Underrecognized Sleep Disorders Persist Following mTBI
- Increased sleep needs are likely part of the recovery process after traumatic brain injury (TBI). However, there is increasing recognition that many patients have long-term sleep–wake disturbances as a residual consequence of TBI.
- In this comprehensive prospective study, patients with first-ever TBI were followed and a sleep assessment was performed 18 months after the trauma.
- Findings included:
- Sleep needs per 24 hours were persistently increased in TBI patients by one hour
- Chronic excessive daytime sleepiness was present in 67% of TBI patients
- The study confirms important sleep dysfunction persisting after TBI and suggests that subjective symptom reporting cannot be relied upon when evaluating this issue.
Objective: This study is a prospective, controlled clinical and electrophysiologic trial examining the chronic course of posttraumatic sleep–wake disturbances (SWD).
Methods: We screened 140 patients with acute, first-ever traumatic brain injury of any severity and included 60 patients for prospective follow-up examinations. Patients with prior brain trauma, other neurologic or systemic disease, drug abuse, or psychiatric comorbidities were excluded. Eighteen months after trauma, we performed detailed sleep assessment in 31 participants. As a control group, we enrolled healthy individuals without prior brain trauma matched for age, sex, and sleep satiation.
Results: In the chronic state after traumatic brain injury, sleep need per 24 hours was persistently increased in trauma patients (8.1 ± 0.5 hours) as compared to healthy controls (7.1 ± 0.7 hours). The prevalence of chronic objective excessive daytime sleepiness was 67% in patients with brain trauma compared to 19% in controls. Patients significantly underestimated excessive daytime sleepiness and sleep need, emphasizing the unreliability of self-assessments on SWD in trauma patients.
Conclusions: This study provides prospective, controlled, and objective evidence for chronic persistence of posttraumatic SWD, which remain underestimated by patients. These results have clinical and medicolegal implications given that SWD can exacerbate other outcomes of traumatic brain injury, impair quality of life, and are associated with public safety hazards.
Lukas L. Imbach, MD, Fabian Büchele, MD, Philipp O. Valko, MD, Tongzhou Li, Angelina Maric, MSc, John F. Stover, MD, Claudio L. Bassetti, MD, Ladislav Mica, MD, Esther Werth, PhD and Christian R. Baumann, MD. Sleep–wake disorders persist 18 months after traumatic brain injury but remain Underrecognized. Neurology, May 24, 2016 vol. 86 no. 21 1945-1949