RT Journal Article
SR Electronic
T1 Positive airway pressure for sleep-disordered breathing in acute quadriplegia: a randomised controlled trial
JF Thorax
JO Thorax
FD BMJ Publishing Group Ltd and British Thoracic Society
SP 282
OP 290
DO 10.1136/thoraxjnl-2018-212319
VO 74
IS 3
A1 Berlowitz, David J
A1 Schembri, Rachel
A1 Graco, Marnie
A1 Ross, Jacqueline M
A1 Ayas, Najib
A1 Gordon, Ian
A1 Lee, Bonne
A1 Graham, Allison
A1 Cross, Susan V
A1 McClelland, Martin
A1 Kennedy, Paul
A1 Thumbikat, Pradeep
A1 Bennett, Cynthia
A1 Townson, Andrea
A1 Geraghty, Timothy J
A1 Pieri-Davies, Sue
A1 Singhal, Raj
A1 Marshall, Karen
A1 Short, Deborah
A1 Nunn, Andrew
A1 Mortimer, Duncan
A1 Brown, Doug
A1 Pierce, Robert J
A1 Cistulli, Peter A
A1 
YR 2019
UL http://thorax.bmj.com/content/74/3/282.abstract
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 ‘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).Conclusion CPAP did not improve Paced Auditory Serial Addition Task scores but significantly reduced sleepiness after acute quadriplegia.Trial registration number ACTRN12605000799651.