Upper Airway Control and Function : Implications for Sleep-Disordered Breathing Tetraplegia is a risk factor for central sleep apnea

Sankari A, Bascom AT, Chowdhuri S, Badr MS. Tetraplegia is a risk factor for central sleep apnea. J Appl Physiol 116: 345–353, 2014. First published October 10, 2013; doi:10.1152/japplphysiol.00731.2013.—Sleepdisordered breathing (SDB) is highly prevalent in patients with spinal cord injury (SCI); the exact mechanism(s) or the predictors of disease are unknown. We hypothesized that patients with cervical SCI (C-SCI) are more susceptible to central apnea than patients with thoracic SCI (T-SCI) or able-bodied controls. Sixteen patients with chronic SCI, level T6 or above (8 C-SCI, 8 T-SCI; age 42.5 15.5 years; body mass index 25.9 4.9 kg/m) and 16 matched controls were studied. The hypocapnic apneic threshold and CO2 reserve were determined using noninvasive ventilation. For participants with spontaneous central apnea, CO2 was administered until central apnea was abolished, and CO2 reserve was measured as the difference in end-tidal CO2 (PETCO2) before and after. Steady-state plant gain (PG) was calculated from PETCO2 and VE ratio during stable sleep. Controller gain (CG) was defined as the ratio of change in VE between control and hypopnea or apnea to the PETCO2. Central SDB was more common in C-SCI than T-SCI (63% vs. 13%, respectively; P 0.05). Mean CO2 reserve for all participants was narrower in C-SCI than in T-SCI or control group ( 0.4 2.9 vs. 2.9 3.3 vs. 3.0 1.2 l·min ·mmHg , respectively; P 0.05). PG was higher in C-SCI than in T-SCI or control groups (10.5 2.4 vs. 5.9 2.4 vs. 6.3 1.6 mmHg·l ·min , respectively; P 0.05) and CG was not significantly different. The CO2 reserve was an independent predictor of apnea-hypopnea index. In conclusion, C-SCI had higher rates of central SDB, indicating that tetraplegia is a risk factor for central sleep apnea. Sleep-related hypoventilation may play a significant role in the mechanism of SDB in higher SCI levels.