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Clinical, Epidemiological and Polysomnographic Aspects in Patients with Spinal Cord Injury
Sleep breathing disorders (SBD) is very prevalent in patients with Spinal cord injury (SCI). However, predisposing and related factors have been under debate in the last years.
To analyze patients with SCI and SBD and compare the aspects found between the different levels of lesion, the polysomnographic results, as well as the clinical profile. To ask if the sleep questionnaires are useful for screening proposals in this specific group.
In a cross sectional study, 18 individuals with SCI were submitted to type I polysomnography (PSG) with transcutaneous capnography, Berlin and Pittsburg Questionnaires (BQ and PSQI) and Functional Independence Measure Scale (FIM). Inclusion criteria: Traumatic SCI with sleep complaints. Some data came from medical records. Each participant had the body mass index (BMI), neck (NC) and abdominal (AC) circumferences measured. They also fulfilled the questionnaires and scales before PSG.
Of the participants, 72,2 % were men; age of 47,44 ± 11,78 years; BMI 25,38 ± 3,57 kg/m2; NC 41,06 ± 5 cm; AC 105,2 ± 17,46 cm; 7 cervical, 8 thoracic, and 3 lumbar levels; time of lesion 11,62 ± 6,92; 55,56% ASIA A, 16,66% ASIA B and C, 11,11% ASIA D. The BQ showed high risk for sleep apnea in 61,11% and the PSQI revealed bad sleep quality in 94,45%. The PSG depicted: 77,78 % of sleep apnea (72,22% obstructive and 16% central); periodic leg movements (PLM) 11,11%; nocturnal hypoventilation 16,67%; and central sleep apnea (CSA) with Cheyne Stokes pattern 11,11 %. The group with cervical lesion had 3,93 more risk for severe apnea (CI 95%) and were more predisposed to CSA and hypoventilation. There was a statistically positive correlation between AC and sleep apnea. The FIM unveiled that the more dependent functionally was the participant, the more severe was the SBD; this may be due to the lesion level.
The majority of SCI individuals related bad sleep quality. The tetraplegic group presented more severe SBD. There was association between apnea severity, higher levels of tetraplegy and CSA. The BQ and PSQI can be useful as a screening test before PSG.
Spinal Cord Injury; Sleep-wake Disorders; Sleep Apnea; Polysomnography; Survey and Questionnaires; Sleep Breathing Disorders.
ANA CAROLINA DE SOUZA CRUZ, CARLA SILVA DE ARAUJO, PATRICIA SOUZA BASTOS, ANA PAULA SILVA CHAMPS