Sleep Problems Often Neglected After Traumatic Brain Injury

Sleep-wake disturbances (SWD) after traumatic brain injury (TBI) persist over a long period of time, but are neglected by the majority of affected patients, according to a new study. SWD can exacerbate other outcomes of TBI, impair quality of life, and are associated with public safety hazards.

“We believe our observations are important for all clinicians and neurologists involved in the management of trauma patients,” said lead study author Lukas L. Imbach, MD, from the department of neurology, University Hospital Zurich.
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The researchers screened 140 patients with acute, first-ever TBI of any severity and included 60 patients for prospective follow-up exams. They excluded patients with prior brain trauma, other neurologic or systemic disease, drug abuse, or psychiatric comorbidities. Eighteen months after trauma, they performed detailed sleep assessment in 31 participants. As a control group, the investigators enrolled healthy individuals without prior brain trauma matched for age, sex, and sleep satiation.

In the chronic state after TBI, sleep need per 24 hours was persistently increased in trauma patients (8.1 ± 0.5 hours) compared with healthy controls (7.1 ± 0.7 hours). The prevalence of chronic objective excessive daytime sleepiness was 67% in patients with brain trauma compared with 19% in controls. Patients significantly underestimated excessive daytime sleepiness and sleep need.

“Most important for primary care providers is the finding that it is not sufficient to screen for sleep problems by questionnaires in this population, because TBI patients underestimate their own sleep problems,” Imbach said. “Therefore, patients with TBI should preferably be examined with objective sleep laboratory examinations rather than self-reported sleep measures. Absence of subjective sleepiness does not rule out clinically significant posttraumatic sleep and wake problems.”

Future research will continue with a more in-depth analysis of neuroimaging and neuropsychological testing in this patient cohort, he said.

—Mike Bederka

Reference:

Imbach LL, Büchele F, Valko PO, et al. Sleep-wake disorders persist 18 months after traumatic brain injury but remain underrecognized [published online April 27, 2016]. Neurology. doi:​ http:/​/​dx.​doi.​org/​10.​1212/​WNL.​0000000000002697