A trial led by Wayne State University interventionist Gino Panza, Ph.D., may prove that breathing mild lower oxygen air in a controlled environment has the potential to improve blood pressure control and sleep in individuals who have suffered a spinal cord injury.
“This study is really important for individuals living with spinal cord injuries because there are currently no interventions showing strong improvements in blood pressure control that do not have major side effects,” Dr. Panza said.
Dr. Panza, an assistant professor of Occupational Therapy in the Eugene Applebaum College of Pharmacy and Health Sciences and in the School of Medicine’s Translational Neuroscience Graduate Program, is the principal investigator on the study. He also is a health science specialist at the John D. Dingell VA Medical Center, where the trial is enrolling patients until Nov. 30, 2026. For more information on signing up as a participant, call 313-576-3304.
“Individuals with spinal cord injuries are often hypotensive. These individuals can also experience both drops in blood pressure as well as spikes in blood pressure. If we try and treat the low blood pressure and drops in blood pressure with pharmaceuticals like midodrine, we can make the spikes in blood pressure worse. Likewise, if we treat the spikes in blood pressure, we can make the drops in blood pressure worse,” he said. “Also, treatment for sleep apnea for these individuals is continuous positive airway pressure, which most people do not like and do not adhere to. Thus, this may be a daytime intervention that may improve sleep. Improvements in sleep may then facilitate the improvements in blood pressure control.”
The study, “Mild intermittent hypoxia may improve autonomic dysfunction in persons living with spinal cord injury: a preliminary snapshot,” published in the journal Frontiers in Neuroscience, outlines the new breathing intervention, which is administered to enrolled patients eight times during a two-week period.
“In this study, we are looking at how the nervous system controls blood pressure and sleep quality. We also investigate how this intervention impacts how the muscle cells use oxygen and if this is an important variable for impacting blood pressure,” Dr. Panza said.
Initial data show promising effects for improving blood pressure control, sleep quality and how the body uses oxygen, he said. If the results remain at the end of the trial, it will be the first intervention that improves the increases and decreases in blood pressure for these patients.”
To administer the intervention, staff fill non-diffusible bags with 8% oxygen, connected to a valve that is either open to room air or to allow the participant to inhale the lower oxygen air. The participant inhales the same amount of air, just a lower percentage of oxygen, taking breaths the same size.
The first valve is connected to another called a two-way non-rebreathing valve, which is connected to a mask.
“This rebreathing valve allows the participant to inhale from the bag or room air under my control, with exhaled air going back into the room. We also have something called a gas blender that we connect 100% oxygen and 100% carbon dioxide. During the protocol, we add both 100% oxygen and carbon dioxide to the tube so we can control exactly what the participant is inhaling,” he said.
Dr. Panza was a postdoctoral fellow and study coordinator in the Department of Physiology from 2017 to 2021, where he used the same protocol in 15-day increments to look at changes in hypertension for those with untreated hypertension and sleep apnea, resulting in the paper “Daily Exposure to Mild Intermittent Hypoxia Reduces Blood Pressure in Male Patients with Obstructive Sleep Apnea and Hypertension.”
That study provided the premise that hypoxia can improve sleep and can lower hypertension, but lowering blood pressure can be an issue for those with spinal cord injury. They also showed that hypoxia can increase blood pressure acutely, but after 15 days it lowers in absolute value, which means it may help the spikes in blood pressure.
“One thing I am very interested, across many populations, is the impact of poor sleep on fatigue, motor function, blood pressure and overall quality of life,” Dr. Panza said. “We are attempting to follow this study up in individuals with complete spinal cord injuries, as the current study is only in individuals with incomplete spinal cord injury and more specifically, those with injuries that are considered C and D (grade). Likewise, I am attempting to move this area of research into those living with multiple sclerosis.”
link