Changes in Sleep Patterns Following Traumatic Brain Injury

Ponsford, Jennie Louise; Parcell, Diane L.; Sinclair, Kelly; Roper, Monique; Rajaratnam, Shanthakumar M W

doi:10.1177/1545968313481283

Cited by 87 publications

(48 citation statements)

References 46 publications

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“…The secondary outcomes thus compared TBI patients with controls across subjective measures of sleep. In light of previous findings, 9,11,18,21,24,25 it was hypothesized that when compared to controls, patients with TBI would display increased daytime sleepiness, and score higher across all domains of the PSQI, indicating poorer sleep quality.…”

Section: Secondary Outcomesmentioning

confidence: 99%

“…Of the 15 authors contacted, 9-12,18-21,24-30 7 replied with the requested objective data, 11,12,19,21,[25][26][27] with 4 supplying subjective data. 9,18,24,29 Two authors were unable to provide data for all measures of interest, 10,20 but these studies were able to be included in some analyses. Two authors were unable to provide objective data and these studies were excluded, 28,30 as the data were inadequately reported.…”

Section: Data Extractionmentioning

confidence: 99%

“…Primary outcomes were decided a priori. Based on our previous work 8,11,18 and that of others, 9,19-21 we hypothesized that patients with TBI would show increased wake after sleep onset and longer sleep onset latency, relative to controls.…”

Section: Primary Outcomesmentioning

confidence: 99%

See 2 more Smart Citations

Sleep Disturbances in Traumatic Brain Injury: A Meta-Analysis

Grima

Ponsford

Rajaratnam

et al. 2016

Journal of Clinical Sleep Medicine

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Study Objectives: Sleep disturbances are frequently reported following traumatic brain injury (TBI); however, the exact disturbances remain unclear. This meta-analysis aimed to characterize sleep disturbance in community dwelling patients with TBI as compared to controls. Methods: Two investigators independently conducted a systematic search of multiple electronic databases from inception to May 27, 2015. Studies were selected if they compared sleep in community dwelling individuals with TBI relative to a control population without head injury. Data were pooled in metaanalysis with outcomes expressed as the standard mean difference (SMD) and 95% confidence interval (CI). The primary outcomes were derived from polysomnography and secondary outcomes were derived from subjective sleep measures. Results: Sixteen studies were included, combining 637 TBI patients and 567 controls, all of whom were community dwelling. Pooled polysomnography data revealed that TBI patients had poorer sleep efficiency (SMD = −0. I NTRO DUCTI O NSleep disturbances are frequently reported following traumatic brain injury (TBI), with over 50% of people experiencing some form of sleep disturbance post TBI.1 Although a large majority of people with TBI generally make a good physical recovery, disrupted sleep can often go untreated, impacting quality of life, impeding rehabilitation and return to pre-injury activities.2-5 Our recent work showed significant interrelationships between daytime sleepiness, daytime fatigue, cognitive impairment, and mood disturbances in TBI. 6 While individuals with TBI are known to report sleep problems, 1 the specific changes to sleep remain poorly characterized.7 Studies have been limited by small sample sizes, with variable and inconsistent findings. [8][9][10][11][12] This makes for a difficult characterization of sleep post TBI. Thus, there is a need to establish the specific aspects of sleep that are most affected post TBI as these have important implications for treatment and rehabilitation. The aim of the current meta-analysis was to characterize both objective sleep disturbances and subjective sleep complaints in individuals with TBI relative to healthy controls. Study outcomes included the comparison of TBI patients to controls across both polysomnography and subjective measures of sleep. It ; Matthew P. Pase, PhD was hypothesized that those with TBI would display widespread objective and subjective sleep deficits as compared to controls without head injury. The present study aimed to summarize current literature, which would identify important avenues for future research. M ETHO DS Study DesignThe search strategy was conducted in accordance with the meta-analysis of observational studies in epidemiology guidelines. 13 Article SearchingOvid Medline, Embase, PsychInfo, Scopus, and the Cochrane Library were systematically searched until May, 27 2015. The search was initially developed by all authors and refined by a librarian at Monash University. The references of recent publications were also hand searc...

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Section: Secondary Outcomesmentioning

confidence: 99%

Section: Data Extractionmentioning

confidence: 99%

See 1 more Smart Citation

Sleep Disturbances in Traumatic Brain Injury: A Meta-Analysis

Grima

Ponsford

Rajaratnam

et al. 2016

Journal of Clinical Sleep Medicine

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“…An association between sleep disturbances and motor learning has been demonstrated in patients with obstructive sleep apnea, with marked impairment in consolidation (Landry et al, 2014). Sleep quality was not assessed in the current study, although disturbances in sleep quality and architecture (Ponsford et al, 2013) may have contributed to the hypothesized slowed consolidation processes. Several studies investigated sleep after TBI with mixed results.…”

Section: Discussionmentioning

confidence: 64%

“…Pain in relation to the execution of the FOS task, upper extremity or finger movements was not reported by the participants, although an increase in discomfort may have had its effect toward the end of the sessions. Sleep disruptions are common in patients with TBI (Ponsford et al, 2013) and may have contributed to increased motor fatigue during the more intensive 2nd week of training.…”

Section: Discussionmentioning

confidence: 99%

Atypical within-session motor procedural learning after traumatic brain injury but well-preserved between-session procedural memory consolidation

Sacher

Cisamariu

Shaklai

et al. 2018

Annals of Physical and Rehabilitation Medicine

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Using the finger-to-thumb opposition sequence (FOS) learning task, we characterized motor skill learning in sub-acute patients hospitalized for rehabilitation following traumatic brain injury (TBI). Ten patients (Trained TBI) and 11 healthy participants (Trained Healthy) were trained using a multi-session protocol: a single session was afforded in the first week of the study, and four daily sessions were afforded during the second week. Intensity of practice was adapted to patients. Performance speed and accuracy were tested before and after each session. Retention was tested 1 month later. Ten patients (Control TBI) had no FOS training and were tested only at the beginning and the end of the 6 week period. Although baseline performance on the FOS was very slow, all three phases of skill learning found in healthy adults (acquisition, between-session consolidation gains, and long-term retention) could be identified in patients with TBI. However, their time-course of learning was atypical. The Trained TBI group improved in speed about double the spontaneous improvements observed in the Control TBI group, with no speed-accuracy tradeoff. Normalized to their initial performance on the FOS, the gains accrued by the Trained TBI group after a first training were comparable to those accrued by healthy adults. Only during the second week with daily training, the rate of improvement of the Trained TBI group lagged behind that of the Trained Healthy group, due to increasing within-sessions losses in performance speed; no such losses were found in healthy participants. The Functional Independence Measure scores at the start of the study correlated with the total gains attained at the end of the study; no correlations were found with severity of injury or explicit memory impairments. Despite within-sessions losses in performance, which we propose reflect cognitive fatigue, training resulted in robust overall learning and long-term retention in patients with moderate-severe TBI. Given that the gains in performance evolved mainly between sessions, as delayed, offline, gains, our results suggest that memory consolidation processes can be effectively engaged in patients with TBI. However, practice protocols and schedules may need to be optimized to better engage the potential for long-term plasticity in these patients.

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