Prevalence of central sleep apnea in people with tetraplegic spinal cord injury: a retrospective analysis of research and clinical data

• Published in: Sleep (New York, N.Y.) Vol. 46; no. 12; p. 1
• Main Authors: Graco, Marnie, Ruehland, Warren R, Schembri, Rachel, Churchward, Thomas J, Saravanan, Krisha, Sheers, Nicole L, Berlowitz, David J
• Format: Journal Article
• Language: English
• Published: US Oxford University Press 11-12-2023
• Subjects: Airway Obstruction; Dyssomnias; Epidemiology; Female; Humans; Hypoventilation; Male; Prevalence; Quadriplegia - complications; Quadriplegia - epidemiology; Retrospective Studies; Sleep apnea syndromes; Sleep Apnea Syndromes - complications; Sleep Apnea Syndromes - epidemiology; Sleep Apnea, Central - complications; Sleep Apnea, Central - epidemiology; Sleep Apnea, Obstructive; Spinal cord injuries; Spinal Cord Injuries - complications; Spinal Cord Injuries - epidemiology; Australia; epidemiology; central; hypoventilation; quadriplegia; sleep apnea syndromes; spinal cord injuries; sleep apnea
• ISSN: 0161-8105; 1550-9109
• DOI: 10.1093/sleep/zsad235

Abstract
Study Objectives
Over 80% of people with tetraplegia have sleep-disordered breathing (SDB), but whether this is predominantly obstructive or central is unclear. This study aimed to estimate the prevalence of central sleep apnea (CSA) in tetraplegia and the contributions of central, obstructive, and hypopnea respiratory events to SDB summary indices in tetraplegia.
Methods
Research and clinical data from 606 individuals with tetraplegia and full overnight polysomnography were collated. The proportions of different respiratory event types were calculated; overall and for mild, moderate, and severe disease. The prevalence of Predominant CSA (Central Apnea Index [CAI] ≥ 5 and more central than obstructive apneas) and Any CSA (CAI ≥ 5) was estimated. Prevalence of sleep-related hypoventilation (SRH) was estimated in a clinical sub-cohort.
Results
Respiratory events were primarily hypopneas (71%), followed by obstructive (23%), central (4%), and mixed apneas (2%). As severity increased, the relative contribution of hypopneas and central apneas decreased, while that of obstructive apneas increased. The prevalence of Predominant CSA and Any CSA were 4.3% (26/606) and 8.4% (51/606) respectively. Being male, on opiates and having a high tetraplegic spinal cord injury were associated with CSA. SRH was identified in 26% (26/113) of the clinical sub-cohort.
Conclusions
This is the largest study to characterize SDB in tetraplegia. It provides strong evidence that obstructive sleep apnea is the predominant SDB type; 9–18 times more prevalent than CSA. The prevalence of CSA was estimated to be 4%–8%, significantly lower than previously reported.
Graphical Abstract
Graphical Abstract