Acute Intermittent Hypoxia and Respiratory Strength Training to Improve Respiratory Function in Individuals with Chronic Spinal Cord Injury: Preliminary Outcomes

Spinal cord injury (SCI) disrupts neural pathways to respiratory motor neurons, causing paralysis and breathing impairment, a major cause of illness and death in SCI. Acute intermittent hypoxia (AIH) is a promising therapeutic modality that elicits spinal synaptic plasticity, improving breathing in rodent models of SCI. AIH also elicits plasticity in limb motor systems in both rodent models and humans with chronic SCI, where functional gains are greatest when paired with task-specific training. The impact of similar combinatorial treatments on breathing ability is unknown. Here, we report preliminary breathing outcomes in seventeen adults with chronic SCI who received AIH and task-specific training (respiratory strength training; RST). Seventeen males with chronic SCI (33.7 ± 15 yrs of age; 1-28 yrs post-SCI; 12 cervical, 5 thoracic injuries; C1-T6 AIS A-D). Respiratory function was 52% ± 19% of the age-predicted normative function for expiratory pressure generation and 123% ± 32% of normative values for inspiratory function. Participants completed four random ordered 5-day protocols of AIH, Sham, RST, and AIH+RST, >3 weeks apart. AIH consisted of 15, 1-minute episodes of breathing a hypoxic gas mixture (9% oxygen), interspersed with 1.5-minute episodes of breathing room air (21% oxygen). Thirty minutes after AIH, RST involved both inspiratory and expiratory training; 4 sets of 6-12 breaths with the pressure threshold device set to 80% of each individual’s maximum. Sham treatments replicated AIH but used room air. A linear mixed model was used to test for differences in maximal inspiratory pressure (MIP), maximal expiratory pressure (MEP), and forced vital capacity (FVC) prior to and 1 day post-intervention. MIP increased 10±15.6% (pre 120±34cmH20, post 129±36 cmH20) 1 day after RST (p=0.001) and 6±10.5% (pre 123±34cmH20; post 131±34cmH20) 1 day after AIH+RST (p=0.04), but did not change after AIH or Sham. MIP increased by >10% in 5/17 participants following AIH+RST and 9/17 participants following RST. Neither MEP nor FVC changed following any block. Although there were no significant differences between AIH+RST and RST intervention blocks, there was a medium effect size (0.44). Since RST and AIH+RST preliminary outcomes suggest functional respiratory benefit, future steps will determine if the combinatorial treatment elicits greater gains. Examination of biomarkers associated with outcomes will provide insight into outcome variability. Department of Defense CDMRP W81XWH1810718 This is the full abstract presented at the American Physiology Summit 2023 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.