Burns S P, Kapur V, Yin K S, Buhrer R
Department of Rehabilitation Medicine, University of Washington, Seattle, Washington, USA.
Spinal Cord. 2001 Jan;39(1):15-22. doi: 10.1038/sj.sc.3101103.
To characterize a population of spinal cord injury (SCI) patients with sleep apnea, and to determine associated factors and comorbidities.
Population-based retrospective case-control study.
584 male patients served by a Veterans Affairs SCI service.
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.
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.
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.
对患有睡眠呼吸暂停的脊髓损伤（SCI）患者群体进行特征描述，并确定相关因素和合并症。
基于人群的回顾性病例对照研究。
584名由退伍军人事务脊髓损伤服务机构服务的男性患者。
查阅病历以获取睡眠呼吸暂停诊断、人口统计学信息、神经学特征及接受的治疗情况。无法获取睡眠研究报告以确定异常呼吸事件的性质（即中枢性、阻塞性、通气不足）。对于每例四肢瘫痪患者，选择一名未被诊断为睡眠呼吸暂停的对照四肢瘫痪患者。
我们识别出53例被诊断为睡眠呼吸暂停的患者：42例四肢瘫痪，11例截瘫。这分别占该人群中所有四肢瘫痪患者的14.9%和所有截瘫患者的3.7%（四肢瘫痪和截瘫比例比较，P<0.0001）。在四肢瘫痪患者中，睡眠呼吸暂停与肥胖及更高的脊髓运动平面相关，但与美国脊髓损伤协会（ASIA）损伤分级无关。非脊髓损伤患者中与睡眠呼吸暂停相关的内科合并症，如高血压，在病例组中更为常见。不到一半的病例组患者接受了某种形式的治疗。对于运动完全性四肢瘫痪患者，与C6及以下平面相比，C5及以上平面的患者接受长期气道正压治疗的情况较少。
在该人群中，睡眠呼吸暂停的诊断较为常见，尤其是在四肢瘫痪患者中。由于本研究仅考虑了先前已诊断的病例，实际患病率可能会高得多。睡眠呼吸暂停与肥胖及更高的神经学平面相关，但与ASIA损伤分级无关。该组内科合并症更为常见，且运动完全性损伤平面较高的患者对治疗的接受度较差。由于未区分睡眠呼吸暂停的类型（中枢性或阻塞性），我们无法基于特定类型的睡眠呼吸暂停对患病率及相关性进行评论。
