Intensive support does not improve positive-airway pressure use in spinal cord injury/disease: a randomized clinical trial

SLEEP, 2024 · DOI: 10.1093/sleep/zsae044 · Published: February 29, 2024

Spinal Cord Injury Sleep Medicine Pulmonology

Simple Explanation

This study evaluated whether a special program could help Veterans with spinal cord injuries or diseases (SCI/D) use their sleep apnea machines (PAP) more often. The program included education, goal setting, and troubleshooting. It was compared to a simple education program. The study found that the special program did not significantly increase PAP machine use compared to just providing education. However, those who used the PAP machine more, regardless of which program they were in, experienced better sleep and fewer symptoms.

Study Duration

3 months

Participants

63 Veterans with SCI/D and SDB

Evidence Level

Level 1, Randomized controlled trial

Key Findings

1
A 3-month supportive/behavioral program did not show significant benefit compared to education alone in increasing PAP use.
2
More PAP use was associated with improved symptoms suggesting more intensive support, such as in-home assistance, may be required.
3
No baseline demographic or clinical variables were associated with PAP use at the 3-month time point.

Research Summary

The study aimed to evaluate the effectiveness of a comprehensive program (BEST) to improve PAP adherence for the treatment of SDB among individuals with SCI/D, compared to a non-directive educational control program. The primary outcomes were objective PAP use (nights ≥4 hours used within 90 days) and sleep quality (Pittsburgh Sleep Quality Index [PSQI] at 3 months). The study found no significant difference in PAP use or sleep quality between the intervention and control groups. However, more PAP use was associated with improvements in sleep quality, insomnia, sleepiness, fatigue, and depression across groups.

Practical Implications

Need for More Intensive Support

More intensive support, such as in-home assistance, may be required to increase PAP use in Veterans with SCI/D and SDB.

Reimagine Management as Chronic Care

There is a need to reimagine the management of sleep disorders in this population from an episodic encounter to a chronic care model.

Address Healthcare Inequity

Failure to address the unique healthcare needs of individuals with SCI is an example of healthcare inequity, requiring an overhaul of the continuum of care.

Study Limitations

1
Study population consisted mostly of male veterans, the majority of whom were socioeconomically disadvantaged.
2
The potential interaction between socioeconomic status and PAP adherence, as well as the potential impact of comorbid conditions and concurrent medications, cannot be determined from our findings.
3
Intervention was designed based on published literature and did not include direct input from end users.

Your Feedback

Was this summary helpful?

Back to Spinal Cord Injury