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Title: Positive airway pressure for sleep-disordered breathing in acute quadriplegia: a randomised controlled trial.
Austin Authors: Berlowitz, David J ;Schembri, Rachel M ;Graco, Marnie ;Ross, Jacqueline M ;Ayas, Najib;Gordon, Ian;Lee, Bonne;Graham, Allison;Cross, Susan V;McClelland, Martin;Kennedy, Paul;Thumbikat, Pradeep;Bennett, Cynthia;Townson, Andrea;Geraghty, Timothy J;Pieri-Davies, Sue;Singhal, Raj;Marshall, Karen;Short, Deborah;Nunn, Andrew;Mortimer, Duncan;Brown, Doug ;Pierce, Robert J;Cistulli, Peter A
Affiliation: National Spinal Injuries Centre, Stoke Mandeville Hospital, Aylesbury, UK
Centre for Health Economics, Monash Business School, Monash University, Clayton, Victoria, Australia
Queensland Spinal Cord Injuries Service and The Hopkins Centre, Research for Rehabilitation and Resilience, Metro South Health and Griffith University, Woolloongabba, Queensland, Australia
Prince of Wales Hospital, Randwick, New South Wales, Australia
Statistical Consulting Centre, School of Mathematics and Statistics, University of Melbourne, Melbourne, Victoria, Australia
The Robert Jones & Agnes Hunt Orthopaedic Hospital, Oswestry, UK
North West Regional Spinal Injuries Centre, Southport and Ormskirk Hospital NHS Trust, Southport, UK
Princess Royal Spinal Cord Injuries Centre, Northern General Hospital, Sheffield, UK
Department of Respiratory and Sleep Medicine, Royal North Shore Hospital, St Leonards, New South Wales, Australia
Institute for Breathing and Sleep, Austin Health, Heidelberg, Victoria, Australia
Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Victoria, Australia
Victorian Spinal Cord Service, Austin Health, Heidelberg, Victoria, Australia
Sydney Medical School, University of Sydney, Melbourne, New South Wales, Australia
Spinal Research Institute, Austin Health, Heidelberg, Victoria, Australia
Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
Auckland Spinal Rehabilitation, Auckland, New Zealand
Department of Physical Medicine and Rehabilitation, University of British Columbia, Vancouver, British Columbia, Canada
Burwood Spinal Unit, Burwood Hospital, Canterbury District Health Board, Christchurch, New Zealand
Issue Date: Mar-2019
Date: 2018-12-11
Publication information: Thorax 2019; 74(3): 282-290
Abstract: Highly prevalent and severe sleep-disordered breathing caused by acute cervical spinal cord injury (quadriplegia) is associated with neurocognitive dysfunction and sleepiness and is likely to impair rehabilitation. To determine whether 3 months of autotitrating CPAP would improve neurocognitive function, sleepiness, quality of life, anxiety and depression more than usual care in acute quadriplegia. Multinational, randomised controlled trial (11 centres) from July 2009 to October 2015. The primary outcome was neurocognitive (attention and information processing as measure with the Paced Auditory Serial Addition Task). Daytime sleepiness (Karolinska Sleepiness Scale) was a priori identified as the most important secondary outcome. 1810 incident cases were screened. 332 underwent full, portable polysomnography, 273 of whom had an apnoea hypopnoea index greater than 10. 160 tolerated at least 4 hours of CPAP during a 3-day run-in and were randomised. 149 participants (134 men, age 46±34 years, 81±57 days postinjury) completed the trial. CPAP use averaged 2.9±2.3 hours per night with 21% fully 'adherent' (at least 4 hours use on 5 days per week). Intention-to-treat analyses revealed no significant differences between groups in the Paced Auditory Serial Addition Task (mean improvement of 2.28, 95% CI -7.09 to 11.6; p=0.63). Controlling for premorbid intelligence, age and obstructive sleep apnoea severity (group effect -1.15, 95% CI -10 to 7.7) did not alter this finding. Sleepiness was significantly improved by CPAP on intention-to-treat analysis (mean difference -1.26, 95% CI -2.2 to -0.32; p=0.01). CPAP did not improve Paced Auditory Serial Addition Task scores but significantly reduced sleepiness after acute quadriplegia. ACTRN12605000799651.
DOI: 10.1136/thoraxjnl-2018-212319
ORCID: 0000-0003-2543-8722
Journal: Thorax
PubMed URL: 30538163
Type: Journal Article
Subjects: sleep apnoea
Appears in Collections:Journal articles

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