Continuous Positive Airway Pressure use for Obstructive Sleep Apnea in Acute, Traumatic Tetraplegia.

Abstract

To describe continuous positive airway pressure (CPAP) use for treatment of obstructive sleep apnea (OSA) in acute tetraplegia, including adherence rates and associated factors. Secondary analysis of CPAP data from a multinational randomized controlled trial. Inpatient rehabilitation units of 11 spinal cord injury centres. People with acute, traumatic tetraplegia and OSA. Auto-titrating CPAP for OSA for three months. Adherence measured as mean daily hours of use. Adherent (yes/no) was defined as an average of at least four hours a night throughout the study. Regression analyses determined associations between baseline factors and adherence. CPAP device pressure and leak data were analysed descriptively. 79 participants from 10 spinal units (91% male, mean age 46 (SD=16), 78 (SD=64) days post-injury) completed the study in the treatment arm and 33% were adherent. Mean daily CPAP use was 2.9 hours (SD=2.3). Better adherence was associated with more severe OSA (p=0.04), and greater CPAP use in the first week (p<0.01). Average 95th percentile pressure was low (9.3cmH2O; SD=1.7) and 95th percentile leak was high (27.1L/min; SD=13.4). Adherence to CPAP following acute, traumatic tetraplegia is low. Early acceptance of therapy and more severe OSA predict CPAP use over three months. People with acute tetraplegia require less pressure to treat their OSA than the non-disabled; however, air leak is high. These findings highlight the need for further investigation of OSA treatment in acute tetraplegia.