Sleep-wake disturbances 3 years after traumatic brain injury

Abstract

Background 6 months after traumatic brain injury (TBI), almost three out of four patients suffer from sleepewake disturbances (SWD) such as post-traumatic hypersomnia (increased sleep need of $2 h compared with before injury), excessive daytime sleepiness (EDS), fatigue and insomnia. The long-term course of posttraumatic SWD, however, is unknown. Objectives To assess the prevalence and characteristics of post-traumatic SWD 3 years after trauma. Design Prospective longitudinal clinical study in 51 consecutive TBI patients (43 males, eight females, mean age 40616 years). Main outcome measures EDS (as assessed by the Epworth sleepiness scale), fatigue (fatigue severity scale), post-traumatic hypersomnia (sleep length per 24 h), insomnia, depression and anxiety. Results Post-traumatic SWD were found in 34 patients (67%): post-traumatic hypersomnia in 14 (27%), EDS in six (12%), fatigue in 18 patients (35%) and insomnia in five patients (10%). SWD were not associated with severity or localisation of, or time interval since, TBI. Insomnia was linked to depressive symptoms. Conclusions This prospective study shows that 3 years after TBI, two out of three patients suffer from residual SWD, particularly fatigue and post-traumatic hypersomnia. In 45% of TBI patients, SWD appear directly related to the trauma itself.

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

“…Subjective complaints of sleep-wake disturbances occur in 30-70% of those with TBI of all severity [76][77][78][79][80]. Insomnia, fatigue, and somnolence are the most common clinical diagnoses reported following mTBI, but sleep-disordered breathing can also develop.…”

“…Similar to hypersomnia, insomnia associated with mTBI is frequently confounded by other factors, particularly pain and comorbid psychiatric disorders. For example, mTBI is frequently associated with significant autonomic dysregulation and alterations in normal circadian patterns [53,78]. Head injuries and neurotrauma may affect normal melatonin production [22].…”

Alterations in Daytime and Nighttime Activity in Piglets after Focal and Diffuse Brain Injury

“…7,8 Recent patient studies have used accelerometer data from traumatic brain injury (TBI) patients to document persistent sleep disturbances days and years after mild-to-moderate TBI, with longer 24-h sleep durations, increased nighttime sleep interruptions, and more daytime drowsiness. [9][10][11][12][13][14] Although animal activity is typically captured from video analysis, there is an emerging science of acceleration-based actigraphy measurements for animal (rats, nonhuman primates, and marmots) 15 species, but none for pigs, a large animal used as a model for studying neurological diseases. 16,17 Given the value of large animal models in understanding the mechanisms and responses to TBI for the development of interventions and therapies, 17 and the similarity of the pig to humans, 16,18 we have adapted this technology and its analysis metrics for use in piglets with TBI.…”

Effects of Blast Exposure on Subjective and Objective Sleep Measures in Combat Veterans with and without PTSD

“…For instance, blast injuries are associated with insomnia and elevated anxiety symptoms, whereas blunt injuries are more commonly associated with OSAS. 16 Over 60% of patients with cmTBI continue to endorse clinically significant sleep disturbances 3 years post-injury, 18 and there is evidence that sleep disturbances impede recovery and rehabilitation.…”

“…16 Other studies have found similarly high rates of sleep complaints in military and civilian samples, which were also corroborated by objective measures. [17][18][19] There is preliminary evidence that blast-vs. blunt-related TBI may be accompanied by distinct profiles of sleep disturbances. For instance, blast injuries are associated with insomnia and elevated anxiety symptoms, whereas blunt injuries are more commonly associated with OSAS.…”