Injury, Sleep, and Functional Outcome in Hospital Patients With Traumatic Brain Injury

Abstract

Problem: Uninterrupted nighttime sleep is associated with better cognition and functional outcomes in healthy adults, but the relationship between sleep and functional outcome in individuals hospitalized with severe TBI remains to be clarified. Objective: (1) Describe nighttime rest-activity variables-wake bouts (WB) (counts), total wake time (TWT) (minutes), and sleep efficiency (SE) (%; time asleep/time in bed)-in people on a neuroscience step-down unit (NSDU) post-TBI; (2) Describe association between injury and nighttime rest-activity on post-TBI functional outcome (using functional independence measure (FIM) at discharge from in-patient care). Methods: Cross-sectional, descriptive pilot study. We recruited participants from the NSDU (N=17, (age, M = 63.4, SD = 17.9); 82% male; 94% Caucasian) who wore wrist actigraphy (source of nighttime rest-activity variables) for up to 5 nights. Injury variables: Glasgow coma scale score (GCS); injury severity score (ISS). We used Spearman's rho & regression to measure associations.

Ambient Stimuli Perpetuate Nighttime Sleep Disturbances in Hospital Patients With TBI

“…Our findings are consistent with studies that show poor sleep in hospitalized patients with TBI (Chiu et al, 2013, 2014; Duclos et al, 2016; Williams et al, 2019; Wiseman-Hakes et al, 2016) and also with studies that cite loud sound and care-provision as significant disrupters of nighttime sleep for hospitalized patients in a neuroscience unit (Thomas et al, 2012; Uğraş et al, 2015). Light not being a significant finding is consistent with other studies that explored subjective nighttime light exposure perception and rest-activity cycles in hospitalized patients (Gathecha et al, 2016) and that reported low nighttime lux in a hospitalized sample (Bernhofer et al, 2014; Fanfulla et al, 2011) and in a sleep lab (Gooley et al, 2011).…”

“…To measure the number of nighttime awakenings Actiwatch Spectrum Plus ® (Phillips Respironics, Bend, OR, USA) wrist actigraphy-watches (48 mm × 37 mm × 15 mm; wt., 31 g with band) were used; watches were calibrated to measure in 30-s epochs. Actigraphy is reliable and valid for assessing sleep disturbances (Ancoli-Israel et al, 2003; Morgenthaler et al, 2015) and has been used in hospitalized patients with TBI (Chiu et al, 2013, 2014; Duclos et al, 2016; Williams et al, 2019). Data were scored with Phillips Actiware ® software (Version 6.0.9) and a standard scoring algorithm developed by experienced sleep researchers at the University of Washington (Buchanan et al, 2017).…”

“…Nearly 300,000 Americans are hospitalized for traumatic brain injury (TBI) each year (Taylor et al, 2017) and restful sleep is critical for neural recovery (Ouellet et al, 2015) in the immediate post-injury phase (Duclos et al, 2017). However, it is unclear how these ambient exposures such as clinician-led monitoring, surveillance (Inouye, 2013; Nelson et al, 2015), and hospital system operations (e.g., maintenance, air-handling, Busch-Vishniac et al, 2005) impede restful sleep in this phase of hospitalization during the nighttime hours despite evidence that patients hospitalized with TBI have poor and fragmented sleep (Chiu et al, 2013, 2014; Duclos et al, 2016; Williams et al, 2019; Wiseman-Hakes et al, 2016). The patients’ exposure to noxious sound, light, and movement stimuli during the nighttime hours is duly important because these ambient stimuli are common to the neuroscience step-down unit (NSDU), a crucial post-injury phase of care where clinicians often evaluate the patients’ discharge destination.…”

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

“…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.…”

“…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.…”