Jordan W Squair1, Amanda H X Lee1, Zoe K Sarafis1, Geoff Coombs1, Otto Barak1, Jacquelyn J Cragg1, Tanja Mijacika1, Renata Pecotic1, Andrei V Krassioukov1, Zoran Dogas1, Zeljko Dujic1, Aaron A Phillips2. 1. From the Departments of Physiology and Pharmacology, Clinical Neurosciences, and Cardiac Sciences (J.W.S., A.A.P.), and Hotchkiss Brain Institute, Libin Cardiovascular Institute of Alberta, Cumming School of Medicine (J.W.S., A.A.P.), University of Calgary; Centre for Heart, Lung and Vascular Health, Faculty of Health and Social Development (G.C.), University of British Columbia Okanagan, Kelowna; International Collaboration on Repair Discoveries (ICORD) (J.W.S., A.H.X.L., Z.K.S., J.J.C., A.V.K.), MD/PhD Training Program (J.W.S.), and Department of Experimental Medicine (J.W.S., A.H.X.L.), Faculty of Medicine, and Faculty of Pharmaceutical Sciences (J.J.C.), University of British Columbia, Vancouver, Canada; Department of Integrative Physiology (O.B., T.M., Z.D.) and Department of Neuroscience, Split Sleep Medicine Center (R.P., Z.D.), University of Split School of Medicine, Split, Croatia; and Department of Physiology (O.B.), University of Novi Sad Medical School, Serbia. 2. From the Departments of Physiology and Pharmacology, Clinical Neurosciences, and Cardiac Sciences (J.W.S., A.A.P.), and Hotchkiss Brain Institute, Libin Cardiovascular Institute of Alberta, Cumming School of Medicine (J.W.S., A.A.P.), University of Calgary; Centre for Heart, Lung and Vascular Health, Faculty of Health and Social Development (G.C.), University of British Columbia Okanagan, Kelowna; International Collaboration on Repair Discoveries (ICORD) (J.W.S., A.H.X.L., Z.K.S., J.J.C., A.V.K.), MD/PhD Training Program (J.W.S.), and Department of Experimental Medicine (J.W.S., A.H.X.L.), Faculty of Medicine, and Faculty of Pharmaceutical Sciences (J.J.C.), University of British Columbia, Vancouver, Canada; Department of Integrative Physiology (O.B., T.M., Z.D.) and Department of Neuroscience, Split Sleep Medicine Center (R.P., Z.D.), University of Split School of Medicine, Split, Croatia; and Department of Physiology (O.B.), University of Novi Sad Medical School, Serbia. aaron.phillips@ucalgary.ca.
Abstract
OBJECTIVE: To determine the population-level odds of individuals with spinal cord injury (SCI) experiencing fatigue and sleep apnea, to elucidate relationships with level and severity of injury, and to examine associations with abnormal cerebrovascular responsiveness. METHODS: We used population-level data, meta-analyses, and primary physiologic assessments to provide a large-scale integrated assessment of sleep-related complications after SCI. Population-level and meta-analyses included more than 60,000 able-bodied individuals and more than 1,800 individuals with SCI. Physiologic assessments were completed on a homogenous sample of individuals with cervical SCI and matched controls. We examined the prevalence of (1) self-reported chronic fatigue, (2) clinically identified sleep apnea, and 3) cerebrovascular responsiveness to changing CO2. RESULTS: Logistic regression revealed a 7-fold elevated odds of chronic fatigue after SCI (odds ratio [OR] 7.9, 95% confidence interval [CI] 3.5-16.2), and that fatigue and trouble sleeping are correlated with the level and severity of injury. We further show that those with SCI experience elevated risk of clinically defined sleep-disordered breathing in more than 600 individuals with SCI (pooled OR 3.1, 95% CI 1.3-7.5). We confirmed that individuals with SCI experience a high rate of clinically defined sleep apnea using primary polysomnography assessments. We then provide evidence using syndromic analysis that sleep-disordered breathing is a factor strongly associated with impaired cerebrovascular responsiveness to CO2 in patients with SCI. CONCLUSIONS: Individuals with SCI have an increased prevalence of sleep-disordered breathing, which may partially underpin their increased risk of stroke. There is thus a need to integrate sleep-related breathing examinations into routine care for individuals with SCI.
OBJECTIVE: To determine the population-level odds of individuals with spinal cord injury (SCI) experiencing fatigue and sleep apnea, to elucidate relationships with level and severity of injury, and to examine associations with abnormal cerebrovascular responsiveness. METHODS: We used population-level data, meta-analyses, and primary physiologic assessments to provide a large-scale integrated assessment of sleep-related complications after SCI. Population-level and meta-analyses included more than 60,000 able-bodied individuals and more than 1,800 individuals with SCI. Physiologic assessments were completed on a homogenous sample of individuals with cervical SCI and matched controls. We examined the prevalence of (1) self-reported chronic fatigue, (2) clinically identified sleep apnea, and 3) cerebrovascular responsiveness to changing CO2. RESULTS: Logistic regression revealed a 7-fold elevated odds of chronic fatigue after SCI (odds ratio [OR] 7.9, 95% confidence interval [CI] 3.5-16.2), and that fatigue and trouble sleeping are correlated with the level and severity of injury. We further show that those with SCI experience elevated risk of clinically defined sleep-disordered breathing in more than 600 individuals with SCI (pooled OR 3.1, 95% CI 1.3-7.5). We confirmed that individuals with SCI experience a high rate of clinically defined sleep apnea using primary polysomnography assessments. We then provide evidence using syndromic analysis that sleep-disordered breathing is a factor strongly associated with impaired cerebrovascular responsiveness to CO2 in patients with SCI. CONCLUSIONS: Individuals with SCI have an increased prevalence of sleep-disordered breathing, which may partially underpin their increased risk of stroke. There is thus a need to integrate sleep-related breathing examinations into routine care for individuals with SCI.
Authors: A A Phillips; N Matin; B Frias; M M Z Zheng; M Jia; C West; A M Dorrance; I Laher; A V Krassioukov Journal: J Physiol Date: 2016-01-18 Impact factor: 5.182
Authors: Vanessa K Noonan; Matthew Fingas; Angela Farry; David Baxter; Anoushka Singh; Michael G Fehlings; Marcel F Dvorak Journal: Neuroepidemiology Date: 2012-04-27 Impact factor: 3.282
Authors: Bernard E Leduc; Jehan H Dagher; Pierre Mayer; François Bellemare; Yves Lepage Journal: Arch Phys Med Rehabil Date: 2007-03 Impact factor: 3.966
Authors: Aaron A Phillips; Darren E R Warburton; Philip N Ainslie; Andrei V Krassioukov Journal: J Cereb Blood Flow Metab Date: 2014-01-29 Impact factor: 6.200
Authors: Jingzhong Ding; F Javier Nieto; Norman J Beauchamp; Tamara B Harris; John A Robbins; Jacqueline B Hetmanski; Linda P Fried; Susan Redline Journal: Sleep Date: 2004-05-01 Impact factor: 5.849
Authors: Jill M Wecht; Andrei V Krassioukov; Maralee Alexander; John P Handrakis; Stephen L McKenna; Michael Kennelly; Michele Trbovich; Fin Biering-Sorensen; Stephen Burns; Stacy L Elliott; Daniel Graves; James Hamer; Klaus Krogh; Todd A Linsenmeyer; Nan Liu; Ellen Merete Hagen; Aaron A Phillips; Jean-Gabriel Previnaire; Gianna M Rodriguez; Chloe Slocum; James R Wilson Journal: Top Spinal Cord Inj Rehabil Date: 2021