Do sleep difficulties exacerbate deficits in sustained attention following traumatic brain injury?

Abstract

Sustained attention has been shown to be vulnerable following traumatic brain injury (TBI). Sleep restriction and disturbances have been shown to negatively affect sustained attention. Sleep disorders are common but under-diagnosed after TBI. Thus, it seems possible that sleep disturbances may exacerbate neuropsychological defi cits for a proportion of individuals who have sustained a TBI. The aim of this prospective study was to examine whether poor sleepers post-TBI had poorer sustained and general attentional functioning than good sleepers post-TBI. Retrospective subjective, prospective subjective, and objective measures were used to assess participants' sleep. The results showed that the poor sleep group had signifi cantly poorer sustained attention ability than the good sleep group. The differences on other measures of attention were not signifi cant. This study supports the use of measures that capture specifi c components of attention rather than global measures of attention, and highlights the importance of assessing and treating sleep problems in brain injury rehabilitation. ( JINS , 2010, 16, 17-25.)

Attention following traumatic brain injury: Neuropsychological and driving simulator data, and association with sleep, sleepiness, and fatigue

“…Although participants were well selected and groups were carefully matched, the sample size was small, with insufficient statistical power to detect small to moderate effects. However, this is comparable to what can be found in the literature: in recently published studies with similar objectives and protocols, sample sizes ranged from 3 to 87 participants with TBI (mean of 28.3) (Bloomfield et al, 2010;Castriotta et al, 2007;Chaumet et al, 2008;Cyr et al, 2009;Lengenfelder et al, 2002;Riese et al, 1999;Wilde et al, 2007); and some studies did not include a control group. In the current study, the heterogeneity in clinical characteristics of participants with TBI could have increased the variability on the main outcome measures, therefore reducing the likelihood of finding significant effects.…”

“…Only a handful of studies have documented the association between cognition and sleep-wake functions in the TBI population. A study comparing self-defined good and poor sleepers revealed that the latter displayed worse sustained attention (Bloomfield, Espie, & Evans, 2010). Similar findings were reported for daytime sleepiness, with poorer attentional performance in sleepy compared to non-sleepy individuals with TBI , and in patients with TBI and obstructive sleep apnoea (OSA) compared to patients without OSA .…”

“…Data on the interaction between sleep and cognition in non-sleep disordered TBI samples are scarce, with one study showing poorer attention in individuals with self-reported sleep disturbances Attention and driving after TBI: Impairments and correlates 20 (Bloomfield et al, 2010). In the general population, sleep deprivation is known to affect cognitive performance (Lim & Dinges, 2010).…”

Self-Reported Sleep Disturbance Mediates the Relationship Between PTSD and Cognitive Outcome in Blast-Exposed OEF/OIF Veterans

“…[22][23][24][25] Individuals with sleep disorders demonstrate deficits on neuropsychological tasks measuring information processing speed, attention, episodic memory, and working memory. 23,26,27 Evidence suggests that sleep problems contribute to the cognitive difficulties observed in both TBI [28][29][30]32 Moreover, improvement in sleep can lead to improvement in cognition in both disorders. 33,34 The above findings motivate the examination of the contribution of sleep disturbances to the cognitive difficulties experienced by OEF/OIF veterans exposed to blast.…”

Sustained attention following traumatic brain injury: Use of the Psychomotor Vigilance Task

“…Several studies in patients with TBI have demonstrated associations between fatigue and worsening sustained attention performances (Ashman et al, 2008;Belmont et al, 2009;Ziino & Ponsford, 2006b) and have provided support for the coping hypothesis (Ashman et al, 2008;Belmont et al, 2009;Ponsford et al, 2012;Ziino & Ponsford, 2006a, 2006b. The role of sleep disturbance or excessive sleepiness on attentional impairment following TBI has also been investigated, and several studies have demonstrated that patients with TBI who were classified as having a sleep disorder or considered poor sleepers show poorer sustained attention performances than those who report "normal sleep" (Bloomfield, Espie, & Evans, 2010;Castriotta et al, 2007;Wilde et al, 2007).…”