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Workshop: No lab? No problem! Local solutions to providing evidence-based management of sleep disordered breathing in spinal cord injury.

Track 2
Wednesday, September 2, 2020
11:00 AM - 12:30 PM
Auditorium - Track 2


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Dr Marnie Graco
Research And Translation Fellow
Alfred Health

No lab? No problem! Local solutions to providing evidence-based management of sleep disordered breathing in spinal cord injury.


Sleep disordered breathing (SDB) is a highly prevalent secondary complication of spinal cord injury (SCI) and is associated with substantial neurocognitive impairment and reduced quality of life. Recent meta-analysis has estimated the prevalence of at least mild SDB in tetraplegia to be over 80%, and at least moderate SDB at over 60%. Despite this, research estimates that less than 20% of people with SCI are diagnosed and treated. This suggests that more than half of people with tetraplegia have a clinically significant disorder that is being overlooked by the health system.

The usual management pathway for SDB in SCI involves referral from the primary care or rehabilitation doctor to specialist sleep services for investigation and management. However, this care model often presents significant access barriers to people with tetraplegia. In the general community, there is increasing recognition that highly prevalent sleep disorders, such as SDB, place unmanageable access pressures on specialist sleep services. Research addressing these access issues in the general community has demonstrated that ambulatory models of diagnosis and treatment can be as effective as laboratory-based ones, and that health professionals other than sleep specialists can deliver safe and effective care.

Our research has identified three spinal cord injury (SCI) centres that have developed local solutions to these access issues. All three SCI centres have created a highly skilled, multi-disciplinary team dedicated to managing respiratory issues, including SDB. Routine screening and diagnosis is performed with portable, automated equipment and the collaborative decision on whether treatment is indicated, and the type of treatment, is based on test results, patient symptoms and patient wishes. These findings demonstrate that is feasible for multi-disciplinary SCI rehabilitation teams to independently manage un-complicated SDB without external referral.

This workshop will provide participants with background knowledge on the epidemiology of SDB in SCI. It will describe the latest evidence on ambulatory diagnostic and treatment methods and alternatives to specialist sleep services. Participants will hear from the SCI rehabilitation centres that have developed “in-house” models of managing SDB and be encouraged to consider local solutions for their setting. Finally, participants will be invited to contribute to the design of planned prospective trials to test the implementation of alternative models of SDB management in SCI.

Session outline:
- Professor David Berlowitz - "Overview of the latest research on epidemiology and treatment of SDB in SCI" (10 minutes)
- Dr. Marnie Graco - "Models of SDB management in SCI" (10 minutes)
- Dr. David Gobets - "Example of a comprehensive SDB service within an SCI centre in the Netherlands" (15 minutes)
- Dr. Colleen O’Connell - "Ambulatory diagnostic and treatment techniques for SDB in SCI" (15 minutes)
- Facilitated discussion:
"What other local solutions might address the under-diagnosis and treatment of SDB?" and
"What are the barriers and enablers to SCI centres providing SDB diagnosis and treatment services?" (25 minutes)
- Dr. Marnie Graco - "Future research opportunities" (10 minutes)
- Professor David Berlowitz - Summation of session ( 5 minutes)


Dr. Marnie Graco is a physiotherapist with a Masters of Public Health. Her PhD thesis (University of Melbourne) investigated the clinical management of obstructive sleep apnoea in people with tetraplegia. Her research sits broadly within a knowledge translation framework and she is experienced in a variety of qualitative and quantitative methodologies. She works at Alfred Health (Melbourne) as Allied Health Research and Translation Lead, where her role is to build capacity for allied health clinicians and departments to undertake knowledge translation research.