Sleep apnea in individuals with spinal cord injury

To determine the rate of sleep-disordered breathing (SDB) in individuals with spinal cord injury (SCI) and its types (central sleep apnea and obstructive sleep apnea, and a comorbid central and obstructive sleep apnea and to assess the response to treatment using positive airway pressure (PAP) (defined as an apnea-hypopnea index (AHI) of less than 5 events/h on initial PAP titration) in individuals with SCI.

Individuals with SCI who underwent a full night of diagnostic polysomnography from 2010-2024 to determine the type of SDB and its severity using the AHI and central apnea index. The inclusion criteria were individuals with chronic SCI at low cervical or thoracic (at C4-T6 levels) who are not mechanically ventilated or had tracheostomies. "Central sleep apnea" is diagnosed with an AHI of 5+ events/h and a central apnea index of at least 50% of the AHI. "Obstructive sleep apnea only" is identified by an AHI of 5+ events/h and a central apnea index of less than 5 events/h. Comorbid central and obstructive sleep apnea is characterized by an AHI of 5+ events/h, with a central apnea index over 5 events/h but under 50% of the total AHI. The positive response to PAP therapy was based on the AHI level of less than 5 events/h after initiating PAP treatment and based on remote monitoring data.

Among the 81 individuals who met the inclusion criteria, 12 patients (15%) were diagnosed with comorbid central and obstructive sleep apnea, 4 patients (5%) presented with central sleep apnea only, 56 patients (69%) had obstructive sleep apnea, and 8 patients (10%) exhibited no SDB. In a subset of participants (n = 51) hypopneas were classified as obstructive or central events based on American Academy of Sleep Medicine definition and revealed that approximately one-third (32%) had central or comorbid central and obstructive sleep apnea, 63% had obstructive sleep apnea, and 6% did not have SDB on polysomnography. A total of 35 (47%) individuals diagnosed with SDB underwent PAP titration and were prescribed PAP. Twenty (27%) individuals received PAP treatment, and only 17 (23%) continued their use for the initial 3 months. Only 11 patients (15%) demonstrated responsiveness to PAP on day 90 (AHI < 5 events/h during therapy).

SDB is extremely common in individuals with SCI. The efficacy of PAP therapy is suboptimal, and adherence rates decline significantly over time.

Sankari A, Aldwaikat A, Habra M, et al. Sleep apnea in individuals with spinal cord injury. J Clin Sleep Med. 2025;21(9):1529-1537.