Sleep Disordered Breathing and SCI: Risk and Assessment

Sleep is a physiologic challenge and overlaying factors secondary to SCI can increase risk of sleep disordered breathing. Sleep disordered breathing can include:

• sleep apnoea: obstructive and central
• related movement disorders
• circadian rhythm sleep-wake disorders 
• insomnia

Risk Factors for Sleep Disorders:

• high thoracic and cervical injuries where prevalence of sleep apnoea is twice that of the general population for multifactorial reasons
• changes with melatonin levels: may be disrupted in cervical level injuries
• males are twice as likely to have sleep disorders
• increased age
• obesity
• large neck circumference
• weakness of laryngeal muscles due to past intubation
• supine sleep position
• pain
• high frequency of leg movements when asleep and awake eg. spasticity
• medications: cardiac and antispasmodic
• alcohol and caffeine consumption
• sedative use
• environmental influences eg. temperature, noise and light
• psychological influences eg. anxiety, depression

Signs and Symptoms of Sleep Disorders:

• sleep fragmentation
• delay in achieving a sleep phase
• loud snoring
• nocturnal choking
• nocturnal hypoxaemia
• excessive daytime sleepiness
• reduced concentration

Sleep disorders can have a profound effect on a person’s ability to participate in life including increased pain, depression, cognitive decline and significantly reducing quality of life. Sleep disorders have also been linked with cardiovascular changes.  

Assessment of Sleep Apnoea

The best method to assess sleep apnoea is to complete sleep studies with full diagnostics eg. video surveillance, brain wave activity, eye movement activity, heart electrical activity, pulse oximetry, leg movement activity etc.

Overnight trials of positive airway pressure or methods to splint the upper airway and/or soft palate, as well as improve ventilation of the lungs, can also be more objectively assessed for treatment of sleep apnoea.

The preference for assessment in order of priority is:

1. Inpatient stay in a sleep clinic with full diagnostics including electroencephalogram (EEG): this is highly recommended if the person has complex needs or if in clinical crisis. NB: If the person is admitted as an inpatient, the facility needs to consider the person’s physical needs with appropriate
   • equipment eg. hoists/slings/electric bed/pressure relieving mattress/commode
   • large bedrooms/space for equipment and circulation
   • personal care supports if required
2. At home or hospital inpatient stay outside of the sleep clinic, with full diagnostics including electroencephalogram (EEG)
3. At home with pulse oximetry but nil electroencephalogram (EEG): will only assess episodes of hypoxia