Introduction
Sleep disturbance is a common problem in patients with spinal cord injury (SCI). According to literature, SCI individuals are at high risk of sleep disturbance including snoring, difficulty in initiating and maintaining sleep, often awaking in the early morning and difficulty in falling asleep again, and easy tiredness during daytime. Factors that aggravate the quality of sleep in tetraplegic patients include pain, spasm, paresthesia, tendency to sleep in supine position, sedative usage or sleep apnea. However, only a few studies have focused on the quality of sleep in SCI population in Korea. The purpose of this study is to investigate the current status of sleep quality in patients with SCI.
Methods
The Nordic Sleep Questionnaires (NSQ) is widely used questionnaire for assessing the quality of sleep, consisting of 21 questions that are quantitative, ordinal or open question. The questionnaire asks the individuals to describe their sleep tendency for the last three months. We handed out the NSQ to patients with SCI as inpatients or outpatients. We also gathered demographic data, neurologic level of injury and severity of pain using the Numeric Rating Scale (NRS). Question 13 and 14 about the time going to bed and waking-up were not analyzed. The collected data were analyzed by descriptive statistic method.
Results
A total of 61 questionnaires from 46 males and 15 females were returned. Twenty six patients were paraplegic while the others were tetraplegic. Mean duration of injury was 11.13±11.63 years. Mean NRS score was 5.03±2.26. Other demographic data are shown in Table 1. Forty four patients (72.1%) reported difficulties in falling asleep, and they needed 39.84±31.25 minutes to fall asleep. Fifty eight (95.1%) subjects answered they wake up during the overnight sleep, and especially more than half of them said it happens every day. Fifty five participants (90.2%) reported that they have not been slept well in last 3 months at various degree with 6.62±2.40 hours of sleeping time, while they needed 7.74±1.91 hours. Twenty one patients (34.4%) needed sleep medications to fall asleep. Distributions of the answers to each question are listed in Table 2 and 3. Twenty five patients reported various sleeping problems in answer to question 21, such as voiding or gastrointestinal problems (20.0%), shallow sleep (28.0%), pain (24.0%), position change (8.0%) and spasm (12.0%).
Conclusion
This study showed current state of sleep quality of patients with SCI. Pain, spasm, position change and voiding or gastrointestinal problem were reported as factors that interfere the sleep. Sleep quality of patients with SCI can be improved by managing these factors. Further study with larger participants will be needed to determine the modifiable factors affecting the quality of sleep.
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