Sleep, Sleep Disorders, and Mild Traumatic Brain Injury. What We Know and What We Need to Know: Findings from a National Working Group

Abstract

Disturbed sleep is one of the most common complaints following traumatic brain injury (TBI) and worsens morbidity and long-term sequelae. Further, sleep and TBI share neurophysiologic underpinnings with direct relevance to recovery from TBI. As such, disturbed sleep and clinical sleep disorders represent modifiable treatment targets to improve outcomes in TBI. This paper presents key findings from a national working group on sleep and TBI, with a specific focus on the testing and development of sleep-related therapeutic interventions for mild TBI (mTBI). First, mTBI and sleep physiology are briefly reviewed. Next, essential empirical and clinical questions and knowledge gaps are addressed. Finally, actionable recommendations are offered to guide active and efficient collaboration between academic, industry, and governmental stakeholders.

A review of sleep disturbances following traumatic brain injury

“…TBI is defined as an injury that includes transient amnesia, alteration or loss of consciousness that results from a force involving the head or body (Wickwire et al 2016;Mathias and Alvaro 2012). TBI can be classified as mild, moderate or severe based on the presence and severity of the above symptoms, as well as neuroimaging characteristics.…”

“…TBI can be classified as mild, moderate or severe based on the presence and severity of the above symptoms, as well as neuroimaging characteristics. Reportedly, up to 1.7 million Americans suffers TBI yearly, with 70% of those deemed mild (Wickwire et al 2016;Mathias and Alvaro 2012). Of those who sustain TBI, recent estimates suggest that 30-66% of patients experience some type of sleep disturbance (Wickwire et al 2016;Mathias and Alvaro 2012;Nakase-Richardson et al 2013;Chan and Feinstein 2015).…”

“…Reportedly, up to 1.7 million Americans suffers TBI yearly, with 70% of those deemed mild (Wickwire et al 2016;Mathias and Alvaro 2012). Of those who sustain TBI, recent estimates suggest that 30-66% of patients experience some type of sleep disturbance (Wickwire et al 2016;Mathias and Alvaro 2012;Nakase-Richardson et al 2013;Chan and Feinstein 2015). Sleep disturbances in post-TBI patients can present acutely or can emerge as a chronic issue during the recovery phase, occasionally lasting years from the initial injury (Wickwire et al 2016).…”

Sleep Quantity and Quality during Acute Concussion: A Pilot Study

“…70,71 However, these observations have not been confirmed in concussions or mild TBI. 72 Despite the lack of clarity, it is likely that there are multiple interrelationships between the proposed mechanisms. Further research is needed to more completely explain not only the individual roles of these factors but their interrelationships as related to sleep and overall outcomes following concussion.…”

Sleep and Weight among Our Veterans

“…3 In traumatic brain injury patients, subjective complaints of daytime sleepiness and poor sleep quality, as well as poorer sleep efficiency and reduced sleep time on polysomnography, are quite common. 4,5 That said, there is evidence that ubiquity of sleep disorders may not be limited to veterans of recent conflicts; in one study, 87% of older veterans, age 55-89, were found to have sleep-disordered breathing. 6 The relationships between sleep and metabolism are plausibly bidirectional and interwoven.…”