Obstructive sleep apnoea triggering autonomic dysreflexia: Isn’t it time for sleep studies to be routine in SCI?

Brain and Spine, 2024 · DOI: https://doi.org/10.1016/j.bas.2023.102725 · Published: December 12, 2023

Spinal Cord Injury Pulmonology Neurology

Simple Explanation

Autonomic dysreflexia is a complication after spinal cord injury, marked by a reflexive increase in blood pressure due to stimuli below the injury level. This case report describes a patient with spinal cord injury who experienced autonomic dysreflexia triggered by obstructive sleep apnoea. Treatment with continuous positive airway pressure (CPAP) resolved the patient's early morning episodes of autonomic dysreflexia.

Study Duration

Not specified

Participants

A 43-year-old male smoker with complete spinal cord injury at C4 neurological level

Evidence Level

Case Report

Key Findings

1
Obstructive sleep apnoea can be a trigger for autonomic dysreflexia in individuals with spinal cord injury.
2
Early morning episodes of autonomic dysreflexia, coupled with daytime fatigue and disrupted sleep, suggest the possibility of underlying sleep apnoea.
3
Continuous positive airway pressure (CPAP) treatment for obstructive sleep apnoea can resolve autonomic dysreflexia episodes.

Research Summary

This case report highlights obstructive sleep apnoea as a potential trigger for autonomic dysreflexia in spinal cord injury patients. The patient's autonomic dysreflexia, characterized by early morning episodes, resolved with CPAP treatment for diagnosed obstructive sleep apnoea. The study suggests a need for increased awareness and routine sleep studies in spinal cord injury patients to identify and manage sleep apnoea as a potential trigger for autonomic dysreflexia.

Practical Implications

Clinical Practice

Consider sleep studies for SCI patients with unexplained AD, especially with nocturnal symptoms.

Treatment Strategies

Explore CPAP therapy for AD management in SCI patients diagnosed with OSA.

Future Research

Conduct further research on the association between sleep apnoea and AD in SCI patients.

Study Limitations

1
Single case report limits generalizability.
2
Lack of formal guidelines or screening recommendations for sleep apnoea in SCI.
3
Challenges in studying the association due to the nature of AD diagnosis and ethical considerations regarding withholding treatment.

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