Patients With Spinal Cord Injuries Should be Assessed for Sleep Apnea
Among the worst injuries I see in my Atlanta personal injury law practice are spinal cord injuries. The effects are more varied and complex that most people can imagine. Any effort to get fair compensation for a spinal cord injury victim must include presentation of a comprehensive life care plan that takes into account the full array of effects of spinal cord injury.
Respiratory problems after spinal cord injury are more complex and subtle that most people recognize. In visiting with spinal cord injury clients, I have often seen caregivers suctioning their air passages every few minutes to clear saliva that the injured person is unable to independently expel. Less obvious is the effect of respiratory problems on sleep and overall health.
The Centers for Disease Control and Prevention reports that about 200,000 people are currently living with spinal cord injury currently in the United States. With such a high number it is important for those suffering spinal cord injuries to take notice of a new study that suggests patients with spinal cord injuries could benefit from careful assessment for sleep apnea.
Results from this study show that 77 percent of spinal cord injury survivors had symptomatic sleep-disordered breathing, and 92 percent has poor sleep quality. The study also found that the nature of sleep-disordered breathing in patients with spinal cord injury is complex, with a high occurrence of both obstructive and central sleep apnea events. The occurrence of central sleep apnea, which requires special consideration in diagnosis and treatment, was more common in patients with cervical injury that those with a thoracic injury.
The principle investigator and lead author is Dr. Abdulghani Sankari at John D. Dingell VA Medical Center and Wayne State University School of Medicine in Detroit, Michigan. He says that this is the first study to assess sleep-disordered breathing and ventilation changes comparing he cervical and thoracic levels of spinal cord injury.
“The majority of spinal cord injury survivors have symptomatic sleep-disordered breathing and poor sleep that may be missed if not carefully assessed,” said Sankari. “Our findings help in identifying the mechanism of sleep-disordered breathing in spinal cord injury and may provide potential targets for new treatment.
These results could stem from the fact that individuals with a spinal cord injury are at an increased risk for developing overall respiratory complications after their injury. Any loss of respiratory muscle control weakens the pulmonary system, decreases the lung capacity, and increases respiratory congestion. With these types of problems occurring in patients with spinal cord injury, it is important that spinal cord injury survivors follow some important steps to prevent respiratory complications.
- Visiting a doctor at least once per year and getting vaccinated against pneumonia
- Avoiding buildup or secretion in the lungs by coughing or receiving cough assist treatments
- Maintaining proper posture and mobility to prevent buildup of congestion.
- Wearing an abdominal binder to help assist your intercostal and abdominal muscles
- Following a healthy diet and managing a healthy weight
- Drinking plenty of water to keep congestion from becoming thick and difficult to cough up
- Not smoking! The harmful effects of smoking include a decrease of oxygen in the blood, an increase in congestion in the chest and windpipe, a reduction in your ability to clear secretions from your lungs, a destruction of lung tissue, and an increase in the risk for respiratory infections such as pneumonia and bronchitis.
- Breathing exercises.
Sankari and his team studied 26 chronic spinal cord injury patients, including 15 with cervical and 11 with thoracic injuries. All subjects had baseline spirometry, a battery of questionnaires and attended polysomnography with flow and pharyngeal pressure measurements.
The study results appear in the January 15th issue of Journal of Clinical Sleep Medicine, which is published by the American Academy of Sleep Medicine.
Ken Shigley is past president of the State Bar of Georgia (2011-12), double board certified in Civil Trial Advocacy and Civil Pretrial Advocacy by the National Board of Legal Specialty Certification, and lead author of Georgia Law of Torts: Trial Preparation and Practice. His Atlanta-based civil trial practice is focused on representation of plaintiffs in cases of catastrophic personal injury and wrongful death.