Sleep Disturbances in Spinal Cord Injury Populations

Individuals with spinal cord injury (SCI) commonly experience a spectrum of sleep disturbances that profoundly affect rehabilitation outcomes, quality of life and overall health. Insomnia, characterised by difficulty initiating or maintaining sleep, frequently arises in this population as a consequence of neuropathic pain, spasticity and psychological stress. Obstructive sleep apnoea is also prevalent, driven by impaired respiratory mechanics, diminished upper-airway tone and autonomic dysfunction below the level of injury. Disruption of circadian rhythms may follow injury to spinal pathways that modulate melatonin secretion, compounding sleep–wake irregularity. Polysomnographic studies in people with tetraplegia report reduced rapid eye movement sleep, increased sleep fragmentation and higher rates of periodic limb movements. These alterations contribute to daytime somnolence, cognitive impairment and worsened mood and are associated with heightened cardiovascular risk. Effective assessment relies on a combination of subjective questionnaires and objective measures such as overnight respiratory monitoring and sleep diaries. Management strategies integrate optimised pain control, spasticity management, respiratory support, sleep hygiene education and, where appropriate, pharmacological agents including melatonin. Emerging evidence underlines the global burden of sleep disruption in SCI, the need for routine sleep assessment in multidisciplinary care and the potential for targeted interventions to enhance recovery and long-term health.

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Sleep Disturbances in Spinal Cord Injury Populations publication trend

The graph below shows the total number of articles in sleep disturbances in spinal cord injury populations across all publications each year (not limited to Nature Index journals).

Technical terms

Tetraplegia: Paralysis affecting all four limbs and torso, typically resulting from cervical spinal cord injury.

Melatonin: Endogenous hormone secreted by the pineal gland that regulates circadian rhythms and sleep–wake cycles.

Polysomnography: Comprehensive overnight recording of physiological sleep parameters, including brain electrical activity, muscle tone and respiratory function.

Periodic limb movements in sleep: Repetitive, stereotyped limb movements occurring during sleep, often leading to arousals and sleep fragmentation.

Sleep diary: Prospective self-reported log of sleep and wake times, perceived sleep quality and daytime symptoms, used to characterise sleep patterns.

References

1. Melatonin Supplementation in Patients with Complete Tetraplegia and Poor Sleep. Sleep Disorders (2013).
2. Qualidade do sono em indivíduos com traumatismo raquimedular. Revista Neurociências (2019).