title: The feasibility of using auto-titrating continuous positive airway pressure to treat obstructive sleep apnoea after acute tetraplegia.
abstract: METHODS
  A prospective cohort with acute tetraplegia.
  
  
  OBJECTIVE
  Obstructive sleep apnoea (OSA) is common within weeks of tetraplegia. This study aimed at determining the feasibility of auto-titrating continuous positive airway pressure (CPAP) to treat OSA after acute tetraplegia.
  
  
  METHODS
  The Victorian Spinal Cord Service, Melbourne, Australia.
  
  
  METHODS
  Participants underwent full, portable polysomnography. Those with an apnoea hypopnoea index of more than 10 events per hour were defined as having OSA and were offered treatment with CPAP. Treatment adherence was objectively monitored, and measures of quality of life, sleepiness and functional outcomes were determined at enrollment and 3 months later at study conclusion.
  
  
  RESULTS
  A total of 44 patients were admitted to our Spinal Cord Service over 9 months, and 19 participated. Fourteen of them had OSA and seven were adherent with therapy for 3 months. Compared with those who did not have OSA, and with those with OSA who were not adherent with CPAP, those who adhered to CPAP were older (mean (s.d.) age 54 years (13) versus non-adherent 28 years (15) and no OSA 29 years (10)) and heavier (body mass index (BMI) 32.5 (11.7), 24.1 (3.7) and 20.6 (3.1), respectively). CPAP-adherant patients and those without OSA showed a 50% or greater improvement in their state sleepiness over the 3 months. Patients with OSA who did not tolerate CPAP had no improvement in sleepiness.
  
  
  CONCLUSIONS
  Auto-titrating CPAP is a feasible treatment for OSA in acute tetraplegia. Intensive clinical support was required initially, and a tolerance of therapy for at least 4 h for one of the first 3 days was predictive of good CPAP usage.
  
  
  BACKGROUND
  Transport Accident Commission.
authors.affiliation: Institute for Breathing and Sleep, Austin Hospital, Melbourne, Victoria, Australia. david.berlowitz@austin.org.au
authors.forename: D J
authors.initials: DJ
authors.lastname: Berlowitz
authors.forename: Jo
authors.initials: J
authors.lastname: Spong
authors.forename: R J
authors.initials: RJ
authors.lastname: Pierce
authors.forename: J
authors.initials: J
authors.lastname: Ross
authors.forename: M
authors.initials: M
authors.lastname: Barnes
authors.forename: D J
authors.initials: DJ
authors.lastname: Brown
mesh_terms: D000328:Adult; D017677:Age Distribution; D000367:Age Factors; D000368:Aged; D015992:Body Mass Index; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic; D010349:Patient Compliance; D017286:Polysomnography; D011175:Positive-Pressure Respiration / Q000295:instrumentation / Q000379:methods*; D011446:Prospective Studies; D011782:Quadriplegia / Q000150:complications* / Q000503:physiopathology; D011788:Quality of Life; D012133:Respiratory Paralysis / Q000150:complications / Q000503:physiopathology; D012890:Sleep / Q000502:physiology; D020181:Sleep Apnea, Obstructive / Q000209:etiology* / Q000503:physiopathology / Q000628:therapy*; D012894:Sleep Stages; D016896:Treatment Outcome; D055815:Young Adult