Prospective evaluation of the nature, course, and impact of acute sleep abnormality after traumatic brain injury.

Nakase-Richardson R, Sherer M, Barnett SD, Yablon SA, Evans CC, Kretzmer T, Schwartz DJ, Modarres M. Prospective evaluation of the nature, course, and impact of acute sleep abnormality after traumatic brain injury. Archives of physical medicine and rehabilitation. 2013 May 1; 94(5):875-82.

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Abstract:

OBJECTIVE: To prospectively characterize the prevalence, course, and impact of acute sleep abnormality among traumatic brain injury (TBI) neurorehabilitation admissions. DESIGN: Prospective observational study. SETTING: Freestanding rehabilitation hospital. PARTICIPANTS: Primarily severe TBI (median emergency department Glasgow Coma Scale [GCS] score = 7; N = 205) patients who were mostly men (71%) and white (68%) were evaluated during acute neurorehabilitation. INTERVENTIONS: None. MAIN OUTCOME MEASURE: Delirium Rating Scale-Revised-98 (DelRS-R98) was administered weekly throughout rehabilitation hospitalization. DelRS-R98 item 1 was used to classify severity of sleep-wake cycle disturbance (SWCD) as none, mild, moderate, or severe. SWCD ratings were analyzed both serially and at 1 month postinjury. RESULTS: For the entire sample, 66% (mild to severe) had SWCD at 1 month postinjury. The course of the SWCD using a subset (n = 152) revealed that 84% had SWCD on rehabilitation admission, with 63% having moderate to severe ratings (median, 24d postinjury). By the third serial exam (median, 35d postinjury), 59% remained with SWCD, and 28% had moderate to severe ratings. Using general linear modeling and adjusting for age, emergency department GCS score, and days postinjury, presence of moderate to severe SWCD at 1 month postinjury made significant contributions in predicting duration of posttraumatic amnesia (P < .01) and rehabilitation hospital length of stay (P < .01). CONCLUSIONS: Results suggest that sleep abnormalities after TBI are prevalent and decrease over time. However, a high percent remained with SWCD throughout the course of rehabilitation intervention. Given the brevity of inpatient neurorehabilitation, future studies may explore targeting SWCD to improve early outcomes, such as cognitive functioning and economic impact, after TBI.