Abstract
Study design
Mixed-methods observational study.
Objective
To describe the sleep-disordered breathing (SDB) management models of three spinal cord injury (SCI) rehabilitation centres that are screening, diagnosing and treating uncomplicated SDB, and to determine their common elements.
Setting
Three specialist SCI rehabilitation centres.
Methods
Data collection at each site included direct observations and interviews with lead clinical staff and an audit of SDB-related clinical practice in 2019. Detailed descriptions of the models of care, including process maps, were developed. A theory-based analysis of the common elements of the three care models was undertaken.
Results
At each centre a multidisciplinary team, consisting of medical, allied health and/or nursing staff, provided a comprehensive SDB management service that included screening, diagnosis and treatment. Inpatients with SCI were assessed for SDB with overnight oximetry and/or polygraphy. Further assessment of patient symptoms, respiratory function, and hypercapnia supported the diagnostic process. Treatment with positive airway pressure was initiated on the ward. Having a collaborative, skilled team with strong leadership and adequate resources were the key, common enablers to providing the service.
Conclusion
It is feasible for multi-disciplinary SCI rehabilitation teams to independently diagnose and treat uncomplicated SDB without referral to specialist sleep services provided they are adequately resourced with equipment and skilled staff. Similar models of care could substantially improve access to SDB treatment for people with SCI. Further research is required to determine the non-inferiority of these alternatives to specialist care.
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Data availability
The datasets generated and/or analysed during the current study are available from the corresponding author on reasonable request.
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Funding
MG’s travel to the three SCI rehabilitation centres was supported by the Queensland University of Technology (QuT) Alan-MacKay-Sim Spinal Cord Injury Travelling Fellowship.
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MG was responsible for designing the study, data collection and analysis, interpreting results, and writing the manuscript. DFO, CMO, MEB, GM, BD, BLK, HL were responsible for obtaining ethical approval and data collection at their sites. They all contributed to the interpretation of the results and manuscript preparation. DJB contributed to study design, interpretation of the results and manuscript preparation.
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The authors declare no competing interests.
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Ethics approval was obtained from: • Horizon Health Network Research Ethics Board, New Brunswick, Canada (2020–2856). • Ethics Committee for Northwestern and Central Switzerland, Basil, Switzerland (2020–00180). • Medical ethics review committee, Amsterdam UMC, The Netherlands (2020.176). We certify that all applicable institutional and governmental regulations concerning the ethical use of human volunteers/animals were followed during the course of this research.
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Graco, M., Gobets, D.F., M O’Connell, C. et al. Management of sleep-disordered breathing in three spinal cord injury rehabilitation centres around the world: a mixed-methods study. Spinal Cord 60, 414–421 (2022). https://doi.org/10.1038/s41393-022-00780-3
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DOI: https://doi.org/10.1038/s41393-022-00780-3
