Evaluating the impact of treatment for sleep/wake disorders on recovery of cognition and communication in adults with chronic TBI

Abstract

ObjectiveTo longitudinally examine objective and self-reported outcomes for recovery of cognition, communication, mood and participation in adults with traumatic brain injury (TBI) and co-morbid post-traumatic sleep/wake disorders.DesignProspective, longitudinal, single blind outcome study.SettingCommunity-based.ParticipantsTen adults with moderate–severe TBI and two adults with mild TBI and persistent symptoms aged 18–58 years. Six males and six females, who were 1–22 years post-injury and presented with self-reported sleep/wake disturbances with onset post-injury.InterventionsIndividualized treatments for sleep/wake disorders that included sleep hygiene recommendations, pharmacological interventions and/or treatments for sleep apnea with follow-up.Main outcome measuresInsomnia Severity Index, Beck Depression and Anxiety Inventories, Latrobe Communication Questionnaire, Speed and Capacity of Language Processing, Test of Everyday Attention, Repeatable Battery for the Assessment of Neuropsychological Status, Daily Cognitive-Communication and Sleep Profile.ResultsGroup analysis revealed positive trends in change for each measure and across sub-tests of all measures. Statistically significant changes were noted in insomnia severity, p = 0.0003; depression severity, p = 0.03; language, p = 0.01; speed of language processing, p = 0.007.ConclusionsThese results add to a small but growing body of evidence that sleep/wake disorders associated with TBI exacerbate trauma-related cognitive, communication and mood impairments. Treatment for sleep/wake disorders may optimize recovery and outcomes.

Chronic Decrease in Wakefulness and Disruption of Sleep-Wake Behavior after Experimental Traumatic Brain Injury

“…The total time spent in each state based on PID during the light phase did change, however: wake ( Fig. 3A; F (2,28) The number of bouts (Fig. 4) was inversely related to mean bout lengths (Fig.…”

“…1 There are growing concerns about prevalence of sleep-wake disturbances among survivors of TBI that exacerbate the resulting long-term behavioral dysfunction. 2 Sleep plays an important role in neurosynaptic plasticity and neurogenesis. 3,4 A wide range of sleep disorders has been reported after TBI in humans.…”

Characterizing Self-Reported Sleep Disturbance after Mild Traumatic Brain Injury

“…Although the base rate of such complaints is high in the general population, 4 it is possible that when they occur after mTBI, they indicate sleep disturbance sufficient to worsen physical and mental recovery. [5][6][7][8] For example, sleep disturbance could: contribute to or exacerbate comorbid conditions such as depression, fatigue and pain 1,9 ; worsen recovery because the normal restorative and recuperative functions of sleep are disrupted 3 ; interfere directly with rehabilitation 5 ; or signal ongoing disruption of neurophysiological processes. 6,10,11 It is possible that sleep disturbance before the TBI is also a contributor to poor outcome by increasing vulnerability or reducing recovery capacity.…”

“…Sleep disturbance is often treatable, despite its initial cause, 14 and treating sleep complaints may help improve outcomes such as neuropsychological functioning in persons with mTBI. 7 Based on previous research, it was predicted that persons who had sustained an mTBI would report (1) poorer subjective sleep quality; (2) longer sleep onset latency (SOL); (3) increased wake after sleep onset (WASO), (4) poorer sleep efficiency, and (5) would experience more severe insomnia symptoms than would controls. It was also expected that habitual sleep duration would be reduced after mTBI compared with controls.…”

Are Sleep Disturbances a Risk for Chronic Traumatic Encephalopathy? Only the Shadow Knows

“…11 In addition, treatment for sleep disturbances in the setting of chronic TBI may improve cognition and mood. 12 Studies of retired and active NFL football players have found that the prevalence of OSA ranges from 14% to 19%. 13,14 However, the prevalence may be much higher in retired players.…”