The Risk of Sleep Disorder Among Persons with Mild Traumatic Brain Injury

Abstract

Sleep disorders and mild traumatic brain injury (mTBI) are among the most commonly occurring neurological problems clinicians encounter simultaneously. Each can cause the other, and both share common predisposing factors. An important question that remains to be addressed is whether high-risk groups can be defined. We observed an accumulation of considerable knowledge on sleep dysfunction in mTBI in recently published works. The results highlight sleep disturbances in mTBI as the product of diverse internal and external influences, acting on a genetically determined substrate. This may partially explain the clinical heterogeneity of mTBI, pointing to the importance of establishing an accurate history on the onset and course of a specific sleep disorder in the early stages post-mTBI in the individual patient. Such an approach will aid not only diagnosis and treatment but may also lead to identification of disorders whose symptoms mimic those of TBI and thereby direct the most suitable treatment and management.

Sleep Disturbances in the Acute Stage of Concussion are Associated With Poorer Long‐Term Recovery: A Systematic Review

“…A review by Mollayeva et al discusses several risk factors that appear to contribute to the development and perpetuation of sleep disturbances following concussion including: the brain region impacted by the concussion, genetics, certain anthropometric risk factors such as craniofacial phenotypes, being female, and older age . Other factors may include continued decreased levels of melatonin, changes in the circadian rhythm, and other psychosocial factors such as anxiety, depression, or change in activities and social interactions .…”

“…Other factors may include continued decreased levels of melatonin, changes in the circadian rhythm, and other psychosocial factors such as anxiety, depression, or change in activities and social interactions . Genetics also can play an important role in sleep regulation . Hong et al evaluated the presence of the PER3 gene polymorphism in individuals with concussion, and found those with the PER3 allele (morning preference) exhibited consolidated sleep and perceived improved daytime functioning 6‐weeks post‐concussion compared to the PER3 allele (evening preference) .…”

“…Not surprisingly, there is much overlap between the factors that may increase risk for developing sleep disturbances and factors that appear to increase risk for development of post‐concussion symptoms and delayed recovery (ie, age, sex, genetics, history of migraine, and learning disabilities) . In addition, cognitive reserve may have a protective effect on cognition during recovery from a concussion .…”

“…Insomnia is a highly prevalent symptom following concussion that can last for months after injury . Sleep disturbances can be due to axonal damage that occurs during the concussive injury resulting in dysregulation of the sleep and arousal centers in the brain, including the suprachiasmatic nucleus, hypothalamus, retino‐hypothalamic tract, and the reticular activating system . In addition, damage to the pineal gland can reduce production of melatonin thereby leading to disruption of the circadian rhythm .…”

TBI and Sleep–Wake Disorders: Pathophysiology, Clinical Management, and Moving towards the Future

“…The variety of SWDs that arise in the setting of TBI include insomnia, pleiosomnia (increased sleep duration), excessive daytime sleepiness (EDS), obstructive sleep apnea, central sleep apnea, circadian rhythm disorders, and potentially parasomnias (see ►Table 1). 4,7,15 The pathophysiology that underlies each of these different disorders remains elusive, and it is not yet clear if one type of brain injury predisposes to one SWD more than another. It is conceivable that the same injury (relative location, type of exposure, degree of severity) may result in different SWDs, depending on the underlying susceptibilities of the patient.…”