Background 6 months after traumatic brain injury (TBI), almost three out of four patients suffer from sleepewake disturbances (SWD) such as post-traumatic hypersomnia (increased sleep need of $2 h compared with before injury), excessive daytime sleepiness (EDS), fatigue and insomnia. The long-term course of posttraumatic SWD, however, is unknown. Objectives To assess the prevalence and characteristics of post-traumatic SWD 3 years after trauma. Design Prospective longitudinal clinical study in 51 consecutive TBI patients (43 males, eight females, mean age 40616 years). Main outcome measures EDS (as assessed by the Epworth sleepiness scale), fatigue (fatigue severity scale), post-traumatic hypersomnia (sleep length per 24 h), insomnia, depression and anxiety. Results Post-traumatic SWD were found in 34 patients (67%): post-traumatic hypersomnia in 14 (27%), EDS in six (12%), fatigue in 18 patients (35%) and insomnia in five patients (10%). SWD were not associated with severity or localisation of, or time interval since, TBI. Insomnia was linked to depressive symptoms. Conclusions This prospective study shows that 3 years after TBI, two out of three patients suffer from residual SWD, particularly fatigue and post-traumatic hypersomnia. In 45% of TBI patients, SWD appear directly related to the trauma itself.

This study provides Class I evidence that modafinil (100-200 mg daily) improves posttraumatic EDS compared with placebo. This study provides Class I evidence that modafinil (100-200 mg daily) does not improve posttraumatic fatigue compared with placebo.