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Diagnosis of Sleep Disordered Breathing in Patients With Chronic Spinal Cord Injury

      We read with great interest the article by Bauman et al
      • Bauman K.A.
      • Kurili A.
      • Schotland H.M.
      • Rodriguez G.M.
      • Chiodo A.E.
      • Sitrin R.G.
      A simplified approach to diagnosing sleep disordered breathing and nocturnal hypercapnia in individuals with spinal cord injury.
      on the diagnosis of sleep disordered breathing (SDB) and nocturnal hypoventilation (NH) in 91 patients with spinal cord injury (SCI). We applaud the effort of the authors in conducting this study. Their data were obtained prospectively to assess the prevalence of SDB and NH using home sleep apnea testing (HSAT) and transcutaneous capnography. The authors concluded that “Unsupervised, home sleep apnea testing with transcutaneous capnography effectively identifies SDB and NH in patients with SCI.”
      • Bauman K.A.
      • Kurili A.
      • Schotland H.M.
      • Rodriguez G.M.
      • Chiodo A.E.
      • Sitrin R.G.
      A simplified approach to diagnosing sleep disordered breathing and nocturnal hypercapnia in individuals with spinal cord injury.
      (p1) Also, the authors speculated that “in many instances the results of a home-based study may be sufficiently abnormal to justify appropriately and inform a prescription for continuous or bilevel PPV.” After reading these conclusions and on the basis of the available evidence of high prevalence of SDB and central breathing instability in patients with tetraplegia, we wish to highlight a few areas that require further consideration.
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      References

        • Bauman K.A.
        • Kurili A.
        • Schotland H.M.
        • Rodriguez G.M.
        • Chiodo A.E.
        • Sitrin R.G.
        A simplified approach to diagnosing sleep disordered breathing and nocturnal hypercapnia in individuals with spinal cord injury.
        Arch Phys Med Rehabil. 2015; (Aug 20 [Epub ahead of print].)
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        Sleep disordered breathing in chronic spinal cord injury.
        J Clin Sleep Med. 2014; 10: 1043
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        Tetraplegia is a risk factor for central sleep apnea.
        J Appl Physiol (1985). 2014; 116: 345-353
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        Identifying sleep disordered breathing in chronic spinal cord injury. SLEEP. 2012; 35: A285
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        Sleep onset hypoventilation in chronic spinal cord injury.
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        Identification and treatment of sleep-disordered breathing in chronic spinal cord injury.
        Spinal Cord. 2015; 53: 145-149

      Linked Article

      • Simplified Approach to Diagnosing Sleep-Disordered Breathing and Nocturnal Hypercapnia in Individuals With Spinal Cord Injury
        Archives of Physical Medicine and RehabilitationVol. 97Issue 3
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          To evaluate a strategy of home-based testing to diagnose sleep-disordered breathing and nocturnal hypercapnia in individuals with spinal cord injury (SCI).
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      • The Authors Respond
        Archives of Physical Medicine and RehabilitationVol. 97Issue 1
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          We are pleased to have the opportunity to respond to these thoughtful comments. Contrary to our expectations, we found no significant correlation between the frequency of central sleep apnea events and the spinal cord injury (SCI) level in this cohort of nearly 100 individuals with SCI (appendix 1 in our original article1). At present we have no definitive explanation, but this correlation, if it exists, may be influenced by other factors such as the common use of sedating drugs, which had the greatest predictive value for central apnea events in the present study (see appendix 1 in our original article1).
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