Risk Factors Associated with Sleep Disturbance following Traumatic Brain Injury: Clinical Findings and Questionnaire Based Study

Abstract

BackgroundSleep disturbance is very common following traumatic brain injury (TBI), which may initiate or exacerbate a variety of co-morbidities and negatively impact rehabilitative treatments. To date, there are paradoxical reports regarding the associations between inherent characteristics of TBI and sleep disturbance in TBI population. The current study was designed to explore the relationship between the presence of sleep disturbance and characteristics of TBI and identify the factors which are closely related to the presence of sleep disturbance in TBI population.Methods98 TBI patients (72 males, mean age ± SD, 47 ± 13 years, range 18-70) were recruited. Severity of TBI was evaluated based on Glasgow Coma Scale (GCS). All participants performed cranial computed tomography and were examined on self-reported sleep quality, anxiety, and depression.ResultsTBI was mild in 69 (70%), moderate in 15 (15%) and severe in 14 (15%) patients. 37 of 98 patients (38%) reported sleep disturbance following TBI. Insomnia was diagnosed in 28 patients (29%) and post-traumatic hypersomnia in 9 patients (9%). In TBI with insomnia group, 5 patients (18%) complained of difficulty falling asleep only, 8 patients (29%) had difficulty maintaining sleep without difficulty in initial sleep and 15 patients (53%) presented both difficulty falling asleep and difficulty maintaining sleep. Risk factors associated with insomnia were headache and/or dizziness and more symptoms of anxiety and depression rather than GCS. In contrast, GCS was independently associated with the presence of hypersomnia following TBI. Furthermore, there was no evidence of an association between locations of brain injury and the presence of sleep disturbance after TBI.ConclusionOur data support and contribute to a growing body of evidence which indicates that TBI patients with insomnia are prone to suffer from concomitant headache and/or dizziness, report more symptoms of anxiety and depression and severe TBI patients are likely to experience hypersomnia.

Sleep Disturbances in Traumatic Brain Injury: A Meta-Analysis

“…7 Insult to the brain is considered a determinant of sleep disturbances, however, no convincing neuroimaging evidence has linked location of cerebral injury with sleep disturbance. 51,52 Although some studies have failed to show that injury severity is a predictor of sleep deficits following TBI, 3,11,24 recent research suggests that intracranial hemorrhage and lower Glasgow Coma Scores are strongly associated with increased sleep need, suggesting that widespread cerebral trauma contributes to sleep disturbances post TBI. 30 Furthermore, Glasgow Coma Scores are independently associated with the presence of excessive sleepiness.…”

“…30 Furthermore, Glasgow Coma Scores are independently associated with the presence of excessive sleepiness. 52 It has been postulated that lesion location may be more important than TBI severity in predicting sleep outcomes, with damage to the sleep wake centers causing the most sleep disturbance. 7 Neurological impairment is often difficult to identify in mild TBI, particularly with the use of gross imagining techniques, such as computerized topography, making it hard to disentangle the roles of injury severity and lesion location in the etiology of sleep disturbance.…”

“…Lastly, sufficient information was not available to examine the potential contributions of sleep disorders. Sleep disorders are common in TBI, including insomnia, 49,63,64 hypersomnia, 30,52 circadian rhythm sleep disorders, [65][66][67] and obstructive sleep apnea. [68][69][70] While our study provides an overall picture of the polysomnographic and subjective sleep deficits experienced in TBI, it does not elucidate the specific sleep disorders contributing to these findings.…”

A review of sleep disturbances following traumatic brain injury

“…This symptom can have a significant impact on quality of life both during wakefulness and sleep and can be seen irrespective of the severity of the injury. Multiple studies have been performed to evaluate the impact of post-traumatic headache (PTH) on sleep, with insomnia the most common symptom experienced (Minen et al 2016;Hou et al 2013). A retrospective cohort study (n = 98) showed that headache and insomnia are frequently comorbid conditions in the mild TBI population, with up to half of patients with PTH also suffering from insomnia (Hou et al 2013).…”

“…Furthermore, central nervous system symptoms occurring as a result of TBI also may cause disruption of sleep (Pillar et al 2003;Lavigne et al 2015;Chaput et al 2009;Minen et al 2016;Hou et al 2013;Jaramillo et al 2016;Farrell-Carnahan et al 2015;Bryan 2013;Holster et al 2017). These include headache, tinnitus and/or vertigo.…”