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Obstructive Sleep Apnea in SCI

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Obstructive sleep apnea is a disease characterized by recurrent collapse of the upper airway during sleep leading to nocturnal hypoxemia and sleep fragmentation. Characteristic symptoms include loud snoring, excessive daytime sleepiness, and nocturnal choking. Risk factors for disease include alcohol use, sedatives, obesity, increased age, and male gender.  Because of activation of systemic inflammation and the sympathetic nervous system, sleep apnea may be an independent risk factor for the development of cardiovascular disease. In the able-bodied, sleep apnea is relatively common and under-diagnosed.

Treatment of obstructive sleep apnea includes lifestyle counseling (i.e. weight loss, avoidance of alcohol). For patients with substantial disease, continuous positive airway pressure (CPAP) therapy is considered to be first-line therapy.  This consists of a mask placed on the face attached to an air compressor via plastic tubing. CPAP devices establish a positive pressure in the upper airway preventing its collapse during sleep. Studies of CPAP in people without SCI demonstrate significant benefits in terms of reducing sleepiness and preventing motor vehicle crashes. Other therapies that have been used to treat obstructive sleep apnea include mandibular advancement devices (dental splints) and upper airway surgery.