Research Reports - Rest-activity cycle disturbances in the acute phase of traumatic brain injury
Neurorehabil Neural Repair. 2013 Dec 30
Duclos C, Dumont M, Blais H, Paquet J, Laflamme E, de Beaumont L, Wiseman-Hakes C, Menon DK, Bernard F, Gosselin N
BACKGROUND: Sleep-wake disturbances are among the most persistent sequelae after
traumatic brain injury (TBI) and probably arise during the hospital stay
following TBI. These disturbances are characterized by difficulties sleeping at
night and staying awake during the day.
OBJECTIVE: The aim of the present study was to document rest-activity cycle
consolidation in acute moderate/severe TBI using actigraphy and to assess its
association with injury severity and outcome.
METHODS: In all, 16 hospitalized patients (27.1 ± 11.3 years) with
moderate/severe TBI wore actigraphs for 10 days, starting in the intensive care
unit (ICU) when continuous sedation was discontinued and patients had reached
medical stability. Activity counts were summed for daytime (7:00-21:59 hours) and
nighttime periods (22:00-6:59 hours). The ratio of daytime period activity to
total 24-hour activity was used to quantify rest-activity cycle consolidation. An
analysis of variance was carried out to characterize the evolution of the daytime
activity ratio over the recording period.
RESULTS: Rest-activity cycle was consolidated only 46.6% of all days; however, a
significant linear trend of improvement was observed over time. Greater TBI
severity and longer ICU and hospital lengths of stay were associated with poorer
rest-activity cycle consolidation and evolution. Patients with more rapid return
to consolidated rest-activity cycle were more likely to have cleared
posttraumatic amnesia and have lower disability at hospital discharge.
CONCLUSIONS: Patients with acute moderate/severe TBI had an altered rest-activity
cycle, probably reflecting severe fragmentation of sleep and wake episodes, which
globally improved over time. A faster return to rest-activity cycle consolidation
may predict enhanced brain recovery.