CLINICAL TRIAL article
Front. Neurosci.
Sec. Autonomic Neuroscience
Volume 19 - 2025 | doi: 10.3389/fnins.2025.1600772
This article is part of the Research TopicPhysiological and Pathological Responses to Hypoxia and High Altitude, Volume IIIView all 13 articles
Mild Intermittent Hypoxia May Improve Autonomic Dysfunction in Persons Living with Spinal Cord Injury: A Preliminary Snapshot
Provisionally accepted
- 1John D. Dingell VA Medical Center, United States Department of Veterans Affairs, Detroit, Michigan, United States
- 2Translational Neuroscience Program, School of Medicine, Wayne State University, Detroit, Michigan, United States
- 3Division of Pulmonary & Critical Care and Sleep Medicine, School of Medicine, Wayne State University, Detroit, Michigan, United States
- 4Departments of Rehabilitation Medicine and Human Performance, and Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, United States
- 5Department of Spinal Cord Injury Research, James J. Peters VA Medical Center, United States Department of Veterans Affairs, Bronx, New York, United States
- 6Departments of Physiology and Internal Medicine, School of Medicine, Wayne State University, Detroit, Michigan, United States
- 7Department of Health Care Sciences, Program of Occupational Therapy, Wayne State University, Detroit, Michigan, United States
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Persons with spinal cord injuries (pwSCI) often suffer from autonomic dysfunction, sleep disordered breathing, and impaired mitochondrial capacity. Current treatment options for these individuals are limited and often have significant side effects. Thus, new interventions that target multiple physiological systems and circumvent physical limitations would be a significant development for pwSCI. One potential intervention is daily mild intermittent hypoxia (MIH) which has been shown to improve blood pressure control and upper airway function during sleep. Four individuals with chronic motor incomplete SCI underwent 8 days of MIH (ClinicalTrials.Gov ID #NCT05351827, https://clinicaltrials.gov/study/NCT05351827). The MIH protocol was administered each morning during wakefulness with end-tidal oxygen maintained at 55-60 mmHg. End-tidal carbon dioxide was maintained at +3 mmHg above baseline during the MIH. Autonomic dysfunction (autonomic dysreflexia and orthostatic hypotension), sleep quality, upper airway function, mitochondrial capacity, and microvascular function were tested before, the day after, and 2 weeks following the MIH protocol. Systolic autonomic dysreflexia improved by 46 ± 14% and orthostatic hypotension improved by 160 ± 63% after MIH. Reductions in the apnea hypopnea index were observed, alongside a concurrent reduction in arousals during sleep. Upper airway function, improved and mitochondrial capacity increased following 8 days of MIH. These preliminary data from four participants in an ongoing clinical trial suggest that 8 days of MIH may improve autonomic dysfunction, sleep quality, and mitochondrial capacity in pwSCI. The recruitment of additional participants is required to support these preliminary findings.
Keywords: tetraplegia, Paraplegia, autonomic dysfunction, Autonomic Dysreflexia, orthostatic hypotension, mild intermittent hypoxia
Received: 27 Mar 2025; Accepted: 23 Jun 2025.
Copyright: © 2025 Soltesz, Zhao, Wecht, Mateika and Panza. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Gino S Panza, John D. Dingell VA Medical Center, United States Department of Veterans Affairs, Detroit, 48201, Michigan, United States
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