Sleep disturbances in the spinal cord injured: an epidemiological questionnaire investigation, including a normal population

Abstract

Study design: Epidemiological review. Objective: To evaluate sleep disturbances in the spinal cord injured. Setting: The Clinic for Para-and Tetraplegia, Hornbñk/Copenhagen, Copenhagen University hospital, Denmark. Methods: All patients admitted with traumatic SCI during the 20-year period 1968 ± 1987 were reviewed. The normal population consisted of 339, 222 men and 117 women. These groups were asked to ®ll in the self-administered Nordic Sleep Questionnaire (NSQ) containing 21 questions. Questions were added regarding employment, smoking, alcohol, co ee or tea consumption, height and weight. The questionnaire for SCI individuals included questions about bladder emptying method, mobility, and spasms. For the SCI population age at injury, cause of injury, neurological level, and functional class were retrieved. Results: Four hundred and eight SCI individuals, 331 men and 77 women, answered the NSQ corresponding to a response rate of 83.8%. Forty-seven per cent had a cervical cord lesion and about half of the population had a complete motor lesion. In comparison with the normal population the SCI individuals had greater di culty in falling asleep, described more frequent awakenings, slept subjectively less well, were more often prescribed sleeping pills, slept more hours, took more and longer naps, and snored more and for more years. In particular, spasms, pain, paraesthesia, and troubles with voiding were claimed to be part of the sleep problems. Conclusion: In spite of the same average age and a higher body mass index in the normal than the SCI population, the SCI individuals showed signi®cantly more sleep problems than the normal population. Spinal Cord (2001) 39, 505 ± 513

Reduced sleep efficiency in cervical spinal cord injury; association with abolished night time melatonin secretion

“…Thus, the absence of night time melatonin secretion may explain part of the excessive daytime sleepiness and disturbed sleep observed in patients with cervical SCI. [1][2][3] Furthermore, the increased latency to REM sleep in subjects with cervical SCI suggests that the absence of night time melatonin may partially underlie the previously observed reduction in REM sleep propensity. 2 Melatonin has been proposed to facilitate sleep by inhibiting the circadian drive for waking that emanates from the SCN, [11][12][13] by binding to the high-affinity melatonin receptors in the human SCN 14 (for a review, see Scheer et al 7 ).…”

“…[1][2][3] We previously found that patients with complete lesions of their cervical spinal cords have an absence of the normal endogenous melatonin secretion at night. This demonstrates that the neural pathway for the endogenous production of melatonin passes through the cervical spinal cord.…”

The feasibility of sleep assessment by actigraph in patients with tetraplegia

“…They take more sleeping pills, and their snores are prolonged and more frequent than those of healthy persons. 1,2 These sleep disturbances may be caused by spastic muscle contractions, pain, sensory disturbances, or incontinence. Impairment of the sleep-wake cycle, a possible consequence of a cervical SCL, may also contribute to these disturbances.…”

Quality of sleep in individuals with spinal cord injury: a comparison between patients with and without pain

“…In a study of Biering-So¨rensen, 16 differences in sleep quality between patients with an SCI and individuals from the general population were assessed with the Nordic Sleep Questionnaire. They found that patients with SCI had poorer sleep quality, for example, reported more difficulties falling asleep, awakened more often at night, slept subjectively less well, were more often prescribed sleeping pills, slept more hours, took more and longer naps, and snored more.…”