The impact of spinal cord injury on breathing during sleep

• Following spinal cord injury (SCI), the incidence of sleep disordered breathing (SDB) is considerably greater than occurs in the general population.
• Both central and obstructive sleep apnea (OSA) has been reported after SCI, but OSA appears to be much more common.
• It is not yet possible to pinpoint a “primary factor” which will predispose an individual with SCI to SDB.
• Following SCI, changes in body mass, lung volume, autonomic function, and sleep position all may be related to increased SDB.
• The role of respiratory neuroplasticity in SDB following SCI should be an area of further study.

The prevalence of sleep disordered breathing (SDB) following spinal cord injury (SCI) is considerably greater than in the general population. While the literature on this topic is still relatively small, and in some cases contradictory, a few general conclusions can be drawn. First, while both central and obstructive sleep apnea (OSA) has been reported after SCI, OSA appears to be more common. Second, SDB after SCI likely reflects a complex interplay between multiple factors including body mass, lung volume, autonomic function, sleep position, and respiratory neuroplasticity. It is not yet possible to pinpoint a “primary factor” which will predispose an individual with SCI to SDB, and the underlying mechanisms may change during progression from acute to chronic injury. Given the prevalence and potential health implications of SDB in the SCI population, we suggest that additional studies aimed at defining the underlying mechanisms are warranted.