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May 24, 2016; 86 (21) Article

Sleep–wake disorders persist 18 months after traumatic brain injury but remain underrecognized

Lukas L. Imbach, Fabian Büchele, Philipp O. Valko, Tongzhou Li, Angelina Maric, John F. Stover, Claudio L. Bassetti, Ladislav Mica, Esther Werth, Christian R. Baumann
First published April 27, 2016, DOI: https://doi.org/10.1212/WNL.0000000000002697
Lukas L. Imbach
From the Departments of Neurology (L.L.I., F.B., P.O.V., T.L., A.M., E.W., C.R.B.) and Traumatology (J.F.S., L.M.), University Hospital Zurich; and Department of Neurology (C.L.B.), Inselspital Bern, Switzerland.
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Fabian Büchele
From the Departments of Neurology (L.L.I., F.B., P.O.V., T.L., A.M., E.W., C.R.B.) and Traumatology (J.F.S., L.M.), University Hospital Zurich; and Department of Neurology (C.L.B.), Inselspital Bern, Switzerland.
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Philipp O. Valko
From the Departments of Neurology (L.L.I., F.B., P.O.V., T.L., A.M., E.W., C.R.B.) and Traumatology (J.F.S., L.M.), University Hospital Zurich; and Department of Neurology (C.L.B.), Inselspital Bern, Switzerland.
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Tongzhou Li
From the Departments of Neurology (L.L.I., F.B., P.O.V., T.L., A.M., E.W., C.R.B.) and Traumatology (J.F.S., L.M.), University Hospital Zurich; and Department of Neurology (C.L.B.), Inselspital Bern, Switzerland.
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Angelina Maric
From the Departments of Neurology (L.L.I., F.B., P.O.V., T.L., A.M., E.W., C.R.B.) and Traumatology (J.F.S., L.M.), University Hospital Zurich; and Department of Neurology (C.L.B.), Inselspital Bern, Switzerland.
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John F. Stover
From the Departments of Neurology (L.L.I., F.B., P.O.V., T.L., A.M., E.W., C.R.B.) and Traumatology (J.F.S., L.M.), University Hospital Zurich; and Department of Neurology (C.L.B.), Inselspital Bern, Switzerland.
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Claudio L. Bassetti
From the Departments of Neurology (L.L.I., F.B., P.O.V., T.L., A.M., E.W., C.R.B.) and Traumatology (J.F.S., L.M.), University Hospital Zurich; and Department of Neurology (C.L.B.), Inselspital Bern, Switzerland.
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Ladislav Mica
From the Departments of Neurology (L.L.I., F.B., P.O.V., T.L., A.M., E.W., C.R.B.) and Traumatology (J.F.S., L.M.), University Hospital Zurich; and Department of Neurology (C.L.B.), Inselspital Bern, Switzerland.
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Esther Werth
From the Departments of Neurology (L.L.I., F.B., P.O.V., T.L., A.M., E.W., C.R.B.) and Traumatology (J.F.S., L.M.), University Hospital Zurich; and Department of Neurology (C.L.B.), Inselspital Bern, Switzerland.
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Christian R. Baumann
From the Departments of Neurology (L.L.I., F.B., P.O.V., T.L., A.M., E.W., C.R.B.) and Traumatology (J.F.S., L.M.), University Hospital Zurich; and Department of Neurology (C.L.B.), Inselspital Bern, Switzerland.
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Citation
Sleep–wake disorders persist 18 months after traumatic brain injury but remain underrecognized
Lukas L. Imbach, Fabian Büchele, Philipp O. Valko, Tongzhou Li, Angelina Maric, John F. Stover, Claudio L. Bassetti, Ladislav Mica, Esther Werth, Christian R. Baumann
Neurology May 2016, 86 (21) 1945-1949; DOI: 10.1212/WNL.0000000000002697

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Abstract

Objective: This study is a prospective, controlled clinical and electrophysiologic trial examining the chronic course of posttraumatic sleep–wake disturbances (SWD).

Methods: We screened 140 patients with acute, first-ever traumatic brain injury of any severity and included 60 patients for prospective follow-up examinations. Patients with prior brain trauma, other neurologic or systemic disease, drug abuse, or psychiatric comorbidities were excluded. Eighteen months after trauma, we performed detailed sleep assessment in 31 participants. As a control group, we enrolled healthy individuals without prior brain trauma matched for age, sex, and sleep satiation.

Results: In the chronic state after traumatic brain injury, sleep need per 24 hours was persistently increased in trauma patients (8.1 ± 0.5 hours) as compared to healthy controls (7.1 ± 0.7 hours). The prevalence of chronic objective excessive daytime sleepiness was 67% in patients with brain trauma compared to 19% in controls. Patients significantly underestimated excessive daytime sleepiness and sleep need, emphasizing the unreliability of self-assessments on SWD in trauma patients.

Conclusions: This study provides prospective, controlled, and objective evidence for chronic persistence of posttraumatic SWD, which remain underestimated by patients. These results have clinical and medicolegal implications given that SWD can exacerbate other outcomes of traumatic brain injury, impair quality of life, and are associated with public safety hazards.

GLOSSARY

EDS=
excessive daytime sleepiness;
ICH=
intracranial hemorrhage;
SWD=
sleep–wake disturbances;
TBI=
traumatic brain injury

Footnotes

  • ↵* These authors contributed equally to this work.

  • Go to Neurology.org for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the article.

  • Editorial, page 1934

  • Received September 22, 2015.
  • Accepted in final form February 1, 2016.
  • © 2016 American Academy of Neurology
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Letters: Rapid online correspondence

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    • Joukje van der Naalt, Neurologist, Department of Neurology, University of Groningen, University Medical Center Groningen the Netherlandj.van.der.naalt@umcg.nl
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