What is Dysautonomia?
The permanent irritation of the autonomous nerve system or the compression of the brain stem/spinal cord can lead to different types of dysautonomia.
Helmi M, Lima A, Gommers D, Van Bommel J, Bakker J. Inflatable external leg compression prevents orthostatic hypotension in a patient with a traumatic cervical spinal cord injury. Future cardiology. 2013 Sep 11;9(5):645-8.
Misra UK, Kalita J, Kapoor R. Postural hypotension in a patient with cervical myelopathy due to cranio-vertebral anomaly. Clinical Autonomic Research. 1997 Oct 1;7(5):223-6.
Gillis DJ, Wouda M, Hjeltnes N. Non-pharmacological management of orthostatic hypotension after spinal cord injury: a critical review of the literature. Spinal Cord. 2008 Oct 1;46(10):652-9.
CCI and Dysautonomia the connection!
Mast cell activation
A permanent irritation of the nerve system can lead to histamine release and mast cell activation.
More information here.
What is sleep apnea?
Sleap apnea describes a condition where breathing stops occur during sleep (apnea).
There are two different types:
Central sleep apnea (brain) and obstructive sleep apnea (respiratory):
Obstructive sleep apnea is caused by some collapse throughout the airway which leads to snoring.
The rarer type is central sleep apnea where the damage is somewhere in the brain or the medulla oblongata which regulates breathing.
Both types can be present in CCI patients.
People who suffer from sleep apnea often complain about daily fatigue, concentration issues, vertigo and headaches.
A not recognized and not treated sleep apnea can lead to severe consequences. Through the lack of oxygen during sleep the heart rate rises which leads to non restorative sleep (arousals). Also sleep apnea stresses the cardio vascular system and can cause stroke, heart attacks and even sudden cardiac arrest.
To diagnose sleep apnea a sleep lab has to do a polysomnography.
The cause of obstructive sleep apnea in CCI patients is most likely a restriction of the airway because of unstable vertebrae.
Central sleep apnea in CCI patients is caused by compression in the area of the medulla oblongata.
Howard RS, Henderson F, Hirsch NP, Stevens JM, Kendall BE, Crockard HA. Respiratory abnormalities due to craniovertebral junction compression in rheumatoid disease. Annals of the rheumatic diseases. 1994 Feb 1;53(2):134-6.
Shoda N, Seichi A, Takeshita K, Chikuda H, Ono T, Oka H, Kawaguchi H, Nakamura K. Sleep apnea in rheumatoid arthritis patients with occipitocervical lesions: the prevalence and associated radiographic features. European Spine Journal. 2009 Jun 1;18(6):905-10.
Sankari A, Martin JL, Bascom AT, Mitchell MN, Badr MS. Identification and treatment of sleep-disordered breathing in chronic spinal cord injury. Spinal cord. 2015 Feb 1;53(2):145-9.
Proserpio P, Lanza A, Sambusida K, Fratticci L, Frigerio P, Sommariva M, Stagni EG, Redaelli T, De Carli F, Nobili L. Sleep apnea and periodic leg movements in the first year after spinal cord injury. Sleep medicine. 2015 Jan 31;16(1):59-66.