Sleep Problems Persist After Traumatic Brain Injury

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Many patients significantly underestimated their daytime sleepiness and sleep need.
Many patients significantly underestimated their daytime sleepiness and sleep need.

Sleep-wake disturbances are persistent and chronically underestimated in patients with traumatic brain injury (TBI), research indicates.

The findings are especially troubling since sleep disturbance can exacerbate outcomes of TBI.

For the study, Lukas L. Imbach, MD, of the University Hospital Zurich, and colleagues screened 140 patients with first-ever acute TBI of any severity. Patients were excluded if they had prior brain trauma, other neurologic or systemic diseases, drug abuse, or psychiatric comorbidities. Sixty patients were included for prospective follow-up exams, with detailed sleep assessments performed on 31 patients 18 months post-trauma.

Researchers assessed patient sleep quality through interview questions addressing sleep habits, fatigue, and other measures. Participants also wore wrist sensors to monitor their amount of sleep in 24-hour periods, and video polysomnography was used to monitor other variations in sleep.

In the chronic state post-TBI, sleep needs in TBI patients were 8.1 hours vs 7.1 hours in healthy controls (P<0.005). During this time, chronic objective excessive daytime sleepiness was reported in 67% of patients with TBI compared to 19% of controls.

Notably, the researchers found that patients with TBI significantly underestimated their daytime sleepiness and sleep need, suggesting that self-assessments may be an unreliable diagnostic tool in trauma patients.

While it may be premature to recommend all patients with TBI for sleep monitoring, the authors emphasize that sleep disturbance can have a significant impact on not only recovery from TBI, but overall quality of life and public safety.

Reference

Imbach LL, Buchele F, Valko PO, et al. Sleep–wake disorders persist 18 months after traumatic brain injury but remain underrecognized. Neurology. 2016; doi: 10.1212/WNL.0000000000002697.

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