Relationship Between Sleep-Disordered Breathing and Neurogenic Obesity in Adults With Spinal Cord Injury

Top Spinal Cord Inj Rehabil, 2021 · DOI: 10.46292/sci20-00044 · Published: January 1, 2021

Spinal Cord Injury Pulmonology Endocrinology

Simple Explanation

Spinal cord injury (SCI) can lead to neurogenic obesity, diabetes, and metabolic syndrome, and these conditions are often linked to sleep-disordered breathing (SDB). This article explores the connection between obesity and obstructive sleep apnea (OSA) in both the general population and people with SCI. The review also discusses how insulin resistance affects SDB and SCI, examining the epidemiology and causes of OSA and central sleep apnea in SCI based on current research. It also covers the diagnosis and treatment of SDB and addresses the impact of insomnia on obesity risk in SCI patients. Ultimately, the authors emphasize the importance of thorough sleep assessments, testing, and treatment to improve sleep quality in individuals with SCI, which may help reduce the effects of neurogenic obesity and metabolic syndrome.

Study Duration

Not specified

Participants

Adults with Spinal Cord Injury

Evidence Level

Review Article

Key Findings

1
Adults with spinal cord injury (SCI) are at a higher risk of disorders related to metabolic syndrome, including sleep-disordered breathing (SDB).
2
There is a high prevalence of OSA in individuals with SCI, likely due to shared epidemiologic risk factors and the increase in obesity, insulin resistance, and metabolic syndrome after SCI.
3
Central sleep apnea (CSA) is a prominent area of concern in individuals with SCI, with studies identifying similarities in the pathophysiology of OSA and CSA, suggesting they may coexist.

Research Summary

This article reviews the relationship between sleep-disordered breathing (SDB) and neurogenic obesity in adults with spinal cord injury (SCI). It highlights the increased risk of metabolic syndrome, obesity, and insulin resistance in individuals with SCI, and how these factors can contribute to SDB. The review discusses the epidemiology and pathophysiology of obstructive sleep apnea (OSA) and central sleep apnea (CSA) in the SCI population, emphasizing the multifactorial nature of OSA in SCI, including obesity, unopposed parasympathetic stimulation, and weakened respiratory muscles. The authors conclude by stressing the importance of detailed sleep histories, diagnostic workups including polysomnography (PSG), and appropriate treatment options like noninvasive positive airway pressure therapies to improve sleep and overall health in individuals with SCI.

Practical Implications

Clinical Assessment

Clinicians should obtain a detailed sleep history in patients with SCI and metabolic syndrome, assessing sleep hygiene and potential sleep disorders.

Diagnostic Workup

Diagnostic evaluations should include polysomnography (PSG), either in a sleep laboratory or at home, to diagnose sleep disorders accurately.

Treatment Strategies

Treatment options, especially noninvasive positive airway pressure therapies, should be offered to patients diagnosed with sleep disorders to improve their overall health and quality of life.

Study Limitations

1
Reliance on extrapolating studies about metabolism, metabolic syndrome, and sleep from the general population.
2
Gaps in the literature regarding the relationship between SDB and SCIs.
3
Limited research on the impact of different medications and SCI comorbidities on obstructive sleep apnea.

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