Research Reports - Persistent sleep disturbances predict poorer outcomes after mild traumatic brain injury
J Head Trauma Rehabil. 2015 Apr 29
Chan LG(1), Feinstein A
OBJECTIVE: To investigate the effect of sleep disturbances on functional and
social outcomes after mild traumatic brain injury.
SETTING: Outpatient traumatic brain injury clinic in a tertiary trauma center.
PARTICIPANTS: A total of 374 mild traumatic brain injury patients were assessed
within 3 months of injury and followed up every 3 months for 1 year.
DESIGN: Analysis of a historical cohort in a naturalistic clinical setting.
MAIN MEASURES: At each visit, symptoms of concussion and psychological distress
and indices of functional and social outcomes were measured with the Rivermead
Postconcussion Questionnaire, 28-item General Health Questionnaire, and Rivermead
Head Injury Follow-up Questionnaire, respectively. Changes in outcome scores over
time were explored using repeated measures analysis of variance and compared
between subjects with persistent (SD) and recovered (SR) sleep disturbances.
Predictors of functional/social outcome were determined using linear regression.
RESULTS: The percentages of subjects reporting sleep disturbances at each time
point were 71.9%, 57.2%, 55.1%, and 53.7%, respectively. For functional and
social outcomes, significant effects of time (F3,315 = 9.54; P < .001), group (SD
vs SR) F1,317 = 5.32; P = .022, and time X group interaction F3,315 = 4.14; P =
.007 were found. Persistent sleep disturbance (P = 0.011) and higher symptom
burden at 6 months postinjury (P < .0001) were independent predictors of poorer
CONCLUSION: Sleep disturbance, independent of psychological distress, is an
important prognostic factor of functional and social outcomes after mild
traumatic brain injury.