Positive airway pressure therapy for sleep-disordered breathing confers short-term benefits to patients with spinal cord injury despite widely ranging patterns of use

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Study design

Prospective, cohort study.


To evaluate the effectiveness of bi-level positive airway pressure (PAP) therapy and the patterns of use for sleep-disordered breathing (SDB) in individuals with spinal cord injury (SCI).


Academic tertiary care center, USA.


Overall, 91 adults with C1-T6 SCI for ≥3 months were recruited and 74 remained in the study to be evaluated for SDB and follow-up. Individuals with SDB but no nocturnal hypercapnia (NH) were prescribed auto-titrating PAP. Those with NH were prescribed PAP with volume-assured pressure support. Device downloads and overnight transcutaneous capnography were performed at 3, 6, and 12 months to quantify PAP use and effectiveness. Participants kept daily event logs, and quality of life (QOL) questionnaires were performed after 3, 6, and 12 months.


Overall, 45% of 91 participants completed the study. There was great diversity among SCI patients in PAP utilization; after 3 months, 37.8% of participants used PAP for ≥70% nights and ≥240 min per night, whereas 42.2% seldom used PAP and 20% used PAP sporadically or for short periods. PAP therapy was effective in improving OSA in 89% and nocturnal hypercapnia in 77%. Higher PAP pressures predicted higher levels of device use. There were marked reductions in symptoms of autonomic dysreflexia (AD) and orthostatic hypotension as well as some improved indices of QOL.


Despite widely diverse patterns of use, PAP therapy may have short-term benefits with regard to QOL and reducing episodes of dizziness and autonomic dysreflexia.

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We wish to thank Kerby Shedden, Ph.D., Director for the University of Michigan Center for Statistical Analysis and Consultation and Research for his advice and expertise. We would also would like to thank Marty Frick and Katie Gootee for administrative support.

Author information


  1. Pulmonary and Critical Care Medicine Division, Department of Internal Medicine, University of Michigan Health System, Ann Arbor, MI, 48109, USA

    • Jeanette P. Brown
    • , Kristy A. Bauman
    • , Armando Kurili
    • , Robert G. Sitrin
    •  & Helena M. Schotland
  2. Department of Physical Medicine and Rehabilitation, University of Michigan Health System, Ann Arbor, MI, 48109, USA

    • Gianna M. Rodriguez
    •  & Anthony E. Chiodo
  3. Department of Neurology, Sleep Disorders Center, University of Michigan Health System, Ann Arbor, MI, 48109, USA

    • Helena M. Schotland


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Conflict of interest

The authors declare that they have no conflict of interest.

Corresponding author

Correspondence to Jeanette P. Brown.

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