Sleep-Disordered Breathing and Spinal Cord Injury: A State-of-the-Art Review

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.

Keywords: OSA; central sleep apnea; continuous positive airway pressure; multiple sclerosis; sleep apnea; sleep-disordered breathing; spinal cord injury; tetraplegia.

Copyright © 2018. Published by Elsevier Inc.

Figures

Figure 1

A diagram to illustrate the mechanism(s) for sleep-disordered breathing because of spinal cord injury. C = cervical; CIH = chronic intermittent hypoxia; LTF = long-term facilitation; Pcrit = critical collapsing pressure; SCI = spinal cord injury; T = thoracic; UA = upper airway.

Figure 2

A, B, Comparison between a specially equipped room for studying patients with spinal cord injury or disease (A) and a standard room in a clinical sleep laboratory (B). Number 1 shows a hospital bed with specially designed mattress, 2 shows a transfer board, 3 shows a urinary catheter, 4 shows a wheelchair, and 5 shows a lift.