A review of sleep research in patients with spinal cord injury

Abstract

Study design: Systematic review. Objectives: Sleep disturbances are a common complaint among individuals with spinal cord injury (SCI) and were not usually present before the SCI. Their sleep disturbances, including disrupted sleep, spasms, and problems with initiating and sustaining sleep through the night, affect SCI individuals' overall quality of life due to excessive tiredness and low energy levels during the day. Despite the high prevalence of sleep complaints in this population, current knowledge about sleep in the SCI population has not been systematically assessed. Setting: Capital Region of Denmark. Methods: We systematically reviewed literature identified from the PubMed and EMBASE databases following PRISMA guidelines.Thirty-seven articles met our inclusion criteria, as only controlled studies were included. This could be a comparison of (1) SCI individuals and able-bodied controls, (2) cervical with thoracolumbar SCI individuals, or (3) cervical, thoracolumbar SCI individuals and able-bodied controls. Results: Individuals with SCI have a higher prevalence of sleep-disordered breathing and periodic leg movements during sleep (PLMS), lower heart rate, but no nocturnal lowering of blood pressure. 24-hour energy expenditure and sleeping metabolic rate were significantly lower, and bowel movements were altered. Endocrine alterations were found in investigations of melatonin, cortisol and antidiuretic hormone. Questionnaires revealed a high prevalence of subjectively poorer sleep quality in individuals with SCI compared with able-bodied controls. Conclusions: There are significant differences between groups with SCI and able-bodied controls. SCI objectively and subjectively markedly affects an individual's sleep.

Bed Sensor Technology for Objective Sleep Monitoring Within the Clinical Rehabilitation Setting: Observational Feasibility Study

“…A high coverage of HR and RR is essential to assess HR- and RR-based functional sleep outcomes. Possible interesting HR- and RR-based functional outcomes for clinicians from the bed sensor could be (1) time in bed, (2) sleep latency, (3) sleep efficiency, (4) total time awake, (5) total sleep time, (6) sleep stages (%), and (7) apnea-hypopnea index [ 1 , 12 , 32 , 45 , 46 ]. To determine these functional sleep outcomes, it is important that HR and RR, as well as movement, can properly be measured with the bed sensor.…”

“…Although rehabilitation focuses mainly on activities during the day, sleep is also important for rehabilitation. Patients with a stroke or SCI can face sleep disturbances including sleep disorders [ 1 - 3 ]. Up to 60% of patients with stroke or SCI suffer from sleep disorders [ 1 , 2 ], which is high compared to the 24% of people with sleep problems in the general European population [ 4 ].…”

“…Patients with a stroke or SCI can face sleep disturbances including sleep disorders [ 1 - 3 ]. Up to 60% of patients with stroke or SCI suffer from sleep disorders [ 1 , 2 ], which is high compared to the 24% of people with sleep problems in the general European population [ 4 ]. Those sleep disturbances may interfere with their long-term rehabilitation process for a variety of reasons in terms of lowering motivation, energy, and concentration, which are needed to fully participate in the rehabilitation process [ 3 , 5 ].…”

“…It also improves implicit learning of motor skills [ 7 ] and cognitive performance [ 8 - 10 ], which may result in performance improvements [ 11 ]. Furthermore, sleep positively affects patients’ daily activity and reduces the risk of diabetes, cardiovascular diseases, and development of metabolic disorders [ 1 , 2 , 8 , 10 , 12 , 13 ], which in its totality contributes to the quality of life. Hence, sleep is essential for optimal inpatient rehabilitation and long-term health, indicating the importance of sleep assessment.…”

Bed Sensor Technology for Objective Sleep Monitoring Within the Clinical Rehabilitation Setting: Observational Feasibility Study (Preprint)

“…Although rehabilitation focuses mainly on activities during the day, sleep is also important for rehabilitation. Patients with a stroke or SCI can face sleep disturbances including sleep disorders [1][2][3]. Up to 60% of patients with stroke or SCI suffer from sleep disorders [1,2], which is high compared to the 24% of people with sleep problems in the general European population [4].…”