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

Abstract

Over 80% of people with tetraplegia have sleep disordered breathing, but whether this is predominantly obstructive or central is unclear. This study aimed to estimate the prevalence of central sleep apnoea (CSA) in tetraplegia and the contributions of central, obstructive and hypopnoea respiratory events to sleep disordered breathing summary indices in tetraplegia. 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 apnoea index ≥5 and more central than obstructive apnoeas) and Any CSA (central apnoea index ≥5) was estimated. Prevalence of sleep-related hypoventilation was estimated in a clinical sub-cohort. Respiratory events were primarily hypopnoeas (71%), followed by obstructive (23%), central (4%) and mixed apnoeas (2%). As severity increased, the relative contribution of hypopnoeas and central apnoeas decreased, while that of obstructive apnoeas 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. Sleep-related hypoventilation was identified in 26% (26/113) of the clinical sub-cohort. This is the largest study to characterize sleep disordered breathing in tetraplegia. It provides strong evidence that obstructive sleep apnoea is the predominant sleep disordered breathing type; 9-18 times more prevalent than CSA. The prevalence of CSA was estimated to be 4-8%, significantly lower than previously reported.