CPAP Therapy for 4 Months Improves Sleep Quality, Daytime Alertness, Fatigue, and Mental Health in People with Chronic Spinal Cord Injury and Moderate-to-Severe Sleep-Related Breathing Disorder: The Preliminary Results of an Ongoing Prospective Study.
Julio Furlan1, Sander Hitzig2, Mark Boulos3
1Lyndhurst Centre, KITE Research Institute, University Health Network; University of Toronto, 2Sunnybrook Health Sciences Centre, 3Sunnybrook Hospital; University of Toronto
Objective:
To examine the cognitive and psychological effects of continuous positive airway pressure (CPAP) therapy in people with chronic spinal cord injury (SCI) and moderate-to-severe sleep-related breathing disorder (SRBD).
Background:
SRBDs are common but under-recognized after SCI.
Design/Methods:
An ongoing single-arm clinical trial (NCT04007380) aims to evaluate the effects of 4 months of CPAP therapy on cognition and mental health in people with SCI who were diagnosed with moderate-to-severe SRBD. Outcomes included the Epworth Sleepiness Scale, Medical Outcomes Study Sleep Scale, Fatigue Severity Scale, Depression, Anxiety & Stress Scale-21, and Montreal Cognitive Assessment (MoCA). The participants shared their experience in a 1-hour semi-structured interview (qualitative analysis).
Results:
By September 2022, we screened 31 individuals (10 females, 21 males; ages range: 37-79 years; mean age: 58.4 years) with complete motor (n=14) or incomplete SCI at cervical (n=20) or thoracic level. Time from SCI onset varied from 4 to 793 months (mean time: 190.5 months). Of the 31 screened participants, the apnea-hypopnea index (AHI) varied from 2.6 to 83.7 events per hour (mean AHI: 23.0). Of the 24 individuals who initiated CPAP therapy, 11 individuals have completed it, whereas three individuals withdrew from the study. The overall mean adherence rate to CPAP was 78.6%; mean nighttime CPAP usage was approximately 5 hours. Daytime sleepiness (p=0.003) and sleep quality (p<0.001) significantly improved with CPAP therapy. Fatigue significantly decreased with CPAP therapy (p=0.048). Mental health indicators improved with CPAP therapy (p=0.049). There was a numeric increase in MoCA scores, but this did not reach significance yet (p=0.160). All 11 participants confirmed that CPAP therapy had a positive impact in their lives.
Conclusions:
Our preliminary results suggest that 4 months of CPAP therapy significantly improves sleep quality, and reduces daytime sleepiness, fatigue, stress, anxiety and mood in people with chronic SCI. The participants’ adherence to CPAP therapy was high (78.6%).