Sleep in the Acute Phase of Severe Traumatic Brain Injury

Abstract

Background and Objectives The onset of pervasive sleep-wake disturbances associated with traumatic brain injury (TBI) is poorly understood. This study aimed to (a) determine the feasibility of using polysomnography in patients in the acute, hospitalized stage of severe TBI and (b) explore sleep quality and sleep architecture during this stage of recovery, compared to patients with other traumatic injuries. Methods A cross-sectional case-control design was used. We examined the sleep of 7 patients with severe TBI (17-47 years; 20.3 ± 15.0 days postinjury) and 6 patients with orthopedic and/or spinal cord injuries (OSCI; 19-58 years; 16.9 ± 4.9 days postinjury). One night of ambulatory polysomnography was performed at bedside. Results Compared to OSCI patients, TBI patients showed a significantly longer duration of nocturnal sleep and earlier nighttime sleep onset. Sleep efficiency was low and comparable in both groups. All sleep stages were observed in both groups with normal proportions according to age. Conclusion Patients in the acute stage of severe TBI exhibit increased sleep duration and earlier sleep onset, suggesting that the injured brain enhances sleep need and/or decreases the ability to maintain wakefulness. As poor sleep efficiency could compromise brain recovery, further studies should investigate whether strategies known to optimize sleep in healthy individuals are efficacious in acute TBI. While there are several inherent challenges, polysomnography is a useful means of examining sleep in the early stage of recovery in patients with severe TBI.

Injury, Sleep, and Functional Outcome in Hospital Patients With Traumatic Brain Injury

“…The sleep characteristics in the present sample are consistent with those of others samples following TBI in post-hospital phases. 5,15,39,40 Specifically, the average sleep efficiency of the participants in this sample was 73%, lower than the 80-90% sleep efficiency recognized as normal in adults without TBI. 37,38 Despite evidence that poor sleep is a common symptom of TBI 5 and that poor sleep can undermine rehabilitative efforts 3,39 none of the nighttime rest/activity measures associate with functional outcome in a comprehensive model.…”

“…So what? We know some studies have shown that sleep disturbances (poor sleep consolidation and architecture) are common in hospitalized patients with TBI, 12,13,14,15 but they have either all occurred in the ICU, have used only subjective measures of sleep, or have included patients with only mild TBI. Therein lies a missed opportunity for exploring nighttime sleep for patients with TBI hospitalized on the neuroscience step-down unit.…”

Sleep-Wake Disturbances After Traumatic Brain Injury: Synthesis of Human and Animal Studies

“…48 Studies indicate that 30-70% of TBI survivors across the entire injury spectrum experience disordered sleep after injury, [6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22] a finding unique to traumatic cerebral injury, as traumatic spinal cord injuries do not cause similar sleep-wake disturbances. 49 Numerous studies have demonstrated that the severity of the inciting head injury does not predict the degree of sleep-wake disturbances; 6 individuals with traumatic brain insults of all severities are at risk. Reported rates vary widely due to methodological variances in many studies, including sample bias (i.e., samples referred to sleep laboratories), varied assessment methods (i.e., subjective self-report versus objective polysomnography or actigraphy), and poor recognition or underreporting by patients and clinicians.…”

A Review of Assessment of Sleep Disruption in Adults Following Traumatic Brain Injury

“…For these patients, continuous intravenous sedation and analgesia were discontinued for a minimum of 48 h prior to study. Specifically, Wiseman-Hakes et al [68] found that compared to OSCI, severe TBI patients showed significantly longer duration of nocturnal sleep and earlier nighttime onset. However, as with previous studies, these authors note and caution that PSG may not be usable for portions of this population due to the confusion and agitation.…”