Sleep disorders in patients with spinal cord injury

Giannoccaro, Maria Pia; Moghadam, Keivan Kaveh; Pizza, Fabio; Boriani, Stefano; Maraldi, Nadir M.; Avoni, Patrizia; Morreale, Angela; Liguori, Rocco; Plazzi, Giuseppe

doi:10.1016/j.smrv.2012.12.005

Cited by 66 publications

(56 citation statements)

References 102 publications

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“…However, in our tetraplegic only population, problems with changing position in bed and breathing were also significant issues. Although the published data are sparse, it is believed that sleep-disordered breathing is more common in people with tetraplegia than paraplegia, 4 and bed mobility is obviously more challenging in people with tetraplegia. It is possible that the addition of people with paraplegia in the Danish sample reduced the relative magnitude of these problems.…”

Section: Discussionmentioning

confidence: 99%

“…[1][2][3] Although the aetiologies remain unclear, obesity, sleeping in supine, nasal congestion, disruption of the melatonin pathway, medications, pain and spasm all likely contribute to the increased prevalence. 4 Because the majority of spinal cord injuries (SCIs) occur in the young, people with SCI typically live with secondary complications for many decades. Understanding the impact of secondary conditions, such as sleep disorders, will enable researchers, policy-makers and funders to direct resources to areas in which they are most likely to have an impact on the quality of life and health outcomes.…”

Section: Introductionmentioning

confidence: 99%

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Subjective sleep disturbances and quality of life in chronic tetraplegia

et al. 2015

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Study design: This is a cross-sectional survey. Objectives: The objective of this study was to evaluate the subjective sleep disturbances and quality of life in chronic tetraplegia. Setting: This study was conducted in a community sample from Victoria, Australia. Methods: People with tetraplegia were mailed a survey battery including the following: demographic questions; Karolinska Sleepiness Scale (KSS); Basic Nordic Sleepiness Questionnaire; Functional Outcomes of Sleep Questionnaire (FOSQ); Multivariate Apnoea Prediction Index and Assessment of Quality of Life (AQoL) Questionnaire. Scores were compared with the best available normative data. Results: A total of 163 of 424 (38%) surveys were returned (77% male; 39% sensory and motor complete; mean age±s.d. = 46±14 years; mean years since injury = 11±8 years). The AQoL health utility score (0.31±0.29) was significantly lower than published population norms. FOSQ total (17.55±2.57) and KSS (3.93±2.27) scores were no different from the best available population data. People with tetraplegia reported worse sleep habits, symptoms and quality than a normal population, as indicated on 17 of 21 questions on the Basic Nordic Sleep Questionnaire. Multivariate analysis found that greater injury severity (coefficient (95% CI) = 0.14 (0.10, 0.18)), increasing age (−0.004 (−0.008, − 0.001)) and worse sleep symptoms (−0.005 (−0.009, − 0.0003)) were all significantly associated with reduced quality of life. Conclusion: People with chronic tetraplegia experience more subjective sleep problems and worse quality of life than their able-bodied counterparts. Quality of life is related to injury severity, age and sleep symptoms. Treating the sleep disorders experienced by people living with tetraplegia has the potential to improve their health and well-being.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Subjective sleep disturbances and quality of life in chronic tetraplegia

et al. 2015

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“…[2][3][4][5][6][7] Sleep problems are especially prevalent in individuals living with neurological conditions, including spinal cord injury (SCI) and multiple sclerosis (MS). [8][9][10][11][12][13] There are a number of neurological factors associated with SCI and/or MS that may contribute to sleep problems in these populations. 10,12,14 In SCI, traumatic and nontraumatic injuries can sever key neural signaling pathways responsible for regulating and maintaining sleep.…”

Section: Introductionmentioning

confidence: 99%

“…[8][9][10][11][12][13] There are a number of neurological factors associated with SCI and/or MS that may contribute to sleep problems in these populations. 10,12,14 In SCI, traumatic and nontraumatic injuries can sever key neural signaling pathways responsible for regulating and maintaining sleep. 10,15 Similarly in MS, demyelination and neurodegeneration [16][17][18][19] throughout the brain and spinal cord can damage neural structures and axonal projections that may be involved in sleep and sleep related disorders such as periodic limb movement 20 and sleep related breathing disorders.…”

Section: Introductionmentioning

confidence: 99%

Comparison of Sleep Problems in Individuals with Spinal Cord Injury and Multiple Sclerosis

Fogelberg

Hughes

Vitiello

et al. 2016

Journal of Clinical Sleep Medicine

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Study Objectives: Sleep problems are common in spinal cord injury (SCI) and multiple sclerosis (MS). However, the degree to which sleep problems differ between these distinct clinical populations has not been evaluated. In this study, we examined self-reported sleep problems in individuals with SCI and those with MS, and compared these clinical groups on the Medical Outcomes Study Sleep Scale (MOS-SS). Methods: Participants were 1,677 individuals (SCI = 581; MS = 1,096) enrolled in longitudinal study of self-reported health outcomes in SCI and MS. Univariate and multivariate analysis of covariance examined group differences on global sleep problems and domain-specific subscales of the MOS-SS. Results: Individuals with SCI reported an average of 30 fewer min of sleep per night (Sleep Quantity subscale) and significantly greater difficulty initiating and maintaining sleep (Sleep Disturbance subscale) compared to individuals with MS. However, groups did not differ on global sleep problems (Sleep Problems Index 9). Conclusions: Although global sleep problems are more common in SCI and MS than in the general population, these groups exhibit differing sleep problem profiles, and thus may require unique treatment approaches to address the specific domains of sleep affected. For individuals with SCI, an additional focus on increasing sleep quantity and reducing sleep disruptions may be warranted.

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“…3 The complex causes of sleep disruption in spinal cord injury have been recently reviewed, 4 but one area of disruption that may be readily addressed is melatonin.…”

Section: Introductionmentioning

confidence: 99%

Sleep disruption in tetraplegia: a randomised, double-blind, placebo-controlled crossover trial of 3 mg melatonin

et al. 2014

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Study design: Randomised, double-blind, placebo-controlled crossover trial of melatonin supplementation to people with complete tetraplegia. Objectives: To investigate the effect that 3 mg melatonin supplementation has on objective and subjective sleep, quality of life and mood of people living with complete tetraplegia. Setting: Austin Hospital Sleep Laboratory and participants' homes, Melbourne, Victoria, Australia. Methods: Two week run-in followed by 3 week nightly administration of 3 mg melatonin or placebo, 2-week washout and further 3 week administration of the opposite treatment. Four testing sessions were conducted; the last nights of the run-in, treatment and washout periods. Testing sessions involved recording full polysomnography, completing a questionnaire battery and collecting urine and blood samples. The questionnaires assessed mood, sleep symptoms and health-related quality of life, and the urine and plasma samples assayed 6-sulphatoxymelatonin (aMT6s) and melatonin levels, respectively. A sleep diary was completed throughout the study. Results: Eight participants (mean (s.d.): age 49.5 years (16), postinjury 16.9 years (7.1)) were recruited in which seven concluded the protocol. Endogenous-circulating melatonin was significantly higher (Pp0.01) following melatonin (urine: 152.94 mg h À1 (74.51), plasma: 43 554.57 pM (33 527.11)) than placebo (urine: 0.86 mg h À1 (0.40), plasma: 152.06 pM (190.55)). Subjective sleep improved significantly following melatonin specifically for duration of sleep per night and psychological wellbeing. Objective sleep showed a significant increase in light sleep with melatonin, with all other sleep parameters being unchanged. Conclusion: These results suggest that increasing melatonin in people with complete tetraplegia is beneficial, especially for subjective sleep. Investigation of the pharmacokinetics of melatonin metabolism in this population is warranted. Sponsorship: This project is proudly supported by the Transport Accident Commission.

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Sleep disorders in patients with spinal cord injury

Cited by 66 publications

References 102 publications

Subjective sleep disturbances and quality of life in chronic tetraplegia

Subjective sleep disturbances and quality of life in chronic tetraplegia

Comparison of Sleep Problems in Individuals with Spinal Cord Injury and Multiple Sclerosis

Sleep disruption in tetraplegia: a randomised, double-blind, placebo-controlled crossover trial of 3 mg melatonin

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