Research Reports - Sleep stage distribution in persons with mild traumatic brain injury

Sleep Med. 2017 Jun;34:179-192. doi: 10.1016/j.sleep.2017.02.021. Epub 2017 Mar

Mollayeva T(1), Colantonio A(2), Cassidy JD(3), Vernich L(4), Moineddin R(4),
Shapiro CM(5).

OBJECTIVE AND BACKGROUND: Sleep stage disruption in persons with mild traumatic
brain injury (mTBI) has received little research attention. We examined
deviations in sleep stage distribution in persons with mTBI relative to
population age- and sex-specific normative data and the relationships between
such deviations and brain injury-related, medical/psychiatric, and extrinsic
PATIENTS AND METHODS: We conducted a cross-sectional polysomnographic
investigation in 40 participants diagnosed with mTBI (mean age 47.54 ± 11.30
years; 56% males).
MEASUREMENTS: At the time of investigation, participants underwent comprehensive
clinical and neuroimaging examinations and one full-night polysomnographic study.
We used the 2012 American Academy of Sleep Medicine recommendations for
recording, scoring, and summarizing sleep stages. We compared participants' sleep
stage data with normative data stratified by age and sex to yield z-scores for
deviations from available population norms and then employed stepwise multiple
regression analyses to determine the factors associated with the identified
significant deviations.
RESULTS: In patients with mTBI, the mean duration of nocturnal wakefulness was
higher and consolidated sleep stage N2 and REM were lower than normal
(p < 0.0001, p = 0.018, and p = 0.010, respectively). In multivariate regression
analysis, several covariates accounted for the variance in the relative changes
in sleep stage duration. No sex differences were observed in the mean proportion
of non-REM or REM sleep.
CONCLUSIONS: We observed longer relative nocturnal wakefulness and shorter
relative N2 and REM sleep in patients with mTBI, and these outcomes were
associated with potentially modifiable variables. Addressing disruptions in sleep
architecture in patients with mTBI could improve their health status. 

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