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.
Great lecture about the connection between CCI and Dysautonomia:
Mast cell activation
If the nervous system is permanently stressed and irritated it can release high amounts of histamine and even lead to mast cell activation syndrome.
More information here.
What is sleep apnea?
Sleap apnea describes a condition in which breathing stops (apnea) occur during sleep.
There are two different types:
Central sleep apnea (brain) and obstructive sleep apnea (respiratory):
Obstructive sleep apnea is caused by parts of the airway collapsing, which then leads to snoring.
Central sleep apnea is rare and unlike obstructive sleep apnea the reason is not found throughout the airway itself, but somewhere in the brain or 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.
Unrecognized and untreated sleep apnea can cause severe consequences. For instance, through the lack of oxygen during sleep the heart rate rises which leads to non-restorative sleep (arousals). Additionally, sleep apnea stresses the cardio vascular system and can cause stroke, heart attacks and even sudden cardiac arrest.
To diagnose sleep apnea a polysomnography has to be performed by a sleep lab.
The cause of obstructive sleep apnea in CCI patients is most likely a restriction of the airway because of unstable and moving 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.