Research Reports - Evolution of severe sleep-wake cycle disturbances following traumatic brain injury

BMC Neurol. 2016 Sep 27;16(1):186.

Duclos C(1,)(2), Dumont M(1,)(2), Potvin MJ(3), Desautels A(1,)(4), Gilbert
D(3,)(5), Menon DK(6), Bernard F(3,)(7), Gosselin N(8,)(9).

BACKGROUND: Sleep-wake disturbances are frequently reported following traumatic
brain injury (TBI), but they remain poorly documented in the acute stage of
injury. Little is known about their origin and evolution.
CASE PRESENTATION: This study presents the case of a patient in the acute phase
of a severe TBI. The patient was injured at work when falling 12 m into a mine
and was hospitalized in the regular wards of a level I trauma centre. From days
31 to 45 post-injury, once he had reached a level of medical stability and
continuous analgosedation had been ceased, his sleep-wake cycle was monitored
using actigraphy. Results showed significant sleep-wake disturbances and severe
sleep deprivation. Indeed, the patient had an average nighttime sleep efficiency
of 32.7 ± 15.4 %, and only an average of 4.8 ± 1.3 h of sleep per 24-h period.
After hospital discharge to the rehabilitation centre, where he remained for
5 days, the patient was readmitted to the same neurological unit for paranoid
delusions. During his second hospital stay, actigraphy recordings resumed from
days 69 to 75 post-injury. A major improvement in his sleep-wake cycle was
observed during this second stay, with an average nighttime sleep efficiency of
96.3 ± 0.9 % and an average of 14.1 ± 0.9 h of sleep per 24-h period.
CONCLUSION: This study is the first to extensively document sleep-wake
disturbances in both the acute and subacute phases of severe TBI. Results show
that prolonged sleep deprivation can be observed after TBI, and suggest that the
hospital environment only partially contributes to sleep-wake disturbances.
Continuous actigraphic monitoring may prove to be a useful clinical tool in the
monitoring of patients hospitalized after severe TBI in order to detect severe
sleep deprivation requiring intervention. The direct impact of sleep-wake
disturbances on physiological and cognitive recovery is not well understood
within this population, but is worth investigating and improving.

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