Sleep and daytime function in people with spinal cord injury

We sought to determine the role of sleep-disordered breathing, insomnia symptoms, and sleep quality in the daytime function and quality of life of veterans with spinal cord injury.

This cross-sectional cohort study took place in a Veterans Administration medical center in the midwestern United States. Thirty-eight male veterans with spinal cord injury (22 cervical, 16 thoracic; mean [standard deviation] age = 62.9 [9.5] years) completed baseline assessments within a larger clinical trial. Measures assessed sleep apnea severity (apnea-hypopnea index), insomnia symptoms (Insomnia Severity Index), self-reported sleep quality (Pittsburg Sleep Quality Index), daytime sleepiness (Epworth Sleepiness Scale), fatigue (Flinders Fatigue Scale), depression (Patient Health Questionnaire-9 item, excluding sleep item), functioning (Spinal Cord Independence Measure), and quality of life (World Health Organization Quality of Life). Bivariate correlations (alpha P < .05) were used to assess relationships between sleep (apnea-hypopnea index, Insomnia Severity Index, Pittsburg Sleep Quality Index, Epworth Sleepiness Scale) and function (Flinders Fatigue Scale, Patient Health Questionnaire-9 item, Spinal Cord Independence Measure, World Health Organization Quality of Life).

Mean apnea-hypopnea index was 29.9 (26.6) events/h, mean Insomnia Severity Index was 9.4 (6.2), mean Pittsburg Sleep Quality Index was 9.0 (4.6), and mean Epworth Sleepiness Scale was 7.0 (5.2). There were no significant relationships between apnea-hypopnea index and function measures. Significant relationships emerged between worse Insomnia Severity Index and worse Patient Health Questionnaire-9, some World Health Organization Quality of Life subscales, and Spinal Cord Independence Measure as well as between worse Pittsburg Sleep Quality Index and worse Flinders Fatigue Scale, Patient Health Questionnaire-9 item, and some World Health Organization Quality of Life subscales (P < .05).

Among veterans with spinal cord injury, insomnia symptom severity and poor sleep quality were associated with worse functioning, whereas sleep-disordered breathing severity was not. Insomnia and poor sleep quality represent modifiable contributors to poor daytime function. Research evaluating the impact of evidence-based insomnia treatments among individuals living with spinal cord injury is warranted.

Registry: ClinicalTrials.gov; Name: Treatment of Sleep-disordered Breathing in Patients With SCI; URL: https://www.clinicaltrials.gov/study/NCT02830074; Identifier: NCT02830074.

Badr AN, Zeineddine S, Salloum A, et al. Sleep and daytime function in people with spinal cord injury. J Clin Sleep Med. 2025;21(11):1903-1909.