A longitudinal evaluation of sleep and breathing in the first year after cervical spinal cord injury.
OBJECTIVE
To establish the incidence of sleep disordered breathing (SDB) after acute tetraplegia and to determine the relation between the Apnea-Hypopnea Index (AHI) score and the previously postulated predictors of SDB in tetraplegia.


METHODS
Inception cohort. We performed full polysomnography immediately after acute tetraplegia and at 2, 4, 13, 26, and 52 weeks postinjury. Spirometry, maximum inspiratory and expiratory pressures, medication usage, and neck and abdominal girth were also assessed. Preinjury SDB was estimated using the multivariate apnea prediction equation.


METHODS
Acute care, subacute care, and community.


METHODS
Consecutive sample with acute tetraplegia. Thirty subjects (25 men) were initially included. Thirteen completed 12 months of follow-up.


METHODS
Not applicable.


METHODS
SDB (AHI score >10 events/h) and respiratory function.


RESULTS
Three subjects (10%; 95% confidence interval [CI], 2%-28%) had probable SDB before injury. In the first 48 hours after injury, no subject had SDB. At 2 weeks, 60% (95% CI, 26%-88%) had SDB; at 4 weeks, 62% (95% CI, 38%-82%); at 13 weeks, 83% (95% CI, 61%-95%); at 26 weeks, 68% (95% CI, 44%-88%); and at 52 weeks, 62% (95% CI, 32%-86%). No consistent relation was found between the previously postulated predictors and SDB.


CONCLUSIONS
SDB is highly prevalent within 4 weeks of acute tetraplegia.
Berlowitz
David J
DJ
Institute for Breathing and Sleep, Austin Health, Studley Road, Heidelberg, Victoria 3084, Australia.
Brown
Douglas J
DJ
Campbell
Donald A
DA
Pierce
Robert J
RJ
D000005:Abdomen / Q000254:growth & development; D000293:Adolescent; D000328:Adult; D000368:Aged; D014151:Anti-Anxiety Agents / Q000627:therapeutic use; D000928:Antidepressive Agents / Q000627:therapeutic use; D001418:Baclofen / Q000627:therapeutic use; D002574:Cervical Vertebrae / Q000293:injuries*; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009125:Muscle Relaxants, Central / Q000627:therapeutic use; D009333:Neck / Q000254:growth & development; D017286:Polysomnography; D011446:Prospective Studies; D011782:Quadriplegia / Q000150:complications* / Q000188:drug therapy; D012129:Respiratory Function Tests; D012891:Sleep Apnea Syndromes / Q000209:etiology*; D013119:Spinal Cord Injuries / Q000150:complications* / Q000188:drug therapy; D013997:Time Factors
D014151:Anti-Anxiety Agents; D000928:Antidepressive Agents; D009125:Muscle Relaxants, Central; D001418:Baclofen