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Knocked out: Sleep disturbances after traumatic brain injury

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Science Translational Medicine  18 Mar 2015:
Vol. 7, Issue 279, pp. 279ec45
DOI: 10.1126/scitranslmed.aaa9869

According to Leonardo da Vinci, “a well-spent day brings happy sleep,” but both can elude a person who has suffered a traumatic brain injury (TBI). Trauma patients often experience sleep-wake disturbances, but the documented prevalence rates vary widely, likely because they are based on retrospective or self-reported data that have not been compared with control groups. To better characterize TBI-associated sleep-wake disturbances, Imbach and colleagues prospectively compared the prevalence of sleep-need and excessive daytime sleepiness after TBI with a matched control group. The investigators also evaluated clinical and laboratory findings that predict poor sleep-wake outcome after TBI.

Patients were evaluated in the acute period after TBI to assess injury severity and potential predictors for sleep-wake disturbances and again at 6 months to assess objective (actigraphy) and subjective sleep data. After 6 months, the average sleep need per 24 hours increased by a mean difference of 1.2 hours (P<0.0001) in patients with first-ever TBI compared to a control group. Objective daytime sleepiness was also increased in the TBI group (57% versus 19% in the control group). Interestingly, TBI patients, but not controls, significantly underestimated sleep-wake disturbances compared with the objective data. Furthermore, the severity of TBI and presence of intracranial hemorrhage were found to predict sleep-wake disturbances. The direct relationship between sleep-wake disturbances and TBI demonstrated by this prospective, controlled study paves the way for future in-depth examinations of TBI patients in sleep laboratories.

L. L. Imbach et al., Increased sleep need and daytime sleepiness 6 months after traumatic brain injury: A prospective controlled clinical trial. Brain 138, 726–735 (2015). [Full Text]

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