Adherence to continuous positive airway pressure therapy in patients with spinal cord injury and obstructive sleep apnea: trajectories and predictors

• Published in: Sleep & breathing 2024-05, Vol.28 (2), p.753-762
• Main Authors: Di Maria, Julie, Hartley, Sarah, Levy, Jonathan, Delord, Vincent, Vaugier, Isabelle, Beghadi, Julien, Ibrahim, Nidal, Bensmail, Djamel, Prigent, Hélène, Léotard, Antoine
• Format: Article
• Language: English
• Subjects: Adult; Aged; Apnea; Continuous Positive Airway Pressure; Dentistry; Female; Humans; Injuries; Internal Medicine; Life Sciences; Male; Mechanical ventilation; Medicine; Medicine & Public Health; Middle Aged; Multivariate analysis; Neurology; Otorhinolaryngology; Patient Compliance; Pediatrics; Pneumology/Respiratory System; Polysomnography; Respiratory tract; Retrospective Studies; Sleep apnea; Sleep Apnea, Obstructive - therapy; Sleep Breathing Physiology and Disorders • Original Article; Sleep disorders; Spinal cord; Spinal cord injuries; Spinal Cord Injuries - therapy
• ISSN: 1520-9512; 1522-1709; 1522-1709
• DOI: 10.1007/s11325-023-02955-5

Purpose To identify specific determinants of non-adherence or cessation of continuous positive airway pressure (CPAP) therapy in a population of patients with spinal cord injuries (SCI). Methods Retrospective analysis of data from patients with SCI who underwent a full night supervised polysomnography between 2015 and 2021 and presented with moderate to severe obstructive sleep apnea (OSA) and for whom CPAP was indicated. Adherence was studied at 1, 6, and 12 months. Univariate and multivariate analyses were performed to identify factors associated with non-adherence (< 4 h per night or CPAP cessation). Factors studied were demographic and disease-related data and both subjective and objective sleep parameters. Results A total of 60 patients were included (40% cervical SCI). In univariate analysis, the only predictive parameters of non-adherence observed at 1, 6, and 12 months were the average use of CPAP on the 1st night ( p = 0.02) and over the 1st week ( p ≤ 0.001). A complete lesion (AIS-A) was predictive of non-adherence at 1 and 6 months ( p = 0.02 at 6 months), while mask leakage was associated with non-adherence at 12 months ( p = 0.02). Upper limb autonomy and the presence of family caregivers did not appear to be protective. In multivariate analysis, only the average use in the first week remained predictive of adherence (> 4 h) in the short, medium and long term. Conclusion In patients with SCI and OSA, the 1st week of CPAP treatment seems to be determinant of short-, medium-, and long-term CPAP adherence. Support for SCI patients from the start of treatment is essential and may help avoid treatment failures.