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Randomized Controlled Trial
. 2025 Nov 1;21(11):1903-1909.
doi: 10.5664/jcsm.11804.

Sleep and daytime function in people with spinal cord injury

Amira N Badr  1 , Salam Zeineddine  2   3 , Anan Salloum  2   3 , Nishtha Pandya  2   3 , Michael N Mitchell  4 , Abdulghani Sankari  2   3 , Isabel D Muñoz  4   5 , M Safwan Badr  2   3 , Jennifer L Martin  4   5 , Monica R Kelly  4   5
Affiliations
Randomized Controlled Trial

Sleep and daytime function in people with spinal cord injury

Amira N Badr et al. J Clin Sleep Med. .

Abstract

Study objectives: We sought to determine the role of sleep-disordered breathing, insomnia symptoms, and sleep quality in the daytime function and quality of life of veterans with spinal cord injury.

Methods: This cross-sectional cohort study took place in a Veterans Administration medical center in the midwestern United States. Thirty-eight male veterans with spinal cord injury (22 cervical, 16 thoracic; mean [standard deviation] age = 62.9 [9.5] years) completed baseline assessments within a larger clinical trial. Measures assessed sleep apnea severity (apnea-hypopnea index), insomnia symptoms (Insomnia Severity Index), self-reported sleep quality (Pittsburg Sleep Quality Index), daytime sleepiness (Epworth Sleepiness Scale), fatigue (Flinders Fatigue Scale), depression (Patient Health Questionnaire-9 item, excluding sleep item), functioning (Spinal Cord Independence Measure), and quality of life (World Health Organization Quality of Life). Bivariate correlations (alpha P < .05) were used to assess relationships between sleep (apnea-hypopnea index, Insomnia Severity Index, Pittsburg Sleep Quality Index, Epworth Sleepiness Scale) and function (Flinders Fatigue Scale, Patient Health Questionnaire-9 item, Spinal Cord Independence Measure, World Health Organization Quality of Life).

Results: Mean apnea-hypopnea index was 29.9 (26.6) events/h, mean Insomnia Severity Index was 9.4 (6.2), mean Pittsburg Sleep Quality Index was 9.0 (4.6), and mean Epworth Sleepiness Scale was 7.0 (5.2). There were no significant relationships between apnea-hypopnea index and function measures. Significant relationships emerged between worse Insomnia Severity Index and worse Patient Health Questionnaire-9, some World Health Organization Quality of Life subscales, and Spinal Cord Independence Measure as well as between worse Pittsburg Sleep Quality Index and worse Flinders Fatigue Scale, Patient Health Questionnaire-9 item, and some World Health Organization Quality of Life subscales (P < .05).

Conclusions: Among veterans with spinal cord injury, insomnia symptom severity and poor sleep quality were associated with worse functioning, whereas sleep-disordered breathing severity was not. Insomnia and poor sleep quality represent modifiable contributors to poor daytime function. Research evaluating the impact of evidence-based insomnia treatments among individuals living with spinal cord injury is warranted.

Clinical trial registration: Registry: ClinicalTrials.gov; Name: Treatment of Sleep-disordered Breathing in Patients With SCI; URL: https://www.clinicaltrials.gov/study/NCT02830074; Identifier: NCT02830074.

Citation: Badr AN, Zeineddine S, Salloum A, et al. Sleep and daytime function in people with spinal cord injury. J Clin Sleep Med. 2025;21(11):1903-1909.

Keywords: daytime functioning; depression; insomnia; sleep-disordered breathing; spinal cord injury.

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Conflict of interest statement

All authors approved the submitted version. This work was supported by the Veterans Administration (VA) Rehabilitation Research and Development Service (grant number RX002116; principal investigator: Badr) and VA Biomedical Laboratory Research & Development Service of the VA Office of Research and Development (grant number I01BX007080; principal investigator: Sankari). Analysis and presentation of this research was supported by the National Institutes of Health/National Heart Lung and Blood Institute (grant number K24HL143055; principal investigator: Martin and K23HL157754; principal investigator: Kelly), VA Health Services Research and Development Service Research Career Scientist Award (#RCS 20-191; Martin), and VA Greater Los Angeles Healthcare System (VAGLAHS) VA Geriatric Research, Education and Clinical Center (GRECC) Advanced Geriatric Fellowship (Kelly). The contents of this manuscript are solely the responsibility of the authors and do not represent the official views of the US government. The authors report no conflicts of interest.

Update of

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