Research Reports - Increased sleep need and daytime sleepiness 6 months after traumatic brain injury

Brain. 2015 Jan 15

Imbach LL(1), Valko PO(2), Li T(2), Maric A(2), Symeonidou ER(2), Stover JF(3), Bassetti CL(4), Mica L(3), Werth E(2), Baumann CR(2)

Post-traumatic sleep-wake disturbances are common after acute traumatic brain
injury. Increased sleep need per 24 h and excessive daytime sleepiness are among
the most prevalent post-traumatic sleep disorders and impair quality of life of
trauma patients. Nevertheless, the relation between traumatic brain injury and
sleep outcome, but also the link between post-traumatic sleep problems and
clinical measures in the acute phase after traumatic brain injury has so far not
been addressed in a controlled and prospective approach. We therefore performed a
prospective controlled clinical study to examine (i) sleep-wake outcome after
traumatic brain injury; and (ii) to screen for clinical and laboratory predictors
of poor sleep-wake outcome after acute traumatic brain injury. Forty-two of 60
included patients with first-ever traumatic brain injury were available for
follow-up examinations. Six months after trauma, the average sleep need per 24 h
as assessed by actigraphy was markedly increased in patients as compared to
controls (8.3 ± 1.1 h versus 7.1 ± 0.8 h, P < 0.0001). Objective daytime
sleepiness was found in 57% of trauma patients and 19% of healthy subjects, and
the average sleep latency in patients was reduced to 8.7 ± 4.6 min (12.1 ± 4.7
min in controls, P = 0.0009). Patients, but not controls, markedly underestimated
both excessive sleep need and excessive daytime sleepiness when assessed only by
subjective means, emphasizing the unreliability of self-assessment of increased
sleep propensity in traumatic brain injury patients. At polysomnography, slow
wave sleep after traumatic brain injury was more consolidated. The most important
risk factor for developing increased sleep need after traumatic brain injury was
the presence of an intracranial haemorrhage. In conclusion, we provide controlled
and objective evidence for a direct relation between sleep-wake disturbances and
traumatic brain injury, and for clinically significant underestimation of
post-traumatic sleep-wake disturbances by trauma patients.

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