Fatigue and Sleep Disturbance Following Traumatic Brain Injury—Their Nature, Causes, and Potential Treatments

Ponsford, Jennie; Ziino, Carlo; Parcell, Diane L.; Shekleton, Julia A; Roper, Monique; Redman, Jennifer R.; Phipps-Nelson, Jo; Rajaratnam, Shanthakumar M W

doi:10.1097/htr.0b013e31824ee1a8

Cited by 201 publications

(150 citation statements)

References 54 publications

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“…49,50 This may be because those with mild TBI retain more self-awareness. 7 Insult to the brain is considered a determinant of sleep disturbances, however, no convincing neuroimaging evidence has linked location of cerebral injury with sleep disturbance. 51,52 Although some studies have failed to show that injury severity is a predictor of sleep deficits following TBI, 3,11,24 recent research suggests that intracranial hemorrhage and lower Glasgow Coma Scores are strongly associated with increased sleep need, suggesting that widespread cerebral trauma contributes to sleep disturbances post TBI.…”

Section: Discussionmentioning

confidence: 99%

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Sleep Disturbances in Traumatic Brain Injury: A Meta-Analysis

Grima

Ponsford

Rajaratnam

et al. 2016

Journal of Clinical Sleep Medicine

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Study Objectives: Sleep disturbances are frequently reported following traumatic brain injury (TBI); however, the exact disturbances remain unclear. This meta-analysis aimed to characterize sleep disturbance in community dwelling patients with TBI as compared to controls. Methods: Two investigators independently conducted a systematic search of multiple electronic databases from inception to May 27, 2015. Studies were selected if they compared sleep in community dwelling individuals with TBI relative to a control population without head injury. Data were pooled in metaanalysis with outcomes expressed as the standard mean difference (SMD) and 95% confidence interval (CI). The primary outcomes were derived from polysomnography and secondary outcomes were derived from subjective sleep measures. Results: Sixteen studies were included, combining 637 TBI patients and 567 controls, all of whom were community dwelling. Pooled polysomnography data revealed that TBI patients had poorer sleep efficiency (SMD = −0. I NTRO DUCTI O NSleep disturbances are frequently reported following traumatic brain injury (TBI), with over 50% of people experiencing some form of sleep disturbance post TBI.1 Although a large majority of people with TBI generally make a good physical recovery, disrupted sleep can often go untreated, impacting quality of life, impeding rehabilitation and return to pre-injury activities.2-5 Our recent work showed significant interrelationships between daytime sleepiness, daytime fatigue, cognitive impairment, and mood disturbances in TBI. 6 While individuals with TBI are known to report sleep problems, 1 the specific changes to sleep remain poorly characterized.7 Studies have been limited by small sample sizes, with variable and inconsistent findings. [8][9][10][11][12] This makes for a difficult characterization of sleep post TBI. Thus, there is a need to establish the specific aspects of sleep that are most affected post TBI as these have important implications for treatment and rehabilitation. The aim of the current meta-analysis was to characterize both objective sleep disturbances and subjective sleep complaints in individuals with TBI relative to healthy controls. Study outcomes included the comparison of TBI patients to controls across both polysomnography and subjective measures of sleep. It ; Matthew P. Pase, PhD was hypothesized that those with TBI would display widespread objective and subjective sleep deficits as compared to controls without head injury. The present study aimed to summarize current literature, which would identify important avenues for future research. M ETHO DS Study DesignThe search strategy was conducted in accordance with the meta-analysis of observational studies in epidemiology guidelines. 13 Article SearchingOvid Medline, Embase, PsychInfo, Scopus, and the Cochrane Library were systematically searched until May, 27 2015. The search was initially developed by all authors and refined by a librarian at Monash University. The references of recent publications were also hand searc...

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Section: Discussionmentioning

confidence: 99%

“…6 While individuals with TBI are known to report sleep problems, 1 the specific changes to sleep remain poorly characterized. 7 Studies have been limited by small sample sizes, with variable and inconsistent findings. [8][9][10][11][12] This makes for a difficult characterization of sleep post TBI.…”

Section: Introductionmentioning

confidence: 99%

Sleep Disturbances in Traumatic Brain Injury: A Meta-Analysis

Grima

Ponsford

Rajaratnam

et al. 2016

Journal of Clinical Sleep Medicine

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“…Nonpharmacologic treatments have also been studied. Although not addressing sleepiness per se, Ponsford et al [90] found that morning bright light therapy improved general fatigue in patients with mTBI.…”

Section: Hypersomnolencementioning

confidence: 99%

Sleep, Sleep Disorders, and Mild Traumatic Brain Injury. What We Know and What We Need to Know: Findings from a National Working Group

et al. 2016

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Disturbed sleep is one of the most common complaints following traumatic brain injury (TBI) and worsens morbidity and long-term sequelae. Further, sleep and TBI share neurophysiologic underpinnings with direct relevance to recovery from TBI. As such, disturbed sleep and clinical sleep disorders represent modifiable treatment targets to improve outcomes in TBI. This paper presents key findings from a national working group on sleep and TBI, with a specific focus on the testing and development of sleep-related therapeutic interventions for mild TBI (mTBI). First, mTBI and sleep physiology are briefly reviewed. Next, essential empirical and clinical questions and knowledge gaps are addressed. Finally, actionable recommendations are offered to guide active and efficient collaboration between academic, industry, and governmental stakeholders.

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“…Sleep-wake regulating centers and associated pathways are damaged in TBI, and these damages will be the cause of disturbances of sleep architecture. Sleep disturbances contribute to fatigue, which may be associated with mental slowness and, slowed information processing [32]. Sleep disturbances also contribute to anxiety and depression.…”

Section: Discussionmentioning

confidence: 99%

Electrophysiologic Evaluation of Diffuse Axonal Injury after Traumatic Brain Injury

Urakami¹

2013

J Neurol Neurophysiol

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Fatigue and Sleep Disturbance Following Traumatic Brain Injury—Their Nature, Causes, and Potential Treatments

Abstract: These findings suggest potential treatments including cognitive behavior therapy supporting lifestyle modifications, pharmacologic treatments with modafinil and melatonin, and light therapy to enhance alertness, vigilance, and mood. Controlled trials of these interventions are needed.

Cited by 201 publications

References 54 publications

Sleep Disturbances in Traumatic Brain Injury: A Meta-Analysis

Sleep Disturbances in Traumatic Brain Injury: A Meta-Analysis

Sleep, Sleep Disorders, and Mild Traumatic Brain Injury. What We Know and What We Need to Know: Findings from a National Working Group

Electrophysiologic Evaluation of Diffuse Axonal Injury after Traumatic Brain Injury

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