Brown Jeanette P, Bauman Kristy A, Kurili Armando, Rodriguez Gianna M, Chiodo Anthony E, Sitrin Robert G, Schotland Helena M
Pulmonary and Critical Care Medicine Division, Department of Internal Medicine, University of Michigan Health System, Ann Arbor, MI, 48109, USA.
Department of Physical Medicine and Rehabilitation, University of Michigan Health System, Ann Arbor, MI, 48109, USA.
Spinal Cord. 2018 Aug;56(8):777-789. doi: 10.1038/s41393-018-0077-z. Epub 2018 Mar 7.
Prospective, cohort study.
To evaluate the effectiveness of bi-level positive airway pressure (PAP) therapy and the patterns of use for sleep-disordered breathing (SDB) in individuals with spinal cord injury (SCI).
Academic tertiary care center, USA.
Overall, 91 adults with C1-T6 SCI for ≥3 months were recruited and 74 remained in the study to be evaluated for SDB and follow-up. Individuals with SDB but no nocturnal hypercapnia (NH) were prescribed auto-titrating PAP. Those with NH were prescribed PAP with volume-assured pressure support. Device downloads and overnight transcutaneous capnography were performed at 3, 6, and 12 months to quantify PAP use and effectiveness. Participants kept daily event logs, and quality of life (QOL) questionnaires were performed after 3, 6, and 12 months.
Overall, 45% of 91 participants completed the study. There was great diversity among SCI patients in PAP utilization; after 3 months, 37.8% of participants used PAP for ≥70% nights and ≥240 min per night, whereas 42.2% seldom used PAP and 20% used PAP sporadically or for short periods. PAP therapy was effective in improving OSA in 89% and nocturnal hypercapnia in 77%. Higher PAP pressures predicted higher levels of device use. There were marked reductions in symptoms of autonomic dysreflexia (AD) and orthostatic hypotension as well as some improved indices of QOL.
Despite widely diverse patterns of use, PAP therapy may have short-term benefits with regard to QOL and reducing episodes of dizziness and autonomic dysreflexia.
前瞻性队列研究。
评估双水平气道正压通气（PAP）治疗对脊髓损伤（SCI）患者睡眠呼吸障碍（SDB）的有效性及使用模式。
美国学术性三级医疗中心。
总共招募了91名C1 - T6脊髓损伤≥3个月的成年人，74名留在研究中接受睡眠呼吸障碍评估及随访。有睡眠呼吸障碍但无夜间高碳酸血症（NH）的个体被处方自动调压PAP。有夜间高碳酸血症的个体被处方容量保证压力支持的PAP。在3个月、6个月和12个月时进行设备数据下载和夜间经皮二氧化碳监测，以量化PAP的使用情况和有效性。参与者记录每日事件日志，并在3个月、6个月和12个月后进行生活质量（QOL）问卷调查。
总体而言，91名参与者中有45%完成了研究。脊髓损伤患者在PAP使用方面存在很大差异；3个月后，37.8%的参与者每晚使用PAP≥70%的时间且每晚≥240分钟，而42.2%很少使用PAP，20%偶尔或短期使用PAP。PAP治疗对89%的阻塞性睡眠呼吸暂停（OSA）患者和77%的夜间高碳酸血症患者有效。较高的PAP压力预示着设备使用水平较高。自主神经反射异常（AD）和体位性低血压症状明显减轻，生活质量的一些指标也有所改善。
尽管使用模式差异很大，但PAP治疗在生活质量以及减少头晕和自主神经反射异常发作方面可能有短期益处。
