title: Characteristics of sleep apnea syndrome in tetraplegic patients.
abstract: OBJECTIVE
  To include a larger number of tetraplegics than in previous studies, in order to more reliably characterize the pathogenesis and predisposing factors of sleep apnea in tetraplegia.
  
  
  METHODS
  Sleep breathing data and oxymetric values were investigated in 50 randomly selected tetraplegic patients and discussed in context with age, gender, BMI, neck circumference, type and height of lesion, time after injury, spirometric values and medication. A non-validated short questionnaire on daytime complaints was added.
  
  
  RESULTS
  Thirty-one patients out of 50 had an RDI > or =15, defined as sleep disordered breathing (SDB); 24 of them combined with an apnea index of 5 or more, these cases were diagnosed as sleep apnea syndrome (SAS). SAS was apparent in 55% and 20% of the studied men and women, respectively. Regression analyses showed no significant correlation between RDI and lesion level, ASIA impairment scale or spirometric values. In contrast, a significant correlation between RDI and age, BMI, neck circumference and time after injury could be shown. Kruskal-Wallis test for dichotomous non-parametric factors, such as gender, cardiac medication and daytime complaints, showed significant differences with regard to RDI. In contrast to able-bodied people with SAS, daytime complaints were only present in tetraplegic patients with severe pathology (RDI>40).
  
  
  CONCLUSIONS
  Incidence of SAS is high in tetraplegia, particularly in older male patients with large neck circumference, long standing spinal cord injury and under cardiac medication. As tetraplegics with RDI between 15 and 40 reported no daytime complaints and often have normal BMI, these tetraplegics are not clinically suspicious for SAS. The increased use of cardiac medication in tetraplegics with SAS may implicate a link between SAS and cardiovascular morbidity, one of the leading causes of death in tetraplegia.
authors.affiliation: Swiss Paraplegic Center, Nottwil, Switzerland.
authors.forename: E
authors.initials: E
authors.lastname: Stockhammer
authors.forename: A
authors.initials: A
authors.lastname: Tobon
authors.forename: F
authors.initials: F
authors.lastname: Michel
authors.forename: P
authors.initials: P
authors.lastname: Eser
authors.forename: W
authors.initials: W
authors.lastname: Scheuler
authors.forename: W
authors.initials: W
authors.lastname: Bauer
authors.forename: M
authors.initials: M
authors.lastname: Baumberger
authors.forename: W
authors.initials: W
authors.lastname: Müller
authors.forename: T H
authors.initials: TH
authors.lastname: Kakebeeke
authors.forename: H
authors.initials: H
authors.lastname: Knecht
authors.forename: G A
authors.initials: GA
authors.lastname: Zäch
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000886:Anthropometry; D002574:Cervical Vertebrae; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement / Q000379:methods*; D017286:Polysomnography / Q000379:methods*; D011175:Positive-Pressure Respiration; D011782:Quadriplegia / Q000150:complications*; D015203:Reproducibility of Results; D012129:Respiratory Function Tests / Q000379:methods; D012143:Respiratory Physiological Phenomena; D012307:Risk Factors; D012680:Sensitivity and Specificity; D012891:Sleep Apnea Syndromes / Q000175:diagnosis* / Q000209:etiology* / Q000503:physiopathology / Q000628:therapy; D013119:Spinal Cord Injuries / Q000150:complications*; D016896:Treatment Outcome