Research Reports - Prospective evaluation of the nature, course, and impact of acute sleep abnormality after traumatic brain injury

Arch Phys Med Rehabil. 2013 May;94(5):875-82

Nakase-Richardson R, Sherer M, Barnett SD, Yablon SA, Evans CC, Kretzmer T, Schwartz DJ, Modarres M

OBJECTIVE: To prospectively characterize the prevalence, course, and impact of
acute sleep abnormality among traumatic brain injury (TBI) neurorehabilitation
DESIGN: Prospective observational study.
SETTING: Freestanding rehabilitation hospital.
PARTICIPANTS: Primarily severe TBI (median emergency department Glasgow Coma
Scale [GCS] score=7; N=205) patients who were mostly men (71%) and white (68%)
were evaluated during acute neurorehabilitation.
MAIN OUTCOME MEASURE: Delirium Rating Scale-Revised-98 (DelRS-R98) was
administered weekly throughout rehabilitation hospitalization. DelRS-R98 item 1
was used to classify severity of sleep-wake cycle disturbance (SWCD) as none,
mild, moderate, or severe. SWCD ratings were analyzed both serially and at 1
month postinjury.
RESULTS: For the entire sample, 66% (mild to severe) had SWCD at 1 month
postinjury. The course of the SWCD using a subset (n=152) revealed that 84% had
SWCD on rehabilitation admission, with 63% having moderate to severe ratings
(median, 24d postinjury). By the third serial exam (median, 35d postinjury), 59%
remained with SWCD, and 28% had moderate to severe ratings. Using general linear
modeling and adjusting for age, emergency department GCS score, and days
postinjury, presence of moderate to severe SWCD at 1 month postinjury made
significant contributions in predicting duration of posttraumatic amnesia (P<.01)
and rehabilitation hospital length of stay (P<.01).
CONCLUSIONS: Results suggest that sleep abnormalities after TBI are prevalent and
decrease over time. However, a high percent remained with SWCD throughout the
course of rehabilitation intervention. Given the brevity of inpatient
neurorehabilitation, future studies may explore targeting SWCD to improve early
outcomes, such as cognitive functioning and economic impact, after TBI.

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