Prevalência dos distúrbios respiratórios do sono e análise da influência dos fatores de gravidade entre pessoas em reabilitação com tetraplegia, paraplegia e sem lesão medular: um estudo transversal comparativo

Abstract

Introduction: Sleep disordered breathing (SDB) seems to be highly prevalent in chronic spinal cord injury (SCI), especially obstructive sleep apnea (OSA), sleep-related hypoventilation (SRH) and central sleep apnea (CSA). The risk factors (RF) for OSA in the general population are obesity, age, sex and snoring. It is unclear, however, whether these factors also contribute to SDB in individuals with SCI. Objectives: to compare the prevalence of SDB; to study the factors related to AOS severity between groups without SCI (WSCI), quadriplegic and paraplegic. Methods: Polysomnographic, sociodemographic, anthropometric data and SDB symptoms of 123 WSCI, 48 paraplegic and 40 quadriplegic individuals were evaluated. We included people with and without SCI, older than 18 years, attended between November 2015 and December 2021, Exclusion criteria were the existence of heart, pulmonary and neurological diseases, except for SCI. All of them underwent polysomnography (PSG) types I or II. The main parameters evaluated were neck circumference (NC), waist circumference (WC), body mass index (BMI), age; AOS, ACS, HRS existence; oxygen desaturation (ODI) and apnea/hypopnea index (AHI), TsatO2<90%. (TsatO2). Results: The three groups showed symptoms of daytime sleepiness (82.9 %, 90.0 %, 79.2 %) and frequent snoring (87.0 %, 77.5 %, 83.3 %). Severe OSA predominated in tetraplegics (p=0.04); as well as IDO ≥ 10 (p=0.01) and TsatO2<90% ≥ 10 min. (p<0.001). The prevalence of CSA and HRS were higher in the SCI groups (p=0.07 and p=0.05, respectively), while the prevalence of OSA was equally high in all groups (83.7%, 95.0%, 77.1%). In the WSCI and paraplegic groups, there was a positive correlation between severity of snoring to PSG and severity of ODI and AHI, which was also observed regarding the correlation between NC, ODI and AHI. The 3 groups showed a positive correlation between WC, ODI and AHI. In the univariate logistic regression analysis, loud snoring, and high WC had higher influence for severe OSA in all groups. Conclusions: OSA, ODI ≥ 10 and TsatO2 < 90% were more prevalent and severe in tetraplegics. HRS and CSA were more prevalent in SCI. NC and snoring showed a positive correlation with AHI and ODI in WSCI and paraplegic. In all groups, WC was positively correlated with ODI and AHI. The absence of correlation between NC and OSA observed in tetraplegics leads to questioning about the role of distribution of central obesity in SDB as the pathogenic factor to airway obstruction in tetraplegia.