Sleep Disordered Breathing
Condition: Sleep Disordered Breathing; Tetraplegia
MeSH terms: Respiratory Aspiration; Sleep Apnea Syndromes; Quadriplegia
Study type: Observational

Summary: 
      Sleep-disordered breathing (SDB) occurs in 2% to 4% of the non-disabled adult population and
      is characterized by periods of complete breathing cessation (apnea) or marked reductions in
      airflow (hypopnea) during sleep. By contrast, the diagnosis of SDB affects as many as 83% of
      persons with tetraplegia within one year of their injury. While some consider daytime
      somnolescence from poor sleep quality a 'tolerable annoyance', SDB can decrease near-term
      physical performance and mental alertness, decay memory and intellectual processing, invoke
      mood disturbances, decrease healthrelated quality of life(HRQoL), and cause vehicular or
      occupational injury. Recurrent sleep arousal is now strongly associated with cardiometabolic
      (CM) component risks including insulin resistance, obesity, inflammatory stress, and
      endothelial dysfunction. Despite considerable advancements in understanding and treating SDB
      - including favored use of positive airway pressure (PAP) - an evidence base sufficient to
      warrant routine evaluation and treatment of SDB and related sleep disorders remains elusive
      for those with spinal cord injury (SCI). To address these knowledge and treatment
      shortcomings the investigators will conduct a hypothesis-driven study with specific aims that
      will: 1) describe by stakeholder survey the clinically-relevant determinants of sleep quality
      in persons with chronic tetraplegia, 2) assess clinical features and co-morbid risks
      associated with SDB in persons with tetraplegia, and 3) determine in persons with tetraplegia
      having SDB whether treatment using PAP reduces health risks and improves HRQoL. Hypothesis 1
      will be tested using data derived from a website survey.
    


Intervention name(s): PAP Device Procedure
Intervention type(s): Procedure
Intervention description(s): Following titration, subjects will be issued a PAP machine programmed at this optimum pressure and instructed to use the device nightly for the ensuing three months. Compliance checks will be conducted at months 1 and 3 by having the subjects present the PAP "Smartcard" for download and interpretation.
Daily compliance will be reported as the total number of hours of PAP use per 24 hour period. Patients who use PAP > 4 hours/ night for more than 50% of the nights at one month and 3 month follow-up will be classified as 'compliant' with PAP. Non-compliance will be addressed by a clinical problem-solving approach normally utilized by sleep laboratory personnel in the UM PAP clinic.
Observational model: Case-Only
Time perspective: Prospective
Sampling method: Probability Sample
Study population: 
        Persons with Chronic Spinal Cord Injury who are asymptomatic for acute treable illness.
      
Biospecimen description: 
      Insulin Sensitivity (SI) and Lipid/Inflammation panels: (30 minutes, Taken at Baseline, 1
      month, and 3 month time points) SI will be calculated using the Quantitative Insulin
      Sensitivity Check Index (QUICKI) method177 that requires single fasting blood glucose and
      insulin values. The same blood sample will be used to assay for a lipid panel containing
      total cholesterol, LDL, HDL, and triglycerides and an inflammatory panel testing hs-CRP and
      IL-6.
    
Keywords: Tetraplegia