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The purpose of this article is to highlight the importance of considering sleep-disordered breathing (SDB) as a potential confounder to rehabilitation research interventions in spinal cord injury (SCI). SDB is highly prevalent in SCI, with increased prevalence in individuals with higher and more severe lesions, and the criterion standard treatment with continuous positive airway pressure remains problematic. Despite its high prevalence, SDB is often untested and untreated in individuals with SCI. In individuals without SCI, SDB is known to negatively affect physical function and many of the physiological systems that negatively affect physical rehabilitation in SCI. Thus, owing to the high prevalence, under testing, low treatment adherence, and known negative effect on the physical function, it is contended that underdiagnosed SDB in SCI may be confounding physical rehabilitation research studies in individuals with SCI. Studies investigating the effect of treating SDB and its effect on physical rehabilitation in SCI were unable to be located. Thus, studies investigating the likely integrated relationship among physical rehabilitation, SDB, and proper treatment of SDB in SCI are needed. Owing to rapid growth in both sleep medicine and physical rehabilitation intervention research in SCI, the authors contend it is the appropriate time to begin the conversations and collaborations between these fields. We discuss a general overview of SDB and physical training modalities, as well as how SDB could be affecting these studies. [ABSTRACT FROM AUTHOR]

Objectives: To assess the physiological responses to, and the agreement between, a 20×20m repeated sprint field test and wheelchair rugby game play, as well as the reliability of the test.Design: Cross-sectional and longitudinal.Methods: Heart rate (HR), blood lactate ([La-]B), and ratings of perceived exertion (RPE) were collected in nineteen elite wheelchair rugby athletes before, during, and after a 20×20m repeated sprint field test and game play. Times to complete 5, 10, and 20m during the field test were also collected.Results: Peak HR and peak [La-]B were positively correlated during the field test (r=0.470, p=0.043), as were peak HR and peak speed (r=0.493, p=0.031), and peak [La-]B and peak speed (r=0.559, p=0.013). During game play, peak [La-]B was correlated with peak RPE (rho=0.703, p=0.001). Intra-class correlations (ICCs) between the field test and game play were significant for peak HR (ICC=0.922, p<0.001) and peak [La-]B (ICC=0.845, p<0.001). Bland-Altman analysis revealed good agreement between HR and [La-]B obtained during the field test and game play and excellent between-day reliability of the 20×20m sprint test.Conclusions: The physiological demands of a 20×20m repeated sprint field test are similar to those of elite wheelchair rugby game play and the test is highly reliable. This simple to implement field test may be useful as a component of team selection and in assessing the effectiveness of training interventions or monitoring athletes across training phases. [ABSTRACT FROM AUTHOR]

BACKGROUND This study determined whether the Autonomic Dysfunction Following Spinal Cord Injury (ADFSCI) questionnaire, a measure of self-reported frequency and severity of symptoms during hypo- and hypertensive episodes, correlates with blood pressure (BP) instability. In addition, test–retest reliability of the ADFSCI questionnaire was assessed. METHODS Thirty individuals with spinal cord injury (SCI) (aged 42±12 years; level of lesion = C3–L1; American Spinal Injury Association Impairment Scale = A–C; lesion duration = 1 month to 30 years after injury) participated in this study. Twenty-four-hour ambulatory BP monitoring (ABPM) was used to assess BP instability. ABPM recorded systolic BP (SBP), diastolic BP (DBP), and heart rate at 15-minute intervals during the daytime and 1-hour intervals during the nighttime. Test–retest reliability was performed by completion of the ADFSCI questionnaire on 2 occasions (i.e., 9±4 days in between). RESULTS Individuals with SCI who self-reported autonomic dysreflexia (AD) episodes showed significantly higher SBP coefficient of variation (CV) (14%) and more AD events (n = 11) than individuals who reported never having AD symptoms (CV = 9%; AD events = 1). Both the number of AD events over the 24-hour period and the BP variability (SBP CV) were significantly related to the patients’ self-reported total AD score (rho = 0.522, P = 0.005; rho = 0.584, P = 0.001, respectively) and daily AD frequency (rho = 0.553, P = 0.003; rho = 0.586, P = 0.001, respectively). Conversely, no significant correlations existed between the number of hypotensive events over the 24-hour period and self-reported frequency and severity in the ADFSCI questionnaire. CONCLUSIONS This study provides evidence that ABPM offers a strong clinical basis for documenting and understanding BP instability, such as AD, and related symptoms in individuals with SCI. [ABSTRACT FROM AUTHOR]