Sleep-Disordered Breathing in Chronic SCI

Inclusion Criteria

• Chronic tetraplegia or paraplegia (C4-L1)
• American Spinal Injury Association (ASIA) Impairment Scale A, B, C or D
• 18 years and older
• At least one year post injury
• Hearing and vision suitable for comprehension of instructions, and perception of cognitive test stimuli
• No color blindness as measured by a brief screen with color perception Ishihara cards
• Stable medical condition for 2 weeks prior to enrollment. Patients admitted to hospital will be eligible for enrolment if the acute illness precipitating admission is in recovery phase for 2 weeks or longer

Exclusion Criteria

• Diagnosis of SDB and successful positive airway pressure (PAP) therapy prior to injury. Those with a diagnosis of SDB post injury who are not receiving therapy for SDB (PAP, surgical, and/or oral appliance) are eligible for study enrollment
• Patients who are intubated, have a tracheostomy, and/or are using long term invasive/non-invasive positive pressure ventilation
• Participants with predominant central sleep apnea on PSG requiring bi-level PAP therapy
• Severe traumatic brain injury (GCS < 8 at first assessment)
• Unable to understand or read English at a grade 5 level
• Inability to provide informed consent
• Evidence of advanced neurological or systemic disease that may affect cognitive functioning (e.g., Alzheimer's disease, Dementia, Parkinson's disease)
• Significant aphasia or language impairments
• Positive airway pressure therapy may be contraindicated in some patients with the following preexisting conditions:
• severe bullous lung disease
• pneumothorax
• pathologically low blood pressure
• dehydration
• cerebrospinal fluid leak, recent cranial surgery, or trauma.