The potential effects of untreated sleep-related breathing disorders on neuropathic pain, spasticity, and cardiovascular dysfunction following spinal cord injury: A cross-sectional prospective study protocol

PLoS ONE, 2023 · DOI: https://doi.org/10.1371/journal.pone.0282860 · Published: May 2, 2023

Spinal Cord Injury Pulmonology Pain Management

Simple Explanation

This study aims to understand the relationship between sleep-related breathing disorders (SRBDs) and other common issues after spinal cord injury (SCI), like neuropathic pain, spasticity, and cardiovascular problems. The researchers hypothesize that if someone with SCI has more severe SRBDs, they will also have more intense neuropathic pain, more severe spasticity, and more significant cardiovascular autonomic dysfunction. The study involves a cross-sectional prospective design, focusing on adults with specific types of SCI (low-cervical/high-thoracic injury, complete/incomplete) to see if SRBDs are linked to these other health issues.

Study Duration

Not specified

Participants

70 individuals with SCI

Evidence Level

Cross-sectional prospective study

Key Findings

1
Individuals with SCI and untreated SRBDs will develop more intense neuropathic pain.
2
Individuals with SCI and untreated SRBDs will develop more severe spasticity.
3
Individuals with SCI and untreated SRBDs will develop more significant cardiovascular dysfunction.

Research Summary

This cross-sectional prospective study will explore the previously understudied hypothesis that SRBDs are associated with increased neuropathic pain, spasticity, and cardiovascular autonomic dysfunction in adult individuals with low-cervical/high-thoracic (injury level at C5 to T6), complete/incomplete (ASIA Impairment Scale A, B, C or D) SCI. The primary objectives of this study are: (a) to evaluate the potential association of neuropathic pain with SRBDs in individuals with SCI; (b) to assess the potential association between spasticity and SRBDs in individuals with SCI; and (c) to study the potential relationship between cardiovascular autonomic dysfunction and SRBDs in individuals living with SCI. The secondary objectives of this study are: (i) to confirm that a home-based or hospital-unattended sleep study is a feasible alternative for the diagnosis of SRBDs in individuals with tetraplegia or paraplegia; and (ii) to compare the costs of a home-based sleep study with conventional in-laboratory polysomnography using cost-minimization analysis.

Practical Implications

Clinical Trials

The results will provide key information for a future clinical trial on CPAP therapy for moderate-to-severe SRBDs.

Improved Diagnosis

The research project will provide key information on how to improve the diagnosis of SRBDs among individuals living with SCI.

Cost-effective Screening

The study aims to show the feasibility and acceptability of screening for SRBDs using unattended-hospital or home-based sleep apnea tests.

Study Limitations

1
Use of pharmacological treatments for neuropathic pain and spasticity will mitigate the strength of association between AHI and these two secondary medical conditions.
2
The unattended-hospital or home-based sleep apnea test underestimates the AHI.
3
Cardiovascular monitoring records have a risk of overestimation of apnea/hypopnea-induced episodes of autonomic dysreflexia during sleep by inadvertently including episodes of autonomic dysreflexia due to other causes.

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