) due to respiratory muscle weakness. In the general population, OSA has been linked to excess cardiovascular morbidity, glucose intolerance, obesity, and hyperlipidemia, problems which are common co- morbidities with SCI. The impact of sleep-disordered breathing in SCI has received little attention. The conventional method for diagnosing sleep- disordered breathing is a facility-based polysomnogram (PSG), which is often unavailable to SCI patients because logistical obstacles limit their access to sleep laboratories. Our hypothesis is that unrecognized sleep-disordered breathing is common, can be diagnosed by home-based testing, and contributes to the morbidity of patients with SCI. This project is a prospective cohort study of 100 subjects with C1-T6 SCI. Sleep-disordered breathing will be assessed in subjects homes with a limited PSG combined with overnight oxygen saturation (SpO2)/transcutaneous pCO2 (tc- pCO2) monitoring. OSA and NH will be treated with noninvasive ventilatory support according to usual standards of care. Subjects will be followed prospectively for 1 year with periodic laboratory studies, quality of life surveys, and daily symptom/event logs. Our specific aims are: 1A: Determine the prevalence of OSA and NH in SCI patients. 1B. Establish the feasibility of home-based PSG s with SpO2/tc- pCO2 monitoring in SCI patients. 2A: Determine whether there are reliable clinical predictors for OSA or NH, and for compliance with noninvasive ventilation. Determine the impact of early recognition and treatment of OSA and NH on: 3A. quality of life, 3B. pulmonary morbidity, 3C. blood pressure instability, and 3D. features of the metabolic syndrome (obesity, diabetes, hyperlipidemia). At the completion of year 1, we have 1. obtained all institutional and DoD regulatory requirements to begin the project.