Positive airway pressure for sleep-disordered breathing in acute quadriplegia: a randomised controlled trial. Issue 3 (11th December 2018)

• Record Type: Journal Article
• Authors: Berlowitz, David J; Schembri, Rachel; 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
• Other Names: author non-byline.; Acland Rick author non-byline.; Alexander Janette L author non-byline.; Backwell Amber E author non-byline.; Booker Lauren author non-byline.; Chowdhury Joy R author non-byline.; Davies Amanda author non-byline.; Duce Brett author non-byline.; Dytor Rebecca author non-byline.; Fox Nurit author non-byline.; Allen Aj Hirsch author non-byline.; Hislop Denise M author non-byline.; Jones Rachel author non-byline.; Jones Teresa author non-byline.; Li Carol author non-byline.; Leigh Meghan author non-byline.; Leighton Sarah author non-byline.; Maclellan Louise author non-byline.; Middleton Victoria author non-byline.; Millard Melinda S author non-byline.; Nier Lianne author non-byline.; O'keeffe Lynne author non-byline.; Osman Aheed author non-byline.; Patti Jessica author non-byline.; Pick Valerie author non-byline.; Ruehland Warren R author non-byline.; Spong Jo author non-byline.; Sutherland Kate author non-byline.; Van lit Amber M author non-byline.; Whittall Catherine author non-byline.
• Is Part Of: Thorax. Volume 74:Issue 3(2019)
• Page Start: 282
• Page End: 290
• Publication Date: 2018-12-11
• Subjects: sleep apnoea; Chest -- Diseases -- Periodicals; Thorax; Chest -- Diseases; Periodicals; Periodicals; 617.54
• DOI: 10.1136/thoraxjnl-2018-212319
• Languages: English
• ISSNs: 0040-6376

Abstract

Abstract : Rationale: 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. Objective: 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. Methods and measurements: 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. Main results: 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). Conclusion: CPAP did not improve Paced Auditory Serial Addition Task scores but significantly reduced sleepiness after acute quadriplegia. Trial registration number: ACTRN12605000799651.