Research Reports - Rapid EEG activity during sleep dominates in mild traumatic brain injury patients with acute pain

J Neurotrauma. 2013 Mar 19

Khoury S, Chouchou F, Amzica F, Giguère JF, Denis R, Rouleau GA, Lavigne GJ

Chronic pain is a highly prevalent post-concussion symptom occurring in a
majority of mild traumatic brain injury (mTBI) patients. About half of mTBI
patients report sleep-wake disturbances. It is known that pain can alter sleep
quality in this population, but the interaction between pain and sleep is not
fully understood. This study aimed to identify how pain affects subjective sleep
(Pittsburgh Sleep Quality Index PSQI), sleep architecture, and quantitative
electroencephalographic (qEEG) brain activity following mTBI. Twenty-four mTBI
patients complaining of sleep-wake disturbances, with and without pain (8 and 16,
respectively), were prospectively recruited 45 (±22.7) days post-trauma on
average. Data were compared with those of 18 healthy controls (no sleep or pain
complaints). The PSQI, sleep architecture, and qEEG activity were analyzed. Pain
was assessed using questionnaires and a 100-mm Visual Analogue Scale (VAS). mTBI
patients reported three times poorer sleep quality than controls on the PSQI.
Sleep architecture significantly differed between mTBI patients and controls, but
was within normal range. Global qEEG showed lower delta (deep sleep) and higher
beta and gamma power (arousal) at certain EEG derivations in mTBI patients
compared to controls (p<0.04). However, mTBI patients with pain showed greater
increase in rapid EEG frequency bands, mostly during REM sleep, and beta bands in
non-REM sleep compared to mTBI patients without pain and controls (p<0.001). Pain
in mTBI patients was associated with more rapid qEEG activity, mostly during REM
sleep, suggesting that pain is associated with poor sleep and is a critical
factor in managing post-concussion symptoms.

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