Research Reports - Sleep-wake disorders persist 18 months after traumatic brain injury but remain underrecognized

Neurology. 2016 Apr 27. pii: 10.1212/WNL.0000000000002697. [Epub ahead of print]

Imbach LL(1), Büchele F(2), Valko PO(2), Li T(2), Maric A(2), Stover JF(2),
Bassetti CL(2), Mica L(2), Werth E(2), Baumann CR(2).

OBJECTIVE: This study is a prospective, controlled clinical and
electrophysiologic trial examining the chronic course of posttraumatic sleep-wake
disturbances (SWD).
METHODS: We screened 140 patients with acute, first-ever traumatic brain injury
of any severity and included 60 patients for prospective follow-up examinations.
Patients with prior brain trauma, other neurologic or systemic disease, drug
abuse, or psychiatric comorbidities were excluded. Eighteen months after trauma,
we performed detailed sleep assessment in 31 participants. As a control group, we
enrolled healthy individuals without prior brain trauma matched for age, sex, and
sleep satiation.
RESULTS: In the chronic state after traumatic brain injury, sleep need per 24
hours was persistently increased in trauma patients (8.1 ± 0.5 hours) as compared
to healthy controls (7.1 ± 0.7 hours). The prevalence of chronic objective
excessive daytime sleepiness was 67% in patients with brain trauma compared to
19% in controls. Patients significantly underestimated excessive daytime
sleepiness and sleep need, emphasizing the unreliability of self-assessments on
SWD in trauma patients.
CONCLUSIONS: This study provides prospective, controlled, and objective evidence
for chronic persistence of posttraumatic SWD, which remain underestimated by
patients. These results have clinical and medicolegal implications given that SWD
can exacerbate other outcomes of traumatic brain injury, impair quality of life,
and are associated with public safety hazards.

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