脊髓损伤患者的睡眠呼吸暂停

Sleep apnea in individuals with spinal cord injury.

作者信息

Sankari Abdulghani, Aldwaikat Ahmad, Habra Moustafa, Salloum Anan, Zeineddine Salam, Pandya Nishtha, Martin Jennifer L, Badr M Safwan

机构信息

Department of Medicine, John D. Dingell VA Medical Center, Detroit, Michigan.

Department of Internal Medicine, Wayne State University, Detroit, Michigan.

出版信息

J Clin Sleep Med. 2025 Sep 1;21(9):1529-1537. doi: 10.5664/jcsm.11752.

DOI:10.5664/jcsm.11752

PMID:40353318

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC12406842/

Abstract

STUDY OBJECTIVES

To determine the rate of sleep-disordered breathing (SDB) in individuals with spinal cord injury (SCI) and its types (central sleep apnea and obstructive sleep apnea, and a comorbid central and obstructive sleep apnea and to assess the response to treatment using positive airway pressure (PAP) (defined as an apnea-hypopnea index (AHI) of less than 5 events/h on initial PAP titration) in individuals with SCI.

METHODS

Individuals with SCI who underwent a full night of diagnostic polysomnography from 2010-2024 to determine the type of SDB and its severity using the AHI and central apnea index. The inclusion criteria were individuals with chronic SCI at low cervical or thoracic (at C4-T6 levels) who are not mechanically ventilated or had tracheostomies. "Central sleep apnea" is diagnosed with an AHI of 5+ events/h and a central apnea index of at least 50% of the AHI. "Obstructive sleep apnea only" is identified by an AHI of 5+ events/h and a central apnea index of less than 5 events/h. Comorbid central and obstructive sleep apnea is characterized by an AHI of 5+ events/h, with a central apnea index over 5 events/h but under 50% of the total AHI. The positive response to PAP therapy was based on the AHI level of less than 5 events/h after initiating PAP treatment and based on remote monitoring data.

RESULTS

Among the 81 individuals who met the inclusion criteria, 12 patients (15%) were diagnosed with comorbid central and obstructive sleep apnea, 4 patients (5%) presented with central sleep apnea only, 56 patients (69%) had obstructive sleep apnea, and 8 patients (10%) exhibited no SDB. In a subset of participants (n = 51) hypopneas were classified as obstructive or central events based on American Academy of Sleep Medicine definition and revealed that approximately one-third (32%) had central or comorbid central and obstructive sleep apnea, 63% had obstructive sleep apnea, and 6% did not have SDB on polysomnography. A total of 35 (47%) individuals diagnosed with SDB underwent PAP titration and were prescribed PAP. Twenty (27%) individuals received PAP treatment, and only 17 (23%) continued their use for the initial 3 months. Only 11 patients (15%) demonstrated responsiveness to PAP on day 90 (AHI < 5 events/h during therapy).

CONCLUSIONS

SDB is extremely common in individuals with SCI. The efficacy of PAP therapy is suboptimal, and adherence rates decline significantly over time.

CITATION

Sankari A, Aldwaikat A, Habra M, et al. Sleep apnea in individuals with spinal cord injury. . 2025;21(9):1529-1537.

摘要

研究目的

确定脊髓损伤（SCI）患者的睡眠呼吸障碍（SDB）发生率及其类型（中枢性睡眠呼吸暂停和阻塞性睡眠呼吸暂停，以及中枢性和阻塞性睡眠呼吸暂停合并症），并评估SCI患者使用气道正压通气（PAP）治疗的反应（定义为初始PAP滴定期间呼吸暂停低通气指数（AHI）小于5次/小时）。

方法

2010年至2024年期间接受整夜诊断性多导睡眠图检查的SCI患者，使用AHI和中枢性呼吸暂停指数确定SDB的类型及其严重程度。纳入标准为低颈段或胸段（C4-T6水平）慢性SCI患者，且未进行机械通气或气管切开术。“中枢性睡眠呼吸暂停”的诊断标准为AHI≥5次/小时且中枢性呼吸暂停指数至少占AHI的50%。“仅阻塞性睡眠呼吸暂停”的定义为AHI≥5次/小时且中枢性呼吸暂停指数小于5次/小时。中枢性和阻塞性睡眠呼吸暂停合并症的特征为AHI≥5次/小时，中枢性呼吸暂停指数超过5次/小时但低于总AHI的50%。对PAP治疗的阳性反应基于开始PAP治疗后AHI水平小于5次/小时，并基于远程监测数据。

结果

在符合纳入标准的81名患者中，12例（15%）被诊断为中枢性和阻塞性睡眠呼吸暂停合并症，4例（5%）仅表现为中枢性睡眠呼吸暂停，56例（69%）有阻塞性睡眠呼吸暂停，8例（10%）未出现SDB。在一部分参与者（n = 51）中，根据美国睡眠医学学会的定义，低通气被分类为阻塞性或中枢性事件，结果显示约三分之一（32%）有中枢性或中枢性和阻塞性睡眠呼吸暂停合并症，63%有阻塞性睡眠呼吸暂停，6%在多导睡眠图检查中未出现SDB。共有35例（47%）被诊断为SDB的患者接受了PAP滴定并被开具了PAP。20例（27%）患者接受了PAP治疗，只有17例（23%）在最初3个月持续使用。只有11例患者（15%）在第90天显示对PAP有反应（治疗期间AHI < 5次/小时）。