Prevalence of Sleep Disturbance in Closed Head Injury Patients in a Rehabilitation Unit

Makley, Michael; English, Jeffrey; Drubach, Dina; Kreuz, Andrew J.; Celnik, Pablo; Tarwater, Patrick M.

doi:10.1177/1545968308315598

Cited by 102 publications

(86 citation statements)

References 22 publications

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“…Natalie Grima, DPsych 1,2,4 ; Jennie Ponsford, PhD 2,4 ; Shantha M. Rajaratnam, PhD 4,5,6 ; Darren Mansfield, MD, PhD 3,4 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.…”

Section: Sleep Disturbances In Traumatic Brain Injury: a Meta-analysismentioning

confidence: 99%

“…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][3][4][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.…”

Section: Introductionmentioning

confidence: 99%

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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: Sleep Disturbances In Traumatic Brain Injury: a Meta-analysismentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Sleep Disturbances in Traumatic Brain Injury: A Meta-Analysis

Grima

Ponsford

Rajaratnam

et al. 2016

Journal of Clinical Sleep Medicine

View full text Add to dashboard Cite

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“…Injury-related damage to sleep-wake regulating centers and associated pathways or neurotransmitter systems is implicated as the cause of such disturbances. 5,11,14 Anxiety and depression that frequently follow TBI are also likely contributing factors. 10,15 From the School of Psychology and Psychiatry (J.A.S., D.L.P., J.R.R., J.P.-N., J.L.P., S.M.W.R.…”

mentioning

confidence: 99%

“…[1][2][3][4][5][6] Reported sleep complaints include insomnia, hypersomnolence, and altered sleep-wake cycles. 7 Understanding of changes to sleep following TBI is limited.…”

mentioning

confidence: 99%

Sleep disturbance and melatonin levels following traumatic brain injury

Shekleton¹,

Parcell²,

Redman³

et al. 2010

Neurology

224

156

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Objectives: Sleep disturbances commonly follow traumatic brain injury (TBI) and contribute to ongoing disability. However, there are no conclusive findings regarding specific changes to sleep quality and sleep architecture measured using polysomnography. Possible causes of the sleep disturbances include disruption of circadian regulation of sleep-wakefulness, psychological distress, and a neuronal response to injury. We investigated sleep-wake disturbances and their underlying mechanisms in a TBI patient sample. Methods:This was an observational study comparing 23 patients with TBI (429.7 Ϯ 287.6 days post injury) and 23 age-and gender-matched healthy volunteers on polysomnographic sleep measures, salivary dim light melatonin onset (DLMO) time, and self-reported sleep quality, anxiety, and depression.Results: Patients with TBI reported higher anxiety and depressive symptoms and sleep disturbance than controls. Patients with TBI showed decreased sleep efficiency (SE) and increased wake after sleep onset (WASO). Although no significant group differences were found in sleep architecture, when anxiety and depression scores were controlled, patients with TBI showed higher amount of slow wave sleep. No differences in self-reported sleep timing or salivary DLMO time were found. However, patients with TBI showed significantly lower levels of evening melatonin production. Melatonin level was significantly correlated with REM sleep but not SE or WASO. Conclusions:Reduced evening melatonin production may indicate disruption to circadian regulation of melatonin synthesis. The results suggest that there are at least 2 factors contributing to sleep disturbances in patients with traumatic brain injury. We propose that elevated depression is associated with reduced sleep quality, and increased slow wave sleep is attributed to the effects of mechanical brain damage. Neurology ® 2010;74:1732-1738 GLOSSARY AUC ϭ area under the curve; DLMO ϭ dim light melatonin onset; EOG ϭ electrooculogram; ESS ϭ Epworth Sleepiness Scale; HADS ϭ Hospital Anxiety and Depression Scale; MEQ ϭ Morningness Eveningness Questionnaire; NREM ϭ non-REM; PSQI ϭ Pittsburgh Sleep Quality Index; PTA ϭ posttraumatic amnesia; SE ϭ sleep efficiency; SOL ϭ sleep onset latency; SWS ϭ slow wave sleep; TBI ϭ traumatic brain injury; WASO ϭ wake after sleep onset.Sleep disturbances are common following traumatic brain injury (TBI), reported by 30%-75% of individuals and contributing to ongoing disability.

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“…Makley et al found that length of stay in acute care increased risk of having sleep wake cycle disturbance and a total prevalence of 68 percent. Presence of sleep disruptions also predicted longer required stay in the rehabilitation center [65]. The second study utilized actigraphy measurements taken for seven consecutive days on a moderate to severe TBI sample, with measurements begun within the first 72 h after admission to a rehabilitation facility.…”

Section: Acute Phase (0-3 Months)mentioning

confidence: 99%