Neuropsychological Function in Patients With Acute Tetraplegia and Sleep Disordered Breathing

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Abstract

Sleep disordered breathing is highly prevalent following spinal cord injury and likely caused by the injury. Beyond the devastating physical consequences of spinal cord injury, neuropsychological dysfunction is also common. In both the able-bodied and chronic spinal cord injury patients, sleep disordered breathing impairs many areas of neuropsychological function. However, this has not been investigated in patients with acute injury.

Study objectives:

To investigate the relationship between apnea severity and neuropsychological function in patients with acute-onset tetraplegia and sleep disordered breathing.

Methods:

Polysomnography and neuropsychological testing were performed on 104 participants (age M = 45.60, SD = 16.38; 10 female) across 11 international sites, 2 months postinjury (M = 60.70 days, SD = 39.48). Neuropsychological tests assessed attention, information processing, executive function, memory, learning, mood, and quality of life.

Results:

More severe sleep apnea was associated with poorer attention, information processing, and immediate recall. Deficits did not extend to memory. Higher preinjury intelligence and being younger reduced the associations with sleep disordered breathing; however, these protective factors were insufficient to counter the damage to attention, immediate recall, and information processing associated with sleep disordered breathing.

Conclusions:

These data suggest that new spinal cord injury may function as a model of “acute sleep apnea” and that more widespread sleep apnea-related deficits, including memory, may only be seen with longer exposure to apnea. These findings have important implications for functioning and skill acquisition during rehabilitation and, as such, highlight the importance of sleep health following tetraplegia.

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