Poor sleep is linked to impeded recovery from traumatic brain injury

Kalmbach, David A.; Conroy, Deirdre A.; Falk, Hayley; Rao, Vani; Roy, Durga; Peters, Matthew E.; Meter, Timothy E. Van; Korley, Frederick K.

doi:10.1093/sleep/zsy147

Cited by 45 publications

(30 citation statements)

References 63 publications

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“…A larger study 12 found a cross-sectional relationship between subjective sleep quality and the functional ambulation score after stroke but had no objective sleep measures. Similarly, Kalmbach et al 13 found that patients with subjective difficulties initiating sleep had lower function at multiple time-points over the first 6 months of recovery from traumatic brain injury (TBI). Sleep variables, such as total sleep time, WASO and daytime napping, have also been shown to explain significant variance in Barthel Index (BI) score at the acute stage of stroke, 14,15 and the percentage of sleep stages I and rapid eye movement (REM) are negatively associated with NIHSS.…”

Section: Introductionmentioning

confidence: 97%

Sleep Disruption After Brain Injury Is Associated With Worse Motor Outcomes and Slower Functional Recovery

Fleming

Smejka

Slater

et al. 2020

Neurorehabil Neural Repair

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Background. Sleep is important for consolidation of motor learning, but brain injury may affect sleep continuity and therefore rehabilitation outcomes. Objective. This study aims to assess the relationship between sleep quality and motor recovery in brain injury patients receiving inpatient rehabilitation. Methods. Fifty-nine patients with brain injury were recruited from 2 specialist inpatient rehabilitation units. Sleep quality was assessed (up to 3 times) objectively using actigraphy (7 nights) and subjectively using the Sleep Condition Indicator. Motor outcome assessments included Action Research Arm test (upper limb function), Fugl-Meyer Assessment (motor impairment), and the Rivermead Mobility Index. The Functional Independence Measure (FIM) was assessed at admission and discharge by the clinical team. Fifty-five age- and gender-matched healthy controls completed one assessment. Results. Inpatients demonstrated lower self-reported sleep quality ( P < .001) and more fragmented sleep ( P < .001) than controls. For inpatients, sleep fragmentation explained significant additional variance in motor outcomes, over and above that explained by admission FIM score ( P < .017), such that more disrupted sleep was associated with poorer motor outcomes. Using stepwise linear regression, sleep fragmentation was the only variable found to explain variance in rate of change in FIM ( R2adj = 0.12, P = .027), whereby more disrupted sleep was associated with slower recovery. Conclusions. Inpatients with brain injury demonstrate impaired sleep quality, and this is associated with poorer motor outcomes and slower functional recovery. Further investigation is needed to determine how sleep quality can be improved and whether this affects outcome.

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Section: Introductionmentioning

confidence: 97%

Sleep Disruption After Brain Injury Is Associated With Worse Motor Outcomes and Slower Functional Recovery

Fleming

Smejka

Slater

et al. 2020

Neurorehabil Neural Repair

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“…Still, 55% of patients with mTBI who had SWD and fatigue 2 weeks after injury had problems that lasted 3 months or longer. Detection of SWD and fatigue is crucial for optimal recovery in patients with mTBI, because such problems are related to a range of negative consequences, including impeded long-term recovery, 68 reduced cognitive functioning, 1 , 69 social and functional outcome, 1 , 70 emotional processing, 71 and other post-concussive symptoms. 1 Screening for SWD and fatigue in an early phase can therefore be beneficial for these patients because interventions and advice about sleep hygiene can be effective and improve overall outcome.…”

Section: Discussionmentioning

confidence: 99%

The Prevalence and Stability of Sleep-Wake Disturbance and Fatigue throughout the First Year after Mild Traumatic Brain Injury

Saksvik

Karaliute

Kallestad

et al. 2020

Journal of Neurotrauma

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In this prospective, longitudinal study, we aimed to determine the prevalence and stability of sleep-wake disturbance (SWD) and fatigue in a large representative sample of patients (Trondheim mild traumatic brain injury [mTBI] follow-up study). We included 378 patients with mTBI (age 16-60), 82 matched trauma controls with orthopedic injuries, and 83 matched community controls. Increased sleep need, poor sleep quality, excessive daytime sleepiness, and fatigue were assessed at 2 weeks, 3 months, and 12 months after injury. Mixed logistic regression models were used to evaluate clinically relevant group differences longitudinally. Prevalence of increased sleep need, poor sleep quality, and fatigue was significantly higher in patients with mTBI than in both trauma controls and community controls at all time points. More patients with mTBI reported problems with excessive daytime sleepiness compared to trauma controls, but not community controls, at all time points. Patients with complicated mTBI (intracranial findings on computed tomography or magnetic resonance imaging) had more fatigue problems compared to those with uncomplicated mTBI, at all three time points. In patients with mTBI who experienced SWDs and fatigue 2 weeks after injury, around half still had problems at 3 months and approximately one third at 12 months. Interestingly, we observed limited overlap between the different symptom measures; a large number of patients reported one specific problem with SWD or fatigue rather than several problems. In conclusion, our results provide strong evidence that mTBI contributes significantly to the development and maintenance of SWDs and fatigue.

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“…Though the mechanisms are not entirely understood, sleep is thought to represent a crucial period of metabolic waste clearance from the brain, potentially due to the increased volume of, and flux through, the glymphatic system 139 . Ensuring adequate sleep support, either through environmental, cognitive, behavioral, or pharmacological means, could therefore be a crucial determinant of the success of therapeutics for a wide range of neurological disorders 140,141 …”

Section: Timing Of Pathophysiological Changes Mattersmentioning

confidence: 99%

Disease-directed engineering for physiology-driven treatment interventions in neurological disorders

Wood

Nance

2019

APL Bioengineering

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Neurological disease is killing us. While there have long been attempts to develop therapies for both acute and chronic neurological diseases, no current treatments are curative. Additionally, therapeutic development for neurological disease takes 15 years and often costs several billion dollars. More than 96% of these therapies will fail in late stage clinical trials. Engineering novel treatment interventions for neurological disease can improve outcomes and quality of life for millions; however, therapeutics should be designed with the underlying physiology and pathology in mind. In this perspective, we aim to unpack the importance of, and need to understand, the physiology of neurological disease. We first dive into the normal physiological considerations that should guide experimental design, and then assess the pathophysiological factors of acute and chronic neurological disease that should direct treatment design. We provide an analysis of a nanobased therapeutic intervention that proved successful in translation due to incorporation of physiology at all stages of the research process. We also provide an opinion on the importance of keeping a high-level view to designing and administering treatment interventions. Finally, we close with an implementation strategy for applying a disease-directed engineering approach. Our assessment encourages embracing the complexity of neurological disease, as well as increasing efforts to provide system-level thinking in our development of therapeutics for neurological disease.

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Poor sleep is linked to impeded recovery from traumatic brain injury

Abstract: Functionally impaired patients diagnosed predominantly with mild TBI exhibit high rates of insomnia and short sleep, which may impede TBI recovery. Monitoring sleep after head injury may identify patients with poor prognoses and allow for early intervention to improve functional outcomes.

Cited by 45 publications

References 63 publications

Sleep Disruption After Brain Injury Is Associated With Worse Motor Outcomes and Slower Functional Recovery

Sleep Disruption After Brain Injury Is Associated With Worse Motor Outcomes and Slower Functional Recovery

The Prevalence and Stability of Sleep-Wake Disturbance and Fatigue throughout the First Year after Mild Traumatic Brain Injury

Disease-directed engineering for physiology-driven treatment interventions in neurological disorders

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