Association of sleep with neurobehavioral impairments during inpatient rehabilitation after traumatic brain injury

Maneyapanda, Mithra B.; Stork, Ryan; Ingraham, Benjamin; Lonini, Luca; Jayaraman, Arun; Shawen, Nicholas; Ripley, David L.

doi:10.3233/nre-182533

Cited by 8 publications

(20 citation statements)

References 24 publications

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“…Given the burdensome nature of PSG and the lack of its availability in many hospital settings, alternatives such as ACG have been used to objectively quantitate sleep. 5,10,[20][21][22][23][24][25] Kamper and colleagues reported good agreement between ACG and PSG in a sample of veterans (n = 50) that was more chronic than the current sample. 10 Across other populations, agreement between ACG and PSG has varied from good agreement between sleep/ wake epoch classification to underestimation and/or overestimation of parameters as reported in this study.…”

Section: Discussionmentioning

confidence: 77%

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Coherence Between Sleep Detection by Actigraphy and Polysomnography in a Multi‐Center, Inpatient Cohort of Individuals with Traumatic Brain Injury

Zeitzer

Hon

Whyte

et al. 2020

PM&R

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Background: Sleep is increasingly recognized as a crucial component to rapid and successful rehabilitation, especially from traumatic brain injuries (TBIs). Assessment of longitudinal patterns of sleep in a hospital setting, however, are difficult and often the expertise or equipment to conduct such studies is not available. Actigraphy (wrist-worn accelerometry) has been used for many years as a simple proxy measurement of sleep patterns, but its use has not been thoroughly validated in individuals with TBI. Objective: To determine the validity of different sensitivity settings of actigraphy analysis to optimize its use as a proxy for recording sleep patterns in individuals with a TBI. Design: Comparison of actigraphy to criterion standard polysomnographic (PSG)-determination of sleep on a single overnight study. Setting: Six rehabilitation hospitals in the TBI Model System. Participants: Two hundred twenty-seven consecutive, medically stable individuals with a TBI. Interventions: Not applicable. Main Outcome Measure: Concordance between PSG-and actigraphy-determined sleep using different sensitivity threshold settings (low, medium, high, automated). Results: Bland-Altman plots revealed increasing error with increasing amounts of wake during the sleep episode. Precision-recall statistics indicate that with less sensitive actigraphy thresholds, episodes identified as "wake" are usually "wake," but many true episodes of "wake" are missed. With more sensitive actigraphy thresholds, more episodes of "wake" are identified, but only some of these are true episodes of "wake." Conclusions: In hospitalized patients with TBI and poor sleep, actigraphy underestimates the level of sleep disruption and has poor concordance with PSG-determined sleep. Alternate methods of scoring sleep from actigraphy data are necessary in this population.

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Section: Discussionmentioning

confidence: 77%

“…Given the burdensome nature of PSG and the lack of its availability in many hospital settings, alternatives such as ACG have been used to objectively quantitate sleep 0025. Kamper and colleagues reported good agreement between ACG and PSG in a sample of veterans (n = 50) that was more chronic than the current sample 0010.…”

Section: Discussionmentioning

confidence: 99%

Coherence Between Sleep Detection by Actigraphy and Polysomnography in a Multi‐Center, Inpatient Cohort of Individuals with Traumatic Brain Injury

Zeitzer

Hon

Whyte

et al. 2020

PM&R

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“…Reviewed studies were published between 1992 and 2022, originating from the United States (n = 18), 3,[33][34][35][36][37][38][39][40][41][42][43][44][45][46][47][48][49] www.headtraumarehab.com E203 Canada (n = 6), [50][51][52][53][54][55] the European Union (n = 2), 56,57 the United Kingdom (n = 1), 58 Australia (n = 1), 59 China (n = 1), 60 and Iran (n = 1). 61 The most common study design was cohort (n = 15), [34][35][36][38][39][40][41]43,44,46,53,55,57,59 followed by crosssectional (n = 10), 3,45,[47][48][49]…”

Section: Sources Of Evidencementioning

confidence: 99%

“…34,[56][57][58] Twenty-four studies reported the mean time elapsed since injury. 3,[33][34][35][36][37][38][39][40][42][43][44][45][48][49][50][51][52][53][54][55][57][58][59]61 Among them, 12 studies had a mean time since injury of 30 days or less, 3,36,38,40,[42][43][44][52][53][54][55]61 while 12 studies reported a mean time since injury of more than 30 days. [33][34][35]37,39,45,48,49,51,[57]…”

Section: Sources Of Evidencementioning

confidence: 99%

Sleep Disruptions in Hospitalized Adults Sustaining a Traumatic Brain Injury: A Scoping Review

Leclerc,

Gervais,

Hjeij

et al. 2023

Journal of Head Trauma Rehabilitation

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Objective: Adults sustaining a traumatic brain injury (TBI) are at risk of sleep disturbances during their recovery, including when such an injury requires hospitalization. However, the sleep-wake profile, and internal and external factors that may interfere with sleep initiation/maintenance in hospitalized TBI patients are poorly understood. This review aimed to: (1) identify/summarize the existing evidence regarding sleep and sleep measurements in TBI adults receiving around-the-clock care in a hospital or during inpatient rehabilitation, and (2) identify internal/external factors linked to poor sleep in this context. Methods: A scoping review was conducted in accordance with the PRISMA Scoping Review Extension guidelines. A search was conducted in MEDLINE, PsycINFO, CINAHL, and Web of Science databases. Results: Thirty relevant studies were identified. The most common sleep variables that were put forth in the studies to characterize sleep during hospitalization were nighttime sleep time (mean = 6.5 hours; range: 5.2-8.9 hours), wake after sleep onset (87.1 minutes; range: 30.4-180 minutes), and sleep efficiency (mean = 72.9%; range: 33%-96%) using mainly actigraphy, polysomnography, and questionnaires (eg, the sleep-wake disturbance item of the Delirium Rating Scale or the Pittsburgh Sleep Quality Index). Twenty-four studies (80%) suggested that hospitalized TBI patients do not get sufficient nighttime sleep, based on the general recommendations for adults (7-9 hours per night). Sleep disruptions during hospitalization were found to be associated to several internal factors including TBI severity, cognitive status, and analgesia intake. External and modifiable factors, such as noise, light, and patient care, were consistently associated with sleep disruptions in this context. Conclusion: Although the literature on sleep disturbances in hospitalized TBI patients has been increasing in recent years, many gaps in knowledge remain, including phenotypes and risk factors. Identifying these factors could help clinicians better understand the multiple sources of TBI patients' sleep difficulties and intervene accordingly.

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“…2,28 Accordingly, some researchers argue that it is unlikely to develop PTSD as a consequence of mTBI alone. 29 Both disturbed sleep 11,30 and nightmares 31 following TBI are associated with impaired neurobehavioral functioning. However, nightmares may have differential relations to emotion and cognition beyond their adverse impact on sleep quality and share etiologies and neurocircuitry with neurobehavioral symptoms in mTBI (eg, emotion regulation).…”

mentioning

confidence: 99%

Associations of Nightmares and Sleep Disturbance With Neurobehavioral Symptoms Postconcussion

Faerman,

Nabasny,

Wright

et al. 2023

Journal of Head Trauma Rehabilitation

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Objective: This study investigates the association of nightmares beyond general sleep disturbance on neurobehavioral symptoms in adults with mild traumatic brain injury (mTBI). Design: Secondary analysis of a concussion cohort study. Participants: One hundred and eleven adults older than 20 years with mTBI were recruited from a specialized concussion treatment center. Main Measures: Behavioral Assessment Screening Tool, Pittsburgh Sleep Quality Index, and self-report of nightmare frequency in the past 2 weeks. Results: Among adults with mTBI, nightmares accounted for the greatest amount of variability in negative affect (β = .362, P < .001), anxiety (β = .332, P < .001), and impulsivity (β = .270, P < .001) after adjusting for age and sex. Overall sleep disturbance had the strongest association with depression (β = .493, P < .001), fatigue (β = .449, P < .001), self-reported executive dysfunction (β = .376, P < .001), and overall burden from concussive symptoms (β = .477, P < .001). Conclusions: Nightmares and sleep disturbance are differentially associated with variance in neurobehavioral symptoms. Nightmares were independently associated with neurobehavioral symptoms representing an excess of normal functioning (eg, anxiety, impulsivity), while general sleep disturbance was associated with neurobehavioral symptoms representing functioning below normal levels (eg, depression, fatigue, self-reported executive dysfunction). Clinical and research implications are discussed.

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Association of sleep with neurobehavioral impairments during inpatient rehabilitation after traumatic brain injury

Cited by 8 publications

References 24 publications

Coherence Between Sleep Detection by Actigraphy and Polysomnography in a Multi‐Center, Inpatient Cohort of Individuals with Traumatic Brain Injury

Coherence Between Sleep Detection by Actigraphy and Polysomnography in a Multi‐Center, Inpatient Cohort of Individuals with Traumatic Brain Injury

Sleep Disruptions in Hospitalized Adults Sustaining a Traumatic Brain Injury: A Scoping Review

Associations of Nightmares and Sleep Disturbance With Neurobehavioral Symptoms Postconcussion

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