Dados do Trabalho

Título

Severity Factors in Obstructive Sleep Apnea in Individuals with Chronic Spinal Cord Injury.

Introdução

Obstructive sleep apnea (OSA) in individuals with spinal cord injury (SCI) is high, with severe forms occurring in up to 67.0% of tetraplegic patients. Nonetheless, factors associated with the increased severity of OSA in this population are poorly studied. Understanding severity factors for OSA in individuals with SCI could improve diagnostic screening methods and favor targeted therapeutic approach to specific OSA phenotypes in this population.

Objetivo

To analyze predictive factors of moderate-to-severe OSA and each likelihood influence to severe forms of OSA in SCI patients.

Métodos

Eighty-eight individuals with chronic SCI (tetraplegia or paraplegia), of duration ≥6 months were included. All were attending rehabilitation programs at the SARAH Network between November 2015 and December 2021 and underwent assisted polysomnography for sleep-related complaints. The exclusion criteria included respiratory, cardiac, and other neurological diseases unrelated to SCI. The severity factors studied were age, sex, body mass index (BMI) ≥25, neck circumference (NC) ≥40 cm, and abdominal circumference (AC) ≥88 cm for women and ≥102 cm for men, level of SCI (tetraplegia/paraplegia), injury severity according to American Spinal Injury Association (ASIA) criteria (from AIS A to C), and history of loud and frequent snoring. In a univariate logistic regression analysis, variables with p<0.2 were selected for the development of a multivariate logistic regression model.

Resultados

With the univariate regression analysis, AIS, gender, and BMI were excluded (p>0.2). Tetraplegia (OR 11.23, 95% CI 2.55-45.76), AC (OR 5.95, 95% CI 1.80-19.7), and a history of snoring (OR 6.69, 95% CI 1.35-33.27) remained in the multivariate regression analysis (p<0.05), while NC and age were excluded (p>0.05). The model showed a specificity of 0.67, sensitivity of 0.89, and accuracy of 0.81, with a ROC curve of 0.86.

Conclusões

OSA severity factors are usable to develop a specific screening questionnaire for people with SCI, as a strategic method for targeted diagnostic approaches. Questionnaires developed and validated for able-bodied individuals, such as the Berlin and the STOP-Bang, may not adequately address people with SCI.

Palavras -chave

SPINAL-CORD-INJURY, OBSTRUCTIVE APNEA, DIAGNOSIS.