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Sleep and Symptomology After Spinal Cord Injury

Graves, Letitia (2019) Sleep and Symptomology After Spinal Cord Injury. Doctoral Dissertation, University of Pittsburgh. (Unpublished)

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Problem: Sleep dysfunction after traumatic spinal cord injury (TSCI) is highly prevalent. However, it has not been characterized beyond self-report of a perceived problem with sleep disordered breathing (SDB) being most commonly investigated. Poor sleep has significant implications for reduced health-related quality of life, diminished neuroplasticity, and long-term functional outcomes.

Methods: This exploratory study utilized an observational prospective study design, collecting objective EEG based sleep data, self-report sleep diary, symptom data and biological marker (DNA methylation) data to characterize sleep and co-occurring symptoms in the subacute rehabilitation phase (30 days post TSCI) over two consecutive nights.

Results: Sample (N=9) were mostly male (75%), Caucasian (89%) with an average age of 45.7 years (SD=19.6; range=18-71 years). Over half of the TSCI diagnoses were incomplete
paraplegia (56%) with ASIA scores of D. Sleep diary reports were variable among participants, however, consistently reported fragmented sleep, underestimates of sleep onset latency (SOL) and wake after sleep onset (WASO), and overestimates of TST. Sleep Profiler summaries scored all participants as having abnormal sleep patterns based on sex and age norms. Sleep architecture, revealed high N1 percentages, and low N3 and REM stages of sleep. SE, was poor across all participants with no one achieving >85%. Overall, most participants had PHQ-9 severity scores
ranging from 2-4, indicating no depression. Pain tended to be moderate to high (>5/10) in most participants on both nights. DNA methylation data was variable across individuals for both genes; however descriptively there were no consistent relationships with sleep variability.

Conclusions: The findings of this study support that sleep after TSCI during the subacute rehabilitation phase is significantly impaired based on subjective and objective measures of sleep. The co-occurring impact of depression and pain on sleep was not clear given the likely confounding effects of demographic variables. This study lays a foundation to characterize sleep after SCI and what is considered “normal” that reflects the unique challenges that accompany specialized populations such as those with neurologic injury.


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Item Type: University of Pittsburgh ETD
Status: Unpublished
CreatorsEmailPitt UsernameORCID
Graves, Letitialyg10@pitt.edulyg10
ETD Committee:
TitleMemberEmail AddressPitt UsernameORCID
Committee ChairConley, Yvetteyconley@pitt.eduyconley
Committee CoChairChasens, Eileenchasense@pitt.educhasense
Committee MemberAlexander, Sheliasalexand@pitt.edusalexand
Committee MemberSowa,
Committee MemberYouk, Adaayouk@pitt.eduayouk
Date: 9 August 2019
Date Type: Publication
Defense Date: 18 June 2019
Approval Date: 9 August 2019
Submission Date: 5 August 2019
Access Restriction: 2 year -- Restrict access to University of Pittsburgh for a period of 2 years.
Number of Pages: 131
Institution: University of Pittsburgh
Schools and Programs: School of Nursing > Nursing
Degree: PhD - Doctor of Philosophy
Thesis Type: Doctoral Dissertation
Refereed: Yes
Uncontrolled Keywords: spinal cord injury; sleep EEG; DNA methylation
Date Deposited: 09 Aug 2019 20:11
Last Modified: 09 Aug 2021 05:15


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