Sleep apnea higher in tetraplegics

[Wise Young]

• Burns SP, Kapur V, Yin KS and Buhrer R (2001). Factors associated with sleep apnea in men with spinal cord injury: a population-based case-control study. Spinal Cord. 39 (1): 15-22. Summary: OBJECTIVE: To characterize a population of spinal cord injury (SCI) patients with sleep apnea, and to determine associated factors and comorbidities. STUDY DESIGN: Population-based retrospective case- control study. SUBJECTS: 584 male patients served by a Veterans Affairs SCI service. MEASURES: Medical records were reviewed for sleep apnea diagnosis, demographic information, neurologic characteristics, and treatments received. Sleep study reports were not available to determine the nature of abnormal respiratory events (ie central, obstructive, hypoventilation). For each case with tetraplegia, a control tetraplegic subject without sleep apnea diagnosis was selected. RESULTS: We identified 53 subjects with diagnosed sleep apnea: 42 tetraplegic, 11 paraplegic. This represented 14.9% of all tetraplegic and 3.7% of all paraplegic patients in the population (P<0.0001 for comparison of tetraplegic and paraplegic proportions). In tetraplegic subjects, sleep apnea was associated with obesity and more rostral motor level, but not with ASIA Impairment Scale. Medical comorbidities associated with sleep apnea in non-SCI patients, such as hypertension, were more common in case subjects. Less than half of case subjects were receiving some form of treatment. For motor-complete tetraplegics, long- term positive airway pressure treatment was less common with motor level C5 and above compared to C6 and below. CONCLUSION: In this population, sleep apnea has been frequently diagnosed, particularly in tetraplegic subjects. The true prevalence is likely to be considerably higher, since this study considered only previously diagnosed cases. Sleep apnea was associated with obesity and higher neurologic level, but not ASIA Impairment Scale. Medical comorbidities were more frequent in this group, and treatment acceptance was poor with higher level motor-complete injuries. Since the type of sleep apnea [central or obstructive) was not distinguished, we cannot comment on the prevalence and associations based on specific types of sleep apnea. <http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?db=m&form=6&dopt=r&uid=11224009> Department of Rehabilitation Medicine, University of Washington, Seattle, Washington, USA.

[Wise Young]

While we have known for a long time that people with tetraplegia have a higher incidence of sleep apnea (breathing difficulties while sleeping), it is more prevalent that I thought, i.e. nearly 15% of the tetraplegic population. It is also interesting that while sleep apnea incidence correlates with injury level and obesity, it does not correlate with injury severity.

[harper]

dr. young, i'm wondering if the conclusion that sleep apnea is most prevalent in obese people may be flawed...i was always a loud snorer and always slim...eventually i developed sleep apnea but it was long before the condition became well known and treated with cpap/bipap machines...by the time i saw a feature on television about sleep apnea and sought treatment i had gained a very signifigant amount of weight...my, then, wife saw the program and recognized the description of apneas and told me that was what i had been doing in my sleep for years...i sought treatment and using the bipap machine literally gave me a new life but the weight was already there and i haven't ever rid myself of most of it...my question is if there is any data that reverses the obesity/apnea conclusion...sleep apnea causing a change to a slow metabolism, as well as inactivity, resulting in uncharacteristic weight gain,,,that is what occured in my case,,,tedEbear

[Noel]

I have Sleep Apnea, I hate it. Some nights its like being murdered in your sleep, but repeatedly. It gives me frightening dreams of death.

Noel

[SCI-Nurse]

Noel: To help you sleep better, you may want to see your practitioner for a referral to be evaluated for sleep apnea. Treatment is fairly simple (CPAP/BIPAP), although some people do not like it.

As far as I know, all insurance will pay for it (commercial or government).

[harper]

noel, i can't stress how much of a difference you will notice in your life if you get treatment for your apnea...do you find yourself nodding off?...depression?...unable to concentrate?...on top of the sleeping difficulties?...i had as many as 100 apneas per hour lasting as long as 1 minute...i thought my life was over,,,then i tuffed it out using the bipap machine until i got used to it and, suddenly, i was back to being a human,,,i feel it literally gave me my life back...it's been 8 years now,,,medicare pays the bills...and i would strongly recommend you call a sleep center or specialist asap...and tuff out the first few nights...you will feel 100% better in about a week,,,tedEbear

[Noel]

Originally posted by SCI-Nurse:

Noel: To help you sleep better, you may want to see your practitioner for a referral to be evaluated for sleep apnea. Treatment is fairly simple (CPAP/BIPAP), although some people do not like it.

I know I should do this but keep putting it off. As a quad living alone the treatment, headgear, appears not to be that simple. I doubt my ability to put the apparatus on and off. Nevertheless, I must be evaluated and treated, this sleep problem is wearing me down.

Noel

[This message was edited by Noel on September 09, 2001 at 05:42 PM.]

[Noel]

Jeff, thank you for the input your words are encouraging.

Originally posted by jeffh55:
noel, i can't stress how much of a difference you will notice in your life if you get treatment for your apnea...do you find yourself nodding off?...depression?...unable to concentrate?...on top of the sleeping difficulties?...

The nodding off is embarrassing. I try to take cat naps to prevent it. Depression is not a problem but I suspect my concentration is impaired.

i had as many as 100 apneas per hour lasting as long as 1 minute...i thought my life was over,,,then i tuffed it out using the bipap machine until i got used to it

If you don't mind, can you outline what you went through and how you treat apnea now?

Thanks again...

Noel

[harper]

noel, when i started treatment it included 2 nights in the the sleep lab at the hospital but things have changed since then,,,you need to have a sleep study done,,,they will determine what machine you need and what settings are needed,,,they will orescribe a cpap or bipap machine for you,,,respironics makes a machine with a mask/headgear set up that can be managed...imho...by an independent quad...i prefer the old one they dont make anymore but such is life...for reference it is the blue head gear for a respironics cpap/bipap machine...tedEbear

[Scorpion]

A friend of mine who's an A/B had sleep apnea, and after he had a sleep study and was fitted with a mouthpiece, he says it has been a huge improvement in his life. Now, if I could convince my Dad to get a sleep study done...

~Rus

"Because you're not promised tomorrow." ~ Stuck Mojo

[SCI-Nurse]

I would encourage anyone who has a SCI to be aware of the importance of screening for sleep apnea.

At our center we discover many cases of this that were previously undiagnosed in people with SCI when they are admitted for other problems, simply by our night nurses being vigilant in watching for unusual snoring, breathing cessation, excessive sleepiness during the day, AM headache and other symptoms. Since many people with SCI sleep in a separate room from their spouse or family, this may not have been previously observed.

A sleep study is fairly easy to do (you do have to spend the night in a sleep lab usually). In addition to the fatigue issues, sleep apnea puts enormous strain on your heart and has been implicated in sudden cardiac arrests, esp. in younger people. (KLD)

[bruce]

I was diagnosed with "moderate" sleep apnea about 6 weeks after my injury as part of a study done at Harborview Hospital in Seattle. Actually sleeping with all the stuff they had on me was hell anyway, and I could not tolerate the cpap.

My wife had been monitoring my breathing anyway and said that early on (&lt; 2 weeks post injury) I would have looong apnea episodes (30 seconds or more). Now, I don't have any symptoms .. I sleep well. I am now 6 months post injury, C6 incomplete.

[dw]

Thank you for posting this important information as I was diagnosed, c4-5, recently with severe sleep apnea. I too had dreams of death and difficulties Itried cpap Wednesday night for the first time. I understand that its affected by your position and I sleep on my back -- the worst thing. I havent come up with a way to sleep on my stomach. I feel run down, tired and drained.