Screening for sleep apnoea in patients with spinal cord injury during rehabilitation
Bibliographic record
Abstract
Introduction Patients with spinal cord injury (SCI) have an increased risk of sleep apnea. A systematic review on sleep apnea in patients with tetraplegia reported a prevalence between 46 and 97% (1), but smaller studies also suggest a problem among patients with paraplegia (2). Therefore, more studies with focus on the whole population is needed. Assessment of sleep apnea can be done with polysomnography or cardiorespiratory monitoring (CRM), but these examinations take time and require a team of professionals with expertise in sleep and are therefore not feasible to perform in all hospitalized patients. A recent study examining questionnaires for screening of sleep apnea showed the Stop Bang Questionnaire (SBQ) to be the most sensitive for detecting patients with obstructive sleep apnea (OSA) (3). However, the SBQ may not capture all types of sleep apnea and more knowledge is needed on the specificity in people with SCI. The purpose of the current study is to examine the prevalence of sleep apnea in first-time hospitalized patients with SCI and whether the SBQ can detect patients at risk for sleep apnea. In this abstract, preliminary data on the prevalence and agreement between the SBQ and the CRM are presented. Method The project was carried out at the Spinal Cord Injury Center of Western Denmark. We screened a cohort of first-time hospitalized patients with SCI from September 2022 to February 2023. All patients received verbal and written information about the project and those who gave consent were screened for sleep apnea. Screening consisted of SBQ and a regular clinical sleep questionnaire. Next, everyone was examined with CRM and assessed for sleep apnea by a doctor specialized in sleep disorders. Results During 5 months, 35 inpatients with first-time SCI were identified. Twenty-six agreed to be part of the project. The participants had an average age of 53 years, 17 men/ 9 women, three with severity of AIS C T1–S3 and 23 with AIS D. None being ventilator dependent. Twenty of 26 (prevalence of 77%) was diagnosed as having sleep apnea based on assessment and CRM. The SBQ classified 3/7/10 respectively being in low/moderate/severe risk of OSA of the 20 diagnosed with sleep apnea. In the six patients not diagnosed with sleep apnea the SBQ showed 3/3 being low/moderate at risk of OSA. Conclusion The preliminary results of the study showed a high prevalence of sleep apnea in first time SCI hospitalized patients. Moreover, the results point towards that the SBQ cannot stand alone identifying sleep apnea in patients with SCI. Further analysis of data is needed to find possible discriminators and guide the relevance of the current setup. (1) Prevalence of sleep-disordered breathing in people with tetraplegia—a systematic review and meta-analysis. Marnie Graco et al. 2021 (2) Sleep disordered breathing in spinal cord injury: A systematic review. Chiodo AE et al. 2016 (3) Screening Questionnaires for ObstructiveSleep Apnea: An Updated SystematicReview. Amra B et al. 2018
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.001 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.003 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".