Department of Respiratory Medicine, Princess Alexandra Hospital, Woolloongabba, Queensland, Australia.
Respirology. 2010 Feb;15(2):272-6. doi: 10.1111/j.1440-1843.2009.01669.x. Epub 2009 Nov 30.
Spinal cord-injured subjects were assessed during the acute admission for sleep-disordered breathing. Polysomnography demonstrated a high incidence of sleep apnoea that persisted during the acute phase. There was no correlation with respiratory function tests or measures of ventilatory control. Screening of this population is worthwhile although the clinical significance is uncertain.
Previous studies have demonstrated an increased incidence of sleep apnoea in spinal cord-injured patients. Many of these studies were performed in long-term, stable spinal cord injury (SCI). The aims of this study were: (i) to determine the prevalence of sleep-disordered breathing (SDB) in acute SCI; (ii) to document the change in SDB over time during the rehabilitation period; and (iii) to correlate the degree of SDB with ventilatory parameters.
Sixteen subjects with an acute SCI level T12 and above with complete motor impairment (American Spinal Injury Association impairment scale A or B) were recruited. Assessment, including polysomnography, respiratory function testing, and hypoxic and hypercapnic ventilatory responses, were performed 6-8 weeks post SCI, and repeated 6 months post SCI.
Eleven of 16 subjects (73%) had evidence of sleep apnoea, five of whom were moderate to severe. This high incidence persisted during the acute admission, with 9 of 12 subjects (75%) having sleep apnoea on polysomnography 20 weeks following injury. There was no correlation between the severity of SDB and other measures, such as level or completeness of injury, respiratory function tests or measures of ventilatory responses.
We have demonstrated a high incidence of sleep apnoea in the acute phase of SCI that persisted during the acute admission. Despite the high incidence of sleep apnoea, patients were relatively asymptomatic. Screening of this population would appear worthwhile given the high prevalence, although the significance of the sleep apnoea and clinical impact is not known.
先前的研究表明，脊髓损伤患者的睡眠呼吸暂停发病率增加。这些研究中的许多都是在长期稳定的脊髓损伤（SCI）中进行的。本研究的目的是：（i）确定急性 SCI 患者睡眠呼吸障碍（SDB）的患病率；（ii）记录康复期间 SDB 的时间变化；（iii）将 SDB 程度与通气参数相关联。
招募了 16 名急性 SCI 水平 T12 及以上且完全运动障碍（美国脊髓损伤协会损伤量表 A 或 B）的患者。评估包括多导睡眠图、呼吸功能测试以及低氧和高碳酸通气反应，分别在 SCI 后 6-8 周和 6 个月后进行。
16 名患者中有 11 名（73%）存在睡眠呼吸暂停的证据，其中 5 名患者为中重度。这种高发病率在急性入院期间持续存在，12 名患者中有 9 名（75%）在损伤后 20 周时多导睡眠图上存在睡眠呼吸暂停。SDB 的严重程度与其他措施（如损伤程度或完整性、呼吸功能测试或通气反应测量）之间无相关性。
我们已经证明了急性 SCI 患者在急性阶段睡眠呼吸暂停的高发病率，这种发病率在急性住院期间持续存在。尽管睡眠呼吸暂停的发病率很高，但患者相对无症状。鉴于高患病率，对该人群进行筛查似乎是值得的，尽管睡眠呼吸暂停的意义和临床影响尚不清楚。
