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dc.contributor.authorBerlowitz, David J
dc.contributor.authorSchembri, Rachel
dc.contributor.authorGraco, Marnie
dc.contributor.authorRoss, Jacqueline M
dc.contributor.authorAyas, Najib
dc.contributor.authorGordon, Ian
dc.contributor.authorLee, Bonne
dc.contributor.authorGraham, Allison
dc.contributor.authorCross, Susan V
dc.contributor.authorMcClelland, Martin
dc.contributor.authorKennedy, Paul
dc.contributor.authorThumbikat, Pradeep
dc.contributor.authorBennett, Cynthia
dc.contributor.authorTownson, Andrea
dc.contributor.authorGeraghty, Timothy J
dc.contributor.authorPieri-Davies, Sue
dc.contributor.authorSinghal, Raj
dc.contributor.authorMarshall, Karen
dc.contributor.authorShort, Deborah
dc.contributor.authorNunn, Andrew
dc.contributor.authorMortimer, Duncan
dc.contributor.authorBrown, Doug
dc.contributor.authorPierce, Robert J
dc.contributor.authorCistulli, Peter A
dc.contributor.authorAcland, Rick
dc.contributor.authorAlexander, Janette L
dc.contributor.authorBackwell, Amber E
dc.contributor.authorBooker, Lauren
dc.contributor.authorChowdhury, Joy R
dc.contributor.authorDavies, Amanda
dc.contributor.authorDuce, Brett
dc.contributor.authorDytor, Rebecca
dc.contributor.authorFox, Nurit
dc.contributor.authorAllen, AJ Hirsch
dc.contributor.authorHislop, Denise M
dc.contributor.authorJones, Rachel
dc.contributor.authorJones, Teresa
dc.contributor.authorLi, Carol
dc.contributor.authorLeigh, Meghan
dc.contributor.authorLeighton, Sarah
dc.contributor.authorMacLellan, Louise
dc.contributor.authorMiddleton, Victoria
dc.contributor.authorMillard, Melinda S
dc.contributor.authorNier, Lianne
dc.contributor.authorO'Keeffe, Lynne
dc.contributor.authorOsman, Aheed
dc.contributor.authorPatti, Jessica
dc.contributor.authorPick, Valerie
dc.contributor.authorRuehland, Warren R
dc.contributor.authorSpong, Jo
dc.contributor.authorSutherland, Kate
dc.contributor.authorVan Lit, Amber M
dc.contributor.authorWhittall, Catherine
dc.date.accessioned2019-10-14T01:47:15Z
dc.date.available2019-10-14T01:47:15Z
dc.date.issued2019
dc.identifier.issn0040-6376
dc.identifier.doi10.1136/thoraxjnl-2018-212319
dc.identifier.urihttp://hdl.handle.net/10072/388346
dc.description.abstractRATIONALE: Highly prevalent and severe sleep-disordered breathing caused by acute cervical spinal cord injury (quadriplegia) is associated with neurocognitive dysfunction and sleepiness and is likely to impair rehabilitation. OBJECTIVE: To determine whether 3 months of autotitrating CPAP would improve neurocognitive function, sleepiness, quality of life, anxiety and depression more than usual care in acute quadriplegia. METHODS AND MEASUREMENTS: Multinational, randomised controlled trial (11 centres) from July 2009 to October 2015. The primary outcome was neurocognitive (attention and information processing as measure with the Paced Auditory Serial Addition Task). Daytime sleepiness (Karolinska Sleepiness Scale) was a priori identified as the most important secondary outcome. MAIN RESULTS: 1810 incident cases were screened. 332 underwent full, portable polysomnography, 273 of whom had an apnoea hypopnoea index greater than 10. 160 tolerated at least 4 hours of CPAP during a 3-day run-in and were randomised. 149 participants (134 men, age 46±34 years, 81±57 days postinjury) completed the trial. CPAP use averaged 2.9±2.3 hours per night with 21% fully 'adherent' (at least 4 hours use on 5 days per week). Intention-to-treat analyses revealed no significant differences between groups in the Paced Auditory Serial Addition Task (mean improvement of 2.28, 95% CI -7.09 to 11.6; p=0.63). Controlling for premorbid intelligence, age and obstructive sleep apnoea severity (group effect -1.15, 95% CI -10 to 7.7) did not alter this finding. Sleepiness was significantly improved by CPAP on intention-to-treat analysis (mean difference -1.26, 95% CI -2.2 to -0.32; p=0.01). CONCLUSION: CPAP did not improve Paced Auditory Serial Addition Task scores but significantly reduced sleepiness after acute quadriplegia. TRIAL REGISTRATION NUMBER: ACTRN12605000799651.
dc.description.peerreviewedYes
dc.languageEnglish
dc.language.isoeng
dc.publisherBMJ Publishing Group Ltd
dc.relation.ispartofpagefrom282
dc.relation.ispartofpageto290
dc.relation.ispartofissue3
dc.relation.ispartofjournalThorax
dc.relation.ispartofvolume74
dc.subject.fieldofresearchClinical Sciences
dc.subject.fieldofresearchcode1103
dc.subject.keywordsScience & Technology
dc.subject.keywordsLife Sciences & Biomedicine
dc.subject.keywordsRespiratory System
dc.subject.keywordsSPINAL-CORD-INJURY
dc.subject.keywordsQUALITY-OF-LIFE
dc.titlePositive airway pressure for sleep-disordered breathing in acute quadriplegia: a randomised controlled trial
dc.typeJournal article
dc.type.descriptionC1 - Articles
dcterms.bibliographicCitationBerlowitz, DJ; Schembri, R; Graco, M; Ross, JM; Ayas, N; Gordon, I; Lee, B; Graham, A; Cross, SV; McClelland, M; Kennedy, P; Thumbikat, P; Bennett, C; Townson, A; Geraghty, TJ; Pieri-Davies, S; Singhal, R; Marshall, K; Short, D; Nunn, A; Mortimer, D; Brown, D; Pierce, RJ; Cistulli, PA; Acland, R; Alexander, JL; Backwell, AE; Booker, L; Chowdhury, JR; Davies, A; Duce, B; Dytor, R; Fox, N; Allen, AJH; Hislop, DM; Jones, R; Jones, T; Li, C; Leigh, M; Leighton, S; MacLellan, L; Middleton, V; Millard, MS; Nier, L; O'Keeffe, L; Osman, A; Patti, J; Pick, V; Ruehland, WR; Spong, J; Sutherland, K; Van Lit, AM; Whittall, C, Positive airway pressure for sleep-disordered breathing in acute quadriplegia: a randomised controlled trial, Thorax, 2019, 74 (3), pp. 282-290
dcterms.dateAccepted2018-10-29
dcterms.licensehttp://creativecommons.org/licenses/by/4.0/
dc.date.updated2019-10-14T01:41:22Z
dc.description.versionVersion of Record (VoR)
gro.rights.copyright© Author(s) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.
gro.hasfulltextFull Text
gro.griffith.authorJones, Rachel
gro.griffith.authorGeraghty, Tim
gro.griffith.authorPick, Val


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