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Sleep and Daytime Function in People with Spinal Cord Injury.

Amira N Badr1, Salam Zeineddine2,3, Anan Salloum2,3

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For veterans with spinal cord injury (SCI), insomnia symptoms and poor sleep quality significantly impact daytime function. Sleep-disordered breathing severity did not show a similar association, highlighting insomnia as a key area for intervention.

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Area of Science:

  • Neurology
  • Sleep Medicine
  • Rehabilitation Medicine

Background:

  • Spinal cord injury (SCI) significantly affects veterans' daily lives.
  • Sleep disturbances are common in individuals with SCI, potentially impacting their overall health and function.
  • Understanding the specific roles of sleep-disordered breathing (SDB), insomnia, and sleep quality is crucial for improving outcomes in this population.

Purpose of the Study:

  • To investigate the relationship between sleep-disordered breathing (SDB), insomnia symptoms, and sleep quality with daytime function and quality of life in veterans with SCI.
  • To identify specific sleep-related factors that contribute to functional impairments in veterans with SCI.

Main Methods:

  • A cross-sectional cohort study was conducted with 38 male veterans with SCI.
  • Participants completed assessments for sleep apnea severity (apnea-hypopnea index, AHI), insomnia symptoms (Insomnia Severity Index, ISI), sleep quality (Pittsburg Sleep Quality Index, PSQI), daytime sleepiness (Epworth Sleepiness Scale, ESS), fatigue, depression, functioning (Spinal Cord Independence Measure, SCIM), and quality of life (WHOQOL-BREF).
  • Bivariate correlations were used to analyze the relationships between sleep parameters and functional outcomes.

Main Results:

  • No significant associations were found between the severity of sleep apnea (AHI) and measures of daytime function.
  • Higher insomnia symptom severity (ISI) was significantly correlated with worse scores on measures of depression (PHQ-9), quality of life (WHOQOL-BREF subscales), and functioning (SCIM).
  • Poorer self-reported sleep quality (PSQI) was associated with increased fatigue (FFS), depression (PHQ-9), and diminished quality of life (WHOQOL-BREF subscales).

Conclusions:

  • Insomnia symptoms and poor sleep quality, but not sleep-disordered breathing severity, are significantly associated with worse daytime function and quality of life in veterans with SCI.
  • Insomnia and poor sleep quality represent potentially modifiable factors that contribute to functional deficits in this population.
  • Further research into the efficacy of evidence-based insomnia treatments for individuals with SCI is warranted to improve their functional outcomes.