Spinal Cord Injury
Spinal cord injury (SCI) is associated with physiological changes and secondary complications that significantly impact health-related quality of life (HRQOL). Although sleep difficulties are common following SCI, little is known about how day-to-day fluctuations in sleep quality affects HRQOL among these individuals. We examined the effect of sleep quality on same-day HRQOL using ecological momentary assessment (EMA) methods over a 7-day period.
Repeated-measures study involving seven days of home monitoring; participants completed HRQOL measures each night and EMA ratings four times throughout the day; multilevel models were used to analyze data.
University of Michigan and University of Washington.
Participants (or Animals, Specimens, Cadavers):
114 individuals with SCI.
Main Outcome Measure(s):
Daily sleep quality was rated on a scale of 1 (Worst) to 10 (Best) each morning. Participants completed HRQOL measures each night (Sleep Disturbance, Sleep-Related Impairment, Fatigue, Cognitive Abilities, Pain Intensity, Pain Interference, Ability to Participate in Social Roles and Activities, Depression, and Anxiety), and EMA ratings of pain, fatigue, and cognitive dysfunction four times throughout each day.
Multilevel random effects models indicated that fluctuations in sleep quality were related in expected directions to same-day ratings for all HRQOL outcomes. Similarly, days of poor sleep were related to higher EMA ratings of pain, fatigue, and cognitive dysfunction. Generally, sleep showed consistent associations with these symptoms across the day; however, sleep was related to pain ratings only in early morning and afternoon, but not at other times of the day.
Findings highlight the important association between sleep and HRQOL for persons with SCI. Future work targeting improving sleep quality may have positive downstream effects for improving HRQOL in persons with SCI.