A prospective, randomised controlled trial of auto-titrating Continuous positive airway pressure treatment for Obstructive Sleep Apnoea after acute Quadriplegia

The COSAQ trial aims to establish the impact on sleep function of using a CPAP nasal mask and pump at night. Continuous positive airway pressure (CPAP) is a nasal/facial mask and machine used at night to treat sleep apnoea. Although CPAP is the usual treatment for sleep apnoea, previous reports suggest that is poorly tolerated in acute quadriplegia. A maximum of 35% of those with chronic quadriplegia are adherent with therapy, with a higher rate of 50% in acute quadriplegia. A range of factors including severe immobility and psychological factors appear to contribute to a low acceptance of CPAP. The SHiQ COSAQ project will examine the impact on sleep function, quality of life and cognition of using CPAP, and establish whether the benefit of using CPAP is outweighed by the inconvenience of using it. People with quadriplegia have extremely high rates of sleep apnoea after injury which is undoubtedly limiting their rehabilitation. Successful treatment may improve acute, sub-acute and community outcomes for this group and demonstrate significant cost-utility.