Sleep-Disordered Breathing and Spinal Cord Injury

Abstract

Individuals living with spinal cord injury or disease (SCI/D) are at increased risk for sleep-disordered breathing (SDB), with a prevalence that is three-to fourfold higher than the general population. The main features of SDB, including intermittent hypoxemia and sleep fragmentation, have been linked to adverse cardiovascular outcomes including nocturnal hypertension in patients with SCI/D. The relationship between SDB and SCI/D may be multifactorial in nature given that level and completeness of injury can affect central control of respiration and upper airway collapsibility differently, promoting central and/or obstructive types of SDB. Despite the strong association between SDB and SCI/D, access to diagnosis and management remains limited. This review explores the role of SCI/D in the pathogenesis of SDB, poor sleep quality, the barriers in diagnosing and managing SDB in SCI/D, and the alternative approaches and future directions in the treatment of SDB, such as novel pharmacologic and nonpharmacologic treatments.

Diverse cognitive impairment after spinal cord injury is associated with orthostatic hypotension symptom burden

“…sleep apnea, major depressive disorder, fatigue and impaired glucose tolerance), which may confound the findings of this study [60][61][62][63]. Sleep apnea is present in up to 50% of individuals with high-level SCI [64], while depression also affects a large proportion of this population [65]. Although significant differences were noted between groups for symptoms of depression, the group means for the BDI-II are both considered to be within the 'none or minimal depression' range (0 -13), indicating non-clinically meaningful differences.…”

A randomised controlled trial of nasal decongestant to treat obstructive sleep apnoea in people with cervical spinal cord injury

“…Taken together, our current findings and the previous research suggest that reducing nasal congestion remains a worthwhile therapeutic target, but that PE is not the best single agent for reducing the AHI in people with tetraplegia and OSA. The emerging literature suggests that the pathophysiology of OSA in tetraplegia is different to what is observed in the non-disabled population [12][13][14][15][16]. Elevated nasal resistance remains an obvious therapeutic target and future research should consider testing steroid treatment and longer acting decongestant agents that do not elicit rebound or other substantive side effects.…”

“…The pathogenesis of OSA results from a combination of anatomical and non-anatomical physiological traits including high upper airway collapsibility, low arousal threshold, high loop gain and low muscle responsiveness [9]. While the relative contributions of these factors are likely to be different in tetraplegia [10], anatomical and physiological changes associated with injury, such as altered autonomic [11], neuromuscular [12] and respiratory control [13], increased adipose tissue and neck circumference [2,14], and increased nasal resistance [15,16], may increase the risk of OSA in people with tetraplegia.…”

<p>Impact Of Spinal Cord Injury On Sleep: Current Perspectives</p>

“…Sleep-disordered breathing in tetraplegia may also be an etiologically bi-phasic disorder; acutely caused by the cervical SCI with partial resolution during injury recovery, only to increase again with age, weight gain, ongoing chronic intermittent hypoxia and the use of medications that compromise respiration 7,23,24. An association between cognitive performance and the severity of SDB has been described acutely after tetraplegic injury, impairments that persisted after adjustment for the known confounders of age and pre-injury estimates of verbal intelligence 43.…”

“…Poor sleep quality is a consistent patient-reported outcome in populations with chronic SCI 2–6. Multiple factors may adversely influence sleep after SCI including very high rates of sleep-disordered breathing (SDB), particularly in those with high thoracic and cervical level injuries,7 high frequency of abnormal legs movements during wake and sleep,8 and poor sleep quality. The latter may be due to pain, insomnia and/or sleep-wake circadian rhythm disturbances 9,10.…”