Positive airway pressure for sleep-disordered breathing in acute quadriplegia

a randomised controlled trial

David J Berlowitz, Rachel Schembri, Marnie Graco, Jacqueline M Ross, Najib Ayas, Ian Gordon, Bonne Lee, Allison Graham, Susan V. Cross, Martin McClelland, Paul Kennedy, Pradeep Thumbikat, Cynthia Bennett, Andrea Townson, Timothy J Geraghty, Sue Pieri-Davies, Raj Singhal, Karen Marshall, Deborah Short, Andrew Nunn & 5 others Duncan Mortimer, Doug Brown, Robert J Pierce, Peter A Cistulli, the COSAQ Collaborative

Research output: Contribution to journalArticleResearchpeer-review

Abstract

Rationale: Highly prevalent and severe sleep-disordered breathing caused by acute cervical spinal cord injury (quadriplegia) is associated with neurocognitive dysfunction and sleepiness and is likely to impair rehabilitation.
Objective: To determine whether 3 months of autotitrating CPAP would improve neurocognitive function, sleepiness, quality of life, anxiety and depression more than usual care in acute quadriplegia.
Methods and measurements: Multinational, randomised controlled trial (11 centres) from July 2009 to October 2015. The primary outcome was neurocognitive (attention and information processing as measure with the Paced Auditory Serial Addition Task). Daytime sleepiness (Karolinska Sleepiness Scale) was a priori identified as the most important secondary outcome.
Main results: 1810 incident cases were screened. 332 underwent full, portable polysomnography, 273 of whom had an apnoea hypopnoea index greater than 10. 160 tolerated at least 4 hours of CPAP during a 3-day run-in and were randomised. 149 participants (134 men, age 46±34 years, 81±57 days postinjury) completed the trial. CPAP use averaged 2.9±2.3 hours per night with 21% fully â € adherent' (at least 4 hours use on 5 days per week). Intention-to-treat analyses revealed no significant differences between groups in the Paced Auditory Serial Addition Task (mean improvement of 2.28, 95% CI â '7.09 to 11.6; p=0.63). Controlling for premorbid intelligence, age and obstructive sleep apnoea severity (group effect â '1.15, 95% CI â '10 to 7.7) did not alter this finding. Sleepiness was significantly improved by CPAP on intention-to-treat analysis (mean difference â '1.26, 95% CI â '2.2 to -0.32; p=0.01).
Conclusion: CPAP did not improve Paced Auditory Serial Addition Task scores but significantly reduced sleepiness after acute quadriplegia. Trial registration number: ACTRN12605000799651.

Original languageEnglish
Pages (from-to)282-290
Number of pages9
JournalThorax
Volume74
Issue number3
DOIs
Publication statusPublished - Mar 2019

Keywords

  • sleep apnoea

Cite this

Berlowitz, D. J., Schembri, R., Graco, M., Ross, J. M., Ayas, N., Gordon, I., ... the COSAQ Collaborative (2019). Positive airway pressure for sleep-disordered breathing in acute quadriplegia: a randomised controlled trial. Thorax, 74(3), 282-290. https://doi.org/10.1136/thoraxjnl-2018-212319
Berlowitz, David J ; Schembri, Rachel ; Graco, Marnie ; Ross, Jacqueline M ; Ayas, Najib ; Gordon, Ian ; Lee, Bonne ; Graham, Allison ; Cross, Susan V. ; McClelland, Martin ; Kennedy, Paul ; Thumbikat, Pradeep ; Bennett, Cynthia ; Townson, Andrea ; Geraghty, Timothy J ; Pieri-Davies, Sue ; Singhal, Raj ; Marshall, Karen ; Short, Deborah ; Nunn, Andrew ; Mortimer, Duncan ; Brown, Doug ; Pierce, Robert J ; Cistulli, Peter A ; the COSAQ Collaborative. / Positive airway pressure for sleep-disordered breathing in acute quadriplegia : a randomised controlled trial. In: Thorax. 2019 ; Vol. 74, No. 3. pp. 282-290.
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title = "Positive airway pressure for sleep-disordered breathing in acute quadriplegia: a randomised controlled trial",
abstract = "Rationale: Highly prevalent and severe sleep-disordered breathing caused by acute cervical spinal cord injury (quadriplegia) is associated with neurocognitive dysfunction and sleepiness and is likely to impair rehabilitation. Objective: To determine whether 3 months of autotitrating CPAP would improve neurocognitive function, sleepiness, quality of life, anxiety and depression more than usual care in acute quadriplegia. Methods and measurements: Multinational, randomised controlled trial (11 centres) from July 2009 to October 2015. The primary outcome was neurocognitive (attention and information processing as measure with the Paced Auditory Serial Addition Task). Daytime sleepiness (Karolinska Sleepiness Scale) was a priori identified as the most important secondary outcome. Main results: 1810 incident cases were screened. 332 underwent full, portable polysomnography, 273 of whom had an apnoea hypopnoea index greater than 10. 160 tolerated at least 4 hours of CPAP during a 3-day run-in and were randomised. 149 participants (134 men, age 46±34 years, 81±57 days postinjury) completed the trial. CPAP use averaged 2.9±2.3 hours per night with 21{\%} fully {\^a} € adherent' (at least 4 hours use on 5 days per week). Intention-to-treat analyses revealed no significant differences between groups in the Paced Auditory Serial Addition Task (mean improvement of 2.28, 95{\%} CI {\^a} '7.09 to 11.6; p=0.63). Controlling for premorbid intelligence, age and obstructive sleep apnoea severity (group effect {\^a} '1.15, 95{\%} CI {\^a} '10 to 7.7) did not alter this finding. Sleepiness was significantly improved by CPAP on intention-to-treat analysis (mean difference {\^a} '1.26, 95{\%} CI {\^a} '2.2 to -0.32; p=0.01). Conclusion: CPAP did not improve Paced Auditory Serial Addition Task scores but significantly reduced sleepiness after acute quadriplegia. Trial registration number: ACTRN12605000799651.",
keywords = "sleep apnoea",
author = "Berlowitz, {David J} and Rachel Schembri and Marnie Graco and Ross, {Jacqueline M} and Najib Ayas and Ian Gordon and Bonne Lee and Allison Graham and Cross, {Susan V.} and Martin McClelland and Paul Kennedy and Pradeep Thumbikat and Cynthia Bennett and Andrea Townson and Geraghty, {Timothy J} and Sue Pieri-Davies and Raj Singhal and Karen Marshall and Deborah Short and Andrew Nunn and Duncan Mortimer and Doug Brown and Pierce, {Robert J} and Cistulli, {Peter A} and {the COSAQ Collaborative}",
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Berlowitz, DJ, Schembri, R, Graco, M, Ross, JM, Ayas, N, Gordon, I, Lee, B, Graham, A, Cross, SV, McClelland, M, Kennedy, P, Thumbikat, P, Bennett, C, Townson, A, Geraghty, TJ, Pieri-Davies, S, Singhal, R, Marshall, K, Short, D, Nunn, A, Mortimer, D, Brown, D, Pierce, RJ, Cistulli, PA & the COSAQ Collaborative 2019, 'Positive airway pressure for sleep-disordered breathing in acute quadriplegia: a randomised controlled trial', Thorax, vol. 74, no. 3, pp. 282-290. https://doi.org/10.1136/thoraxjnl-2018-212319

Positive airway pressure for sleep-disordered breathing in acute quadriplegia : a randomised controlled trial. / Berlowitz, David J; Schembri, Rachel; Graco, Marnie; Ross, Jacqueline M; Ayas, Najib; Gordon, Ian; Lee, Bonne; Graham, Allison; Cross, Susan V.; McClelland, Martin; Kennedy, Paul; Thumbikat, Pradeep; Bennett, Cynthia; Townson, Andrea; Geraghty, Timothy J; Pieri-Davies, Sue; Singhal, Raj; Marshall, Karen; Short, Deborah; Nunn, Andrew; Mortimer, Duncan; Brown, Doug; Pierce, Robert J; Cistulli, Peter A; the COSAQ Collaborative.

In: Thorax, Vol. 74, No. 3, 03.2019, p. 282-290.

Research output: Contribution to journalArticleResearchpeer-review

TY - JOUR

T1 - Positive airway pressure for sleep-disordered breathing in acute quadriplegia

T2 - a randomised controlled trial

AU - Berlowitz, David J

AU - Schembri, Rachel

AU - Graco, Marnie

AU - Ross, Jacqueline M

AU - Ayas, Najib

AU - Gordon, Ian

AU - Lee, Bonne

AU - Graham, Allison

AU - Cross, Susan V.

AU - McClelland, Martin

AU - Kennedy, Paul

AU - Thumbikat, Pradeep

AU - Bennett, Cynthia

AU - Townson, Andrea

AU - Geraghty, Timothy J

AU - Pieri-Davies, Sue

AU - Singhal, Raj

AU - Marshall, Karen

AU - Short, Deborah

AU - Nunn, Andrew

AU - Mortimer, Duncan

AU - Brown, Doug

AU - Pierce, Robert J

AU - Cistulli, Peter A

AU - the COSAQ Collaborative

PY - 2019/3

Y1 - 2019/3

N2 - Rationale: Highly prevalent and severe sleep-disordered breathing caused by acute cervical spinal cord injury (quadriplegia) is associated with neurocognitive dysfunction and sleepiness and is likely to impair rehabilitation. Objective: To determine whether 3 months of autotitrating CPAP would improve neurocognitive function, sleepiness, quality of life, anxiety and depression more than usual care in acute quadriplegia. Methods and measurements: Multinational, randomised controlled trial (11 centres) from July 2009 to October 2015. The primary outcome was neurocognitive (attention and information processing as measure with the Paced Auditory Serial Addition Task). Daytime sleepiness (Karolinska Sleepiness Scale) was a priori identified as the most important secondary outcome. Main results: 1810 incident cases were screened. 332 underwent full, portable polysomnography, 273 of whom had an apnoea hypopnoea index greater than 10. 160 tolerated at least 4 hours of CPAP during a 3-day run-in and were randomised. 149 participants (134 men, age 46±34 years, 81±57 days postinjury) completed the trial. CPAP use averaged 2.9±2.3 hours per night with 21% fully â € adherent' (at least 4 hours use on 5 days per week). Intention-to-treat analyses revealed no significant differences between groups in the Paced Auditory Serial Addition Task (mean improvement of 2.28, 95% CI â '7.09 to 11.6; p=0.63). Controlling for premorbid intelligence, age and obstructive sleep apnoea severity (group effect â '1.15, 95% CI â '10 to 7.7) did not alter this finding. Sleepiness was significantly improved by CPAP on intention-to-treat analysis (mean difference â '1.26, 95% CI â '2.2 to -0.32; p=0.01). Conclusion: CPAP did not improve Paced Auditory Serial Addition Task scores but significantly reduced sleepiness after acute quadriplegia. Trial registration number: ACTRN12605000799651.

AB - Rationale: Highly prevalent and severe sleep-disordered breathing caused by acute cervical spinal cord injury (quadriplegia) is associated with neurocognitive dysfunction and sleepiness and is likely to impair rehabilitation. Objective: To determine whether 3 months of autotitrating CPAP would improve neurocognitive function, sleepiness, quality of life, anxiety and depression more than usual care in acute quadriplegia. Methods and measurements: Multinational, randomised controlled trial (11 centres) from July 2009 to October 2015. The primary outcome was neurocognitive (attention and information processing as measure with the Paced Auditory Serial Addition Task). Daytime sleepiness (Karolinska Sleepiness Scale) was a priori identified as the most important secondary outcome. Main results: 1810 incident cases were screened. 332 underwent full, portable polysomnography, 273 of whom had an apnoea hypopnoea index greater than 10. 160 tolerated at least 4 hours of CPAP during a 3-day run-in and were randomised. 149 participants (134 men, age 46±34 years, 81±57 days postinjury) completed the trial. CPAP use averaged 2.9±2.3 hours per night with 21% fully â € adherent' (at least 4 hours use on 5 days per week). Intention-to-treat analyses revealed no significant differences between groups in the Paced Auditory Serial Addition Task (mean improvement of 2.28, 95% CI â '7.09 to 11.6; p=0.63). Controlling for premorbid intelligence, age and obstructive sleep apnoea severity (group effect â '1.15, 95% CI â '10 to 7.7) did not alter this finding. Sleepiness was significantly improved by CPAP on intention-to-treat analysis (mean difference â '1.26, 95% CI â '2.2 to -0.32; p=0.01). Conclusion: CPAP did not improve Paced Auditory Serial Addition Task scores but significantly reduced sleepiness after acute quadriplegia. Trial registration number: ACTRN12605000799651.

KW - sleep apnoea

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