Abstract
Quadriplegia is a severe, catastrophic injury that acutely causes obstructive sleep apnoea alongside lifelong physical disability. Treatment with nasal continuous positive airway pressure (CPAP) is particularly challenging in this group. We hypothesised that 3 months of auto-titrating CPAP would improve neuropsychological function, sleepiness, quality of life, anxiety and depression more than usual care in acute quadriplegia.
Methods: 11 spinal cord injury centres across Australia, New Zealand, Canada and the UK screened 1628 people (July 2009-October 2015) who sustained a new, traumatic quadriplegia. 337 people met the inclusion criteria and underwent full, portable polysomnography. 265 had an apnoea hypopnoea index greater than 10, were classified as “OSA positive” and proceeded to a 3 night CPAP trial. 160 tolerated at least 4 hours of CPAP during run-in and were randomized.
Results: 149 participants (134 men, age 46±34, 81±57 days post-injury) completed the trial. Linear modelling revealed no differences in improvement in attention and information processing, as measured by the Paced Auditory Serial Addition Task, on intention-to-treat (p=.59; mean difference 2.6, 95% CI, -6.9 to 12.1) or per protocol for adherence (primary outcome). Intention-to-treat analyses revealed that CPAP significantly improved the secondary outcome of sleepiness (p=0.01, 1.17, -2.1 to -.25).
Discussion: CPAP significantly improved sleepiness after acute quadriplegia but did not improve neurocognition beyond that seen with post-injury, spontaneous recovery.
Trial registration: Australian New Zealand Clinical Trial Registry ACTRN12605000799651.
- Copyright ©the authors 2016