Department of Allied Health, Alfred Health, Melbourne, VIC, Australia.
Department of Allied Health, La Trobe University, Melbourne, VIC, Australia.
Spinal Cord. 2021 May;59(5):474-484. doi: 10.1038/s41393-020-00595-0. Epub 2021 Jan 14.
Systematic review with meta-analysis.
To determine the prevalence of sleep-disordered breathing (SDB) in people with tetraplegia and to identify the characteristics associated with SDB.
A systematic literature search using Medline, EMBASE, Cochrane Central Register of Controlled Trials (CENTRAL) and grey literature sources was conducted using a combination of spinal cord injury (SCI) and SDB related terms. Articles were restricted to publication dates between 1/1/2000 and 4/9/2020 and with objectively measured SDB with an overnight sleep study. The frequency of SDB stratified by the apnoea hypopnea index (AHI) was extracted and weighted averages, using a random effects model, were calculated with 95% confidence intervals. Sub-group analyses were performed where possible.
Twelve articles were included in the review; of these nine were included in meta-analysis (combined sample = 630). Sample sizes and case detection methods varied. Reported SDB prevalence rates ranged from 46 to 97%. The prevalence of at least mild (AHI ≥ 5), moderate (AHI ≥ 15) and severe (AHI ≥ 30) SDB were 83% (95% CI = 73-91), 59% (46-71) and 36% (26-46), respectively. Sub-group analyses found that prevalence increased with age (p < 0.001). There were no statistically significant differences in SDB prevalence by sex (p = 0.06), complete/incomplete SCI (p = 0.06), body mass index (p = 0.07), acute/chronic SCI (p = 0.73) or high/low level of cervical SCI (p = 0.90).
Our results confirm that SDB is highly prevalent in people with tetraplegia, and prevalence increases with age. The high prevalence suggests that routine screening and subsequent treatment should be considered in both acute and community care.
系统评价与荟萃分析。
确定四肢瘫痪患者睡眠呼吸障碍（SDB）的患病率，并确定与 SDB 相关的特征。
使用 Medline、EMBASE、Cochrane 中央对照试验注册中心（CENTRAL）和灰色文献资源，结合脊髓损伤（SCI）和 SDB 相关术语进行系统文献检索。文章的出版日期限制在 2000 年 1 月 1 日至 2020 年 4 月 9 日之间，并采用夜间睡眠研究进行客观测量的 SDB。提取 SDB 的呼吸暂停低通气指数（AHI）分层频率，并使用随机效应模型计算加权平均值，置信区间为 95%。在可能的情况下进行了亚组分析。
共纳入 12 篇文章进行综述；其中 9 篇文章纳入荟萃分析（合并样本量=630）。样本量和病例检出方法存在差异。报告的 SDB 患病率范围为 46%至 97%。至少轻度（AHI≥5）、中度（AHI≥15）和重度（AHI≥30）SDB 的患病率分别为 83%（95%CI=73-91）、59%（46-71）和 36%（26-46）。亚组分析发现，患病率随年龄增长而增加（p<0.001）。性别（p=0.06）、完全/不完全 SCI（p=0.06）、体重指数（p=0.07）、急性/慢性 SCI（p=0.73）或高/低水平颈段 SCI（p=0.90）对 SDB 患病率无统计学差异。
我们的研究结果证实，SDB 在四肢瘫痪患者中高度普遍，且患病率随年龄增长而增加。高患病率表明，在急性和社区护理中都应考虑常规筛查和随后的治疗。
