Sleep disorders are a relatively common occurrence after brain injury. Sleep disturbances often result in a poor daytime performance and a poor individual sense of well-being. Unfortunately, there has been minimal attention paid to this common and often disabling sequela of brain injury. This study attempts to define and to correlate the incidence and type of sleep disturbances that occur after brain injury. Consecutive admissions to a rehabilitation unit were used to create a longitudinal database designed to predict long-term outcomes for individuals who suffered a brain injury. Fifty percent of subjects had difficulty sleeping. Sixty-four percent described waking up too early, 25% described sleeping more than usual, and 45% described problems falling asleep. Eighty percent of subjects reporting sleep problems also reported problems with fatigue. Logistic regression analysis revealed the following: the more severe the brain injury the less likely the subject would be to have a sleep disturbance; subjects who had sleep disturbances were more likely to have problems with fatigue; females were more likely to have trouble with sleep. This study demonstrates the substantial prevalence of sleep disturbances after brain injury. It underscores the relationship between sleep disorders and perception of fatigue. It also underscores the need for clinicians to strive for interventional studies to look at the treatment of sleep and fatigue problems after brain injury.
[Show abstract][Hide abstract] ABSTRACT: Le sommeil joue un rôle essentiel dans l’équilibre physiologique et psychologique de l’individu. Son analyse chez le patient cérébrolésé est donc importante à la fois pour affiner le diagnostic et pour établir un pronostic. Après le positionnement du problème médical, nous faisons ici la revue des études sur le sommeil chez les patients en état de conscience altéré. En résumé, il apparaît que la préservation des stades de sommeil standard varie avec la sévérité de la blessure cérébrale et influence le pronostic. Cependant, du fait que ces études sont anciennes, peu nombreuses et hétérogènes d’un point de vue méthodologique, il semble nécessaire de définir, pour l’analyse du sommeil chez les patients cérébrolésés, de nouveaux critères adaptés de la méthodologie standard. Nous présentons ainsi notre propre étude sur le sommeil chez les patients en état neurovégétatif et en état de conscience minimale qui est la première à être basée sur une polysomnographie de 24 h et une analyse multicentrique des données. Les résultats confirment que ces patients peuvent présenter des phases de repos à n’importe quel moment du jour ou de la nuit. Pendant ces périodes de repos, les différents stades de sommeil standards peuvent être conservés, déformés ou absents. Nous mettons aussi en évidence que les fuseaux de sommeil sont prédictifs d’une amélioration comportementale et que le sommeil paradoxal différencie les patients en état de conscience minimale de ceux en état neurovégétatif. De plus, la polysomnographie a l’avantage d’être une technique ambulatoire, relativement simple et peu coûteuse par rapport aux autres outils paracliniques. En conclusion, l’examen du sommeil pourrait être effectué en routine clinique afin d’affiner l’évaluation neurologique des patients cérébrolésés.
Médecine du Sommeil 11/2014; 11(4). DOI:10.1016/j.msom.2014.10.001
"Controversy exists whether severity of TBI is directly correlated with increased prevalence of insomnia. Clinchot et al. (1998) and Fichtenberg et al. (2002) showed an inverse relationship and Cohen et al. (1992) noted increased prevalence with increasing severity of TBI. Some researchers have postulated the reason for this counterintuitive finding lies in the fact that the people with severe brain injury likely underreport and those with milder injury are more aware of their problem and therefore more likely to report about insomnia. "
[Show abstract][Hide abstract] ABSTRACT: Study of insomnia and associated factors in Traumatic Brain Injury
This study is designed to investigate prevalence and risk factors of insomnia in TBI. This study has also tried to explore the connection between insomnia with neuroanatomical localization of TBI as well as depression
Material and Method
All eligible participants were evaluated initially after two week interval for first 4 weeks and monthly interval subsequently till one year. Demographic and injury characteristics of the participants were assessed on a self designed semi structured performa. Interviews focused on assessment of severity of TBI, insomnia and depression using GCS, ISI and PHQ-9 respectively.
Total 204 patients were included, mean age was 33.34 years. 40.2% participants were found to have insomnia. None of the demographic variables were associated with insomnia except severity and duration of TBI. Moderate TBI patient (70.73%) had significantly higher occurrence of insomnia than the mild cases (19.67%) (P = 0.000, df 1). First three month after TBI witnessed more than half (63.41%) of those patient who had insomnia. This was found statistically significant (P < 0.017). Neuroanatomical localization was also correlated with insomnia. Cerebral contusion was the most common (40.24%) site of impact. Almost half (42.42%) of the patients with insomnia had multiple contusions. 32.84% of the study population had depression. No significant correlation could be established between depression and insomnia.
Insomnia is a prevalent condition after TBI requiring more clinical and scientific attention as it may have important repercussions on rehabilitation.
Asian Journal of Psychiatry 04/2014; 8(1). DOI:10.1016/j.ajp.2013.12.017
"Some data show that less severe TBI might be associated with greater sleep complaints [3,6,7,11,15], probably because individuals with a milder severity of TBI are prone to struggle to restore their lifestyles and have better insight into the impact of injury. On the contrary, other studies demonstrate that a milder severity of TBI doesn’t contribute significantly to the prediction of the presence of sleep disruption [8,16-19]. "
[Show abstract][Hide abstract] ABSTRACT: Sleep disturbance is very common following traumatic brain injury (TBI), which may initiate or exacerbate a variety of co-morbidities and negatively impact rehabilitative treatments. To date, there are paradoxical reports regarding the associations between inherent characteristics of TBI and sleep disturbance in TBI population. The current study was designed to explore the relationship between the presence of sleep disturbance and characteristics of TBI and identify the factors which are closely related to the presence of sleep disturbance in TBI population.
98 TBI patients (72 males, mean age ± SD, 47 ± 13 years, range 18-70) were recruited. Severity of TBI was evaluated based on Glasgow Coma Scale (GCS). All participants performed cranial computed tomography and were examined on self-reported sleep quality, anxiety, and depression.
TBI was mild in 69 (70%), moderate in 15 (15%) and severe in 14 (15%) patients. 37 of 98 patients (38%) reported sleep disturbance following TBI. Insomnia was diagnosed in 28 patients (29%) and post-traumatic hypersomnia in 9 patients (9%). In TBI with insomnia group, 5 patients (18%) complained of difficulty falling asleep only, 8 patients (29%) had difficulty maintaining sleep without difficulty in initial sleep and 15 patients (53%) presented both difficulty falling asleep and difficulty maintaining sleep. Risk factors associated with insomnia were headache and/or dizziness and more symptoms of anxiety and depression rather than GCS. In contrast, GCS was independently associated with the presence of hypersomnia following TBI. Furthermore, there was no evidence of an association between locations of brain injury and the presence of sleep disturbance after TBI.
Our data support and contribute to a growing body of evidence which indicates that TBI patients with insomnia are prone to suffer from concomitant headache and/or dizziness, report more symptoms of anxiety and depression and severe TBI patients are likely to experience hypersomnia.
PLoS ONE 10/2013; 8(10):e76087. DOI:10.1371/journal.pone.0076087 · 3.23 Impact Factor
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