Positive airway pressure for sleep-disordered breathing in acute quadriplegia: a randomised controlled trial.
sleep apnoea
Journal
Thorax
ISSN: 1468-3296
Titre abrégé: Thorax
Pays: England
ID NLM: 0417353
Informations de publication
Date de publication:
03 2019
03 2019
Historique:
received:
10
07
2018
revised:
24
10
2018
accepted:
29
10
2018
pubmed:
13
12
2018
medline:
16
5
2019
entrez:
13
12
2018
Statut:
ppublish
Résumé
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. 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. 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 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 '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 -7.09 to 11.6; p=0.63). Controlling for premorbid intelligence, age and obstructive sleep apnoea severity (group effect -1.15, 95% CI -10 to 7.7) did not alter this finding. Sleepiness was significantly improved by CPAP on intention-to-treat analysis (mean difference -1.26, 95% CI -2.2 to -0.32; p=0.01). CPAP did not improve Paced Auditory Serial Addition Task scores but significantly reduced sleepiness after acute quadriplegia. ACTRN12605000799651.
Identifiants
pubmed: 30538163
pii: thoraxjnl-2018-212319
doi: 10.1136/thoraxjnl-2018-212319
pmc: PMC6467247
doi:
Banques de données
ANZCTR
['ACTRN12605000799651']
Types de publication
Journal Article
Randomized Controlled Trial
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
282-290Investigateurs
Rick Acland
(R)
Janette L Alexander
(JL)
Amber E Backwell
(AE)
Lauren Booker
(L)
Joy R Chowdhury
(JR)
Amanda Davies
(A)
Brett Duce
(B)
Rebecca Dytor
(R)
Nurit Fox
(N)
Aj Hirsch Allen
(AH)
Denise M Hislop
(DM)
Rachel Jones
(R)
Teresa Jones
(T)
Carol Li
(C)
Meghan Leigh
(M)
Sarah Leighton
(S)
Louise Maclellan
(L)
Victoria Middleton
(V)
Melinda S Millard
(MS)
Lianne Nier
(L)
Lynne O'keeffe
(L)
Aheed Osman
(A)
Jessica Patti
(J)
Valerie Pick
(V)
Warren R Ruehland
(WR)
Jo Spong
(J)
Kate Sutherland
(K)
Amber M Van Lit
(AM)
Catherine Whittall
(C)
Commentaires et corrections
Type : CommentIn
Informations de copyright
© Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.
Déclaration de conflit d'intérêts
Competing interests: DJB, NA and AT report a grant from the Rick Hansen Foundation during the conduct of the study. DM, PAC, BL, IG, DJB, DB and NA report a grant from the National Health and Medical Research Council during the conduct of the study. RJP, PK, DJB and DB report a grant from the Transport Accident Commission during the conduct of the study. All authors received non-financial support from ResMed during the conduct of the study. Outside the submitted work PAC has an appointment to an endowed academic chair at the University of Sydney that was created from ResMed funding. He has received research support from ResMed, SomnoMed and Zephyr Sleep Technologies. He is a consultant/adviser to Zephyr Sleep Technologies and ResMed (Narval). He has a pecuniary interest in SomnoMed related to a previous role in R&D (2004).
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