Article

Defining sleep disturbance after brain injury

Department of Physical Medicine & Rehabilitation, The Ohio State University, Columbus 43210, USA.
American Journal of Physical Medicine & Rehabilitation (Impact Factor: 2.01). 06/1998; 77(4):291-5. DOI: 10.1097/00002060-199807000-00006
Source: PubMed

ABSTRACT 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.

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    • "22 Trauma 3,5 m Insomnie Sévérité et temps depuis blessure Aucune Questionnaire sommeil 38 items Aucun 27 29,5 m Hypersomnie Clinchot et al. [61] 130 Toutes 12 m Insomnie, Hypersomnie Sévérité blessure, sexe Aucune Interview téléphonique Aucun Guilleminault et al. [65] 184 Trauma 15,5 m Patterns ESS & MSLT Sévérité blessure Epworth Sleepiness (ESS), Stanford Sleepiness Wilkinson Addition Test, Tapping test, Test psychovigilance PSG nocturne, Test déprivation, MSLT "
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    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; DOI:10.1016/j.msom.2014.10.001
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    • "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. "
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    ABSTRACT: Study of insomnia and associated factors in Traumatic Brain Injury Objectives 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 Design Prospective study 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. Results 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. Conclusion 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
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    • "The mechanisms of fatigue after TBI remain debated. It has been found associated with depression, pain, disturbed sleep, or neuroendocrine abnormalities (Bushnik et al., 2007; Chaumet et al., 2008; Clinchot et al., 1998; Kreutzer et al., 2001). Van Zomeren et al. (1984) argued that fatigue after TBI could be due to the constant compensatory effort required to reach an adequate level of performance in everyday life, despite cognitive deficits and slowed processing. "
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    ABSTRACT: Survivors from a coma due to severe traumatic brain injury (TBI) frequently suffer from long-lasting disability, which is mainly related to cognitive deficits. Such deficits include slowed information processing, deficits of learning and memory, of attention, of working memory, and of executive functions, associated with behavioral and personality modifications. This review presents a survey of the main neuropsychological studies of patients with remote severe TBI, with special emphasis on recent studies on working memory, divided attention (dual-task processing), and mental fatigue. These studies found that patients have difficulties in dealing with two simultaneous tasks, or with tasks requiring both storage and processing of information, at least if these tasks require some degree of controlled processing (i.e., if they cannot be carried out automatically). However, strategic aspects of attention (such as allocation of attentional resources, task switching) seem to be relatively well preserved. These data suggest that severe TBI is associated with a reduction of resources within the central executive of working memory. Working memory limitations are probably related to impaired (i.e., disorganized and augmented) activation of brain executive networks, due to diffuse axonal injury. These deficits have disabling consequences in everyday life.
    Progress in brain research 01/2009; 177:89-110. DOI:10.1016/S0079-6123(09)17708-7 · 5.10 Impact Factor
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